The term heart failure can be frightening, but in reality, it just means that the heart is not pumping as well as it could be. When the heart muscle is weak, blood cannot be pumped efficiently enough to get oxygen to all of the cells. Sometimes the heart becomes dilated and weak. Other times it may be stiff and thickened. Over time, the heart cannot keep up with its workload. When this happens, there isn't enough oxygenated blood reaching the brain and muscles, and fluid begins to back up in the lungs and other tissues. The lack of oxygen causes the main symptoms of heart failure such as fatigue, shortness of breath, and difficulty completing tasks that require exertion.
Symptoms are usually worse at night when lying flat. Symptoms are very similar for systolic and diastolic heart failure. Your doctor may need further testing to see which type you have.
What are the risk factors for heart failure?
The most common risk factors for heart failure include:
• Coronary artery disease
• Previous heart attack
• Heart valve problems
Other major risk factor include
• High blood pressure
• Genetics (congenital heart defects)
• Infections (especially viral infections)
Less well recognized risk factors of heart failure include:
• Sleep apnea
• Nutrient deficiencies
• An unhealthy diet (low in antioxidant vegetables and high in animal fats)
• Lack of exercise
All of these also contribute to coronary artery disease, which is a major risk factor for heart failure.
What causes heart failure?
The cause of heart failure is a weakened or thickened cardiac muscle. For example, in chronic high blood pressure (hypertension), the heart must pump extra forcefully against the additional blood pressure. First it becomes enlarged and thickened. But over time, the heart weakens, scarring (fibrosis) develops, and it becomes less efficient at pumping. It can become larger (dilated) and weak or thickened and stiff. When the risk factors for heart failure are present, there usually is inflammatory stress, which further damages the cardiac muscle depleting cells of energy and antioxidants.
What are heart failure stages or classifications?
While doctors define heart failure in stages or classifications, it represents a progression of heart muscle weakness. Sometimes people refer to this process as chronic heart failure but technically that term isn't correct.
The New York Heart Association (NYHA) puts the stages of heart failure into four classifications:
• Class I: no limitations in activity. Normal activities can be performed.
• Class II: mild limitations and mild symptoms with activity; no symptoms at rest
• Class III: noticeable limitations in activity; only comfortable at rest
• Class IV: symptoms occur at any level of activity and uncomfortable even resting
The American Heart Association along with the American College of Cardiology grades heart failure in four stages, and takes into account that heart failure can be present even before symptoms appear:
• Stage A: No heart failure, but at high risk due to another medical condition that can lead to heart failure, such as high blood pressure, diabetes, obesity, or coronary artery disease
• Stage B: The heart has been damaged by the patient's other medical condition(s) or other factors, but no symptoms are present yet.
• Stage C: The heart is damaged and the patient is experiencing heart failure symptoms.
• Stage D: The patient has severe heart failure that requires specialized care, despite receiving treatment (end-stage).
How is heart failure diagnosed?
• Heart failure can be diagnosed by physical exam, reported symptoms, or chest X-ray.
• An echocardiogram test can identify a low ejection fraction or a thickened, stiff heart muscle.
• Echocardiograms may be used to distinguish between systolic and diastolic types of heart failure.
• Blood tests such as BNP (beta naturetic peptide) suggest heart failure.
• Algorithms and guidelines exist to score and weigh signs and symptoms to help make the diagnosis.
What diet and lifestyle management techniques help heart failure?
Many lifestyle and diet factors can improve, or even reverse, congestive heart failure. Cardiac rehabilitation programs can teach people how to make lifestyle changes, as can integrative cardiology clinics.
Some of the lifestyle factors that make a difference include:
• Manage stress
• Quit smoking or using tobacco
• Eliminate alcohol
• Eat a healthy Mediterranean, vegetarian, or vegan diet
Talk to your doctor before taking any herbs or supplements.
What are the potential complications of heart failure?
The complications of heart failure include severe fatigue and weakness, inability to complete activities of daily living, kidney damage, and progressive heart failure that could ultimately require heart transplant.
What is the prognosis and life expectancy for a person with heart failure?
The course of heart failure is highly variable. People who address their risk factors and make lifestyle changes may never progress. However, if changes are not made, if medications are not taken, or if the underlying causes are not correctable, heart failure can become a progressive and eventually fatal condition. This means that the heart muscle will continue to get weaker and have more difficulty keeping up with the workload. Fortunately, many treatment options exist for heart failure.
Self-Care for Heart Failure Patients
• Become familiar with the different symptoms caused by fluid and salt retention, such as weight gain, swelling, and fatigue, discomfort when lying down, or having to wake during the night to sit up and catch your breath. If any of these symptoms are experienced, immediately inform the doctor or nurse.
• Measure your weight and record it every morning – or at least for two Mornings per week – immediately after going using the toilet after You wake up. Write down your weight reading before eating Breakfast, as any weight gain of more than one kilogram in 1-2 days (Or 2 kilograms in 3 days) indicates fluid and salt retention.
• Limit salt intake to 2-3 grams per day, and avoid eating salty food in general, including canned foods, pickled foods, and soy sauce. Also, limit intake of drinking water according to the treatment plan.
• Overweight patients should aim to lose weight if possible, as weight gain means the heart must work harder to pump blood to the rest of the body. In cases where the patient experiences loss of appetite, sickness, vomiting, stomach cramps, weight loss of more than 5 kilograms in 6 months, or where the patient's BMI is less than 22 kg/m2, the patient should eat small portions of easily digestible food at regular intervals in order to prevent malnutrition.
• Avoid smoking tobacco and drinking alcohol (or have no more than 2 drinks per day), as alcohol adversely affects the heart.
• Keep to a suitable exercise regime. Start off with walks on a flat surface, starting with short sessions of 2-5 minutes per day, and then increasing the sessions to 5-10 minutes per day. Joining an exercise-based cardiac rehabilitation program is also an option. However, if fatigue, exhaustion, or feelings of discomfort occur during exercise, stop immediately.
• Take any medications as instructed. However, if any unusual symptoms occur – which could be side effects of medication – consult your doctor (prior to stopping your medication). If purchasing any additional medication from the pharmacy, consult your doctor regarding the side effects of the medications on your heart and kidneys, as well as interactions with other medications which you are currently taking.
• Try to lower stress levels with relaxing activities such as a light exercise or meditation.
• Avoid walking long distances, especially if needing to sit for long periods along the way. Heart failure patients should not go out for walks alone; they should be accompanied by a friend or relative. Additionally, avoid flying if your symptoms worsen.
• Get vaccinated for the flu yearly, if possible.
• Have regular health check-ups and meet with the doctor as scheduled.