Introduction
Heart failure is an important topic. The aim of this post is to present an easily understood conversation on what is heart failure and the right thing to do all the time as non-doctors.
Definition
A good definition of heart failure is that found in the Meriam-Webster dictionary. Heart failure is “a condition in which the heart is unable to pump blood at an adequate rate or in adequate volume”. (Merriam-Webster Dictionary, 2022). [1]
The main point is heart failure is a dysfunction of the heart. The extent of dysfunction is the extent of inability to function. We can differentiate between acute heart failure and non-acute heart failure.
Acute heart failure. This is heart failure due to sudden reduction of blood supply to the heart muscle due to a block in the vessel (called a heart attack), or it may be due to a disruption of the conduction of the electrical circuit within the heart (called an arrhythmia or heart block). All these will present with chest pain, faintness, and/or sweating. This is an emergency and one should be sent to the Emergency Department without delay.
Non acute heart failure. This is dysfunction of the heart and will be the main focus of this conversation. Non acute heart failure can be grouped into several categories for ease of understanding.
1-1- Systolic pump dysfunction — A common example is the result of narrowing of the heart vessels due to ageing. It can also be due to heart muscle damage from a past heart attack, or be the consequence of long-standing high blood pressure. (Smith A, Kahli P, 2021). [2]
1-2-Diastolic pump dysfunction — A common example is Type 2 diabetes mellitus. In diastolic heart failure, the left ventricle is stiff and cannot relax properly between heart beats. Filling of the left ventricle during diastole is thus impaired. During the systolic phase, the stiff ventricle is only able to pump out a lower than normal output.(Smith A, Kahli P, 2021). [2]
2-1-Heart valve narrowing — e.g., aortic valve narrowing (also called aortic valve stenosis or just aortic stenosis); or mitral valve narrowing (also called mitral valve stenosis or just mitral valve stenosis). There are two other heart valves that may be narrowed namely, the tricuspid valve (so tricuspid valve stenosis), and the pulmonary value (so pulmonary valve stenosis). These latter two valve narrowings are less commonly encountered in practice than aortic or mitral stenosis.
2-2-Heart valve leakage may due the valve not able to close tightly because of disease or congenital abnormality. So we have aortic valve incompetence, mitral valve incompetence, tricuspid incompetence, and pulmonary valve incompetence.
3-1-Atrial septal defect (ASD). The upper chambers are separated into left atrium and right atrium by a wall called the atrial septum. Now this wall can have a hole in it as the result of a congenital defect. so the two chambers are connected. A large ASD can allow extra blood to flow from the left upper chamber to the right upper chamber to overfill the lungs and overwork the right side of the heart resulting in weakening of the right side of the heart and also cause pulmonary hypertension. The ASD can be patched by surgery.
3-2-Ventricular septal defect (VSD). The lower chambers are similarly separated into right ventricle and left ventricle by a wall called the ventricular septum. A hole due to a congenital defect will connect the two ventricular chambers. If the VSD is large, the extra blood pumped into the lung arteries results in congestion of the lungs. A small VSD does not cause congestion problems but is prone to infection by bacteria. The hole can be patched by surgery.
3-3-Fallot’s tetralogy and other abnormalities. These are more complex abnormalities of the structure of the heart . They will require surgical correction.
In a nutshell the above give us an idea why heart dysfunction occurs. The strategy of what to do will depend on what can be done.
Classifications of heart failure
Doctors classify the extent of heart dysfunction into stages to help identify the extent of heart dysfunction, and also to plan treatment (Heart failure: Mayo Clinic, 2022).[3]
There are in existence two such classifications of heart failure — the older New York Heart Association classification and the newer American College of Cardiology/American Heart Association classification. Doctors often will use both classification systems together to help decide the most appropriate treatment .[3]
New York Heart Association Heart Failure Classification
This classification groups heart failure into 4 classes: [3]
Class I heart failure. There is no heart failure symptoms.
Class II heart failure. Everyday activities can be done without difficulty but exertion causes shortness of breath or fatigue.
Class III heart failure. It is difficult to complete everyday activities.
Class IV heart failure. Shortness of breath occurs even at rest. This category includes the most severe heart failure.
American College of Cardiology/American Heart Association classification
This system of classification uses the letters A to D to classify the stages of heart failure. Of note is Stage A identifies persons with risk factors for heart failure even when they have no signs or symptoms. Examples are overweight, high blood pressure, diabetes mellitus, and familial high cholesterol. Doctors use this classification system to identify risk factors and begin early and more aggressive treatment to help prevent or delay heart failure.
Stage A heart failure. There are risk factors for heart failure but no signs or symptoms.
Stage B heart failure. There is heart disease but no signs or symptoms of heart failure.
Stage C heart failure. There is heart disease and signs or symptoms of heart failure.
Stage D heart failure. Advanced heart failure requiring specialized treatment.
Action to take to prevent heart failure
Healthy lifestyle
- Healthy diet
- Regular exercise
- Healthy weight control
Regular exercise
- Walking as exercise — 5 days a week
- Resistance exercise eg., push-ups. Seek doctor’s advice before you start on these.
Weight control
Keep an eye on the weight to ensure it is within normal. Note that excessive sudden gain can be due to excessive intake of salty food leading to fluid retention and high blood pressure.
Medications
You may need medications to control high blood pressure, high cholesterol, and high blood sugar. Good to take your medications as directed by your doctor.
Action to take if you have heart failure
- You can take action to provide self care by paying attention to the following:
- Fluid balance — important not to exceed your daily requirement if you are prescribed the daily amount to drink. It is useful to divide the amount into two parts – one for first part of the day, and the remainder for the second part of the day. This way, you will not consume all within the first half of the day. Check for feet swelling — if there is feet swelling, it may mean you are drinking beyond your daily tolerated quantity . Work closely with your doctor
- Blood sugar, weight control, BP control — important to pay attention to details.
- Exercise within limits of fitness tolerance — check out with your doctor on the limits.
- Medications — Besides the medications for controlling high blood pressure, high cholesterol, high sugar as are relevant, you may need medications to take care of the heart failure. It is important to be regular with your medications.
- Age well everyday — practise the principles of DEWSS.
- See your doctor regularly. See him also if you are suddenly unwell. Do not procrastinate.
Take home messages
1-Know the definition of heart failure.
2-Have a working understanding of what are the different causes of heart failure. What applies to you?
3-You can take action to prevent heart failure. Pay attention to reduction of risk factors. [2]
4-You can take action to provide self-care if you have heart failure. See your doctor regularly. See him also if you are suddenly unwell.
Acknowledgements
Grateful thanks are due to the following
1-Feature image from Magdaline John.
2-Nowel W. Fine. Graphic. Heart failure: Systolic vs diastolic. Libin Cardiovascular Institute. Cumming School of Medicine. University of Calgary; MSD. Consumer Version, 2021.
References
- Merriam-Webster Dictionary, 2022. Definition of heart failure. Accessed 27 Aug 22. https://www.merriam-webster.com/dictionary/heart%20failure
- Smith A, Kohli P. Systolic vs diastolic heart failure: What is the difference. Medical News Today, 2021-03-15. Accessed 27 Aug 2022. https://www.healthline.com/health/heart-failure/systolic-vs-diastolic#symptoms
- Mayo Clinic. Heart failure.- Diagnosis and treatment. Accessed 27 Aug 2022. https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148
Dr LG Goh
Dr GOH Lee Gan is a retired Associate Professor in the Department of Family Medicine, National University Health System. He has an interest in learning and teaching how we can age well everyday (AWE).
