What is heart failure?
Heart failure, also known as congestive cardiac failure or CCF, is a medical condition in which the heart is rendered unable to efficiently pump blood and maintain blood flow according to the metabolic needs of the body. Heart failure can be caused by a variety of illnesses such as hypertension, coronary artery disease, history of myocardial infarction, atrial fibrillation, valvular heart disease, excess use of alcohol, infection, and cardiomyopathy. These diseases have an adverse effect on the structure or function of the heart which ultimately leads to its failure. Unfortunately, heart failure is a common condition with approximately 26 million people affected worldwide. In the US, around 550,000 people are diagnosed each year and overall 5.8 million of the US population is affected by it. Heart failure is a deadly disease, increasing in prevalence, and expensive to treat.
Being a chronic disease, patients affected by heart failure not only have to deal with painful symptoms but also suffer from poor physical and mental health that often has serious effects on their quality of life. In most cases, heart failure can only be managed by lifestyle modifications, medication, and in some cases, different types of device treatments or cardiac transplantation. However, some reversible causes of heart failure such as certain infections, excess of alcohol, anemia, thyrotoxicosis, hypertension, and arrhythmias must be excluded. Unfortunately, in most patients, the condition is chronic and progressively worsens with time unless managed properly and has an annual death rate of 10%.
Signs and Symptoms
Heart failure is mostly a chronic condition but may occur acutely in some patients. The common signs and symptoms presenting in patients are as below:
- Dyspnea, especially on exertion or on lying down
- Generalized fatigue and weakness of the body
- Swelling of extremities
- Rapid or irregular heartbeat
- Reduced stamina
- Continuous cough or wheeze associated with blood-tinged phlegm
- Swelling of the abdomen
- A rapid increase in weight due to fluid retention
- Anorexia and nausea
- Decreased ability to concentrating
- Chest pain when the cause is myocardial infarction
Risk factors of heart disease
Heart failure is a chronic condition that may be the result of a single risk factor or an accumulation of multiple risk factors. Risk factors of heart failure can be classified as modifiable or non-modifiable:
- Cigarette smoking
- Alcohol or drug abuse
- High fatty or sugary diet
- Sedentary lifestyle
- High levels of LDL cholesterol
- Male gender
- Family history of heart diseases
- History of preeclampsia
- Old age (65 years and older)
Precautions to lower the risk of heart disease
The best approach to lower the risk of heart failure in the future is to avoid or manage the risk factors associated with it. There are many ways one can lower this risk by adopting several lifestyle changes:
Uncontrolled hypertension can lead to heart failure as well as many other illnesses and therefore should be regularly checked and kept within the normal range if high. High blood pressure can be managed by a combination of lifestyle changes and medication in order to prevent future complications.
Cholesterol and triglyceride levels:
Raised cholesterol levels in the blood can lead to increased risk of myocardial infarction and peripheral vascular disease and can contribute to heart failure. Triglycerides are another lipid that should be kept in check as they can cause coronary heart disease.
Maintain a healthy weight:
Obesity is associated with 11% of heart failure cases presenting in men and 14% in women. It is an important risk factor that contributes to heart failure directly by causing hemodynamic and myocardial changes leading to cardiac dysfunction. It can also act indirectly by increasing the predisposition of other risk factors, like hypertension or diabetes, that lead to heart failure.
A good diet can go a long way in improving one’s health and preventing multiple diseases. A low sodium diet along with plenty of fruits, vegetables, and whole grains. Incorporating lean meat, fish, poultry, and legumes in the diet as well as choosing to bake, grill or steam foods instead of frying can help reduce the risk of heart failure. Foods high in salt added sugars and saturated fats increase the risk of hypertension and heart failure.
Regular physical activity not only improves overall health but also reduces symptoms of heart disease. In some cases, it can even reverse injury in aging hearts and can prevent the development of heart failure in the future. Double or quadruple the amount of recommended daily exercise was reported to decrease the risk of heart failure by 19% and 35%, respectively. Regular physical exercise strengthens the cardiac muscles, decreases blood cholesterol levels, and reduces blood pressure.
Avoid alcohol and smoking:
Excess consumption of alcohol has multiple adverse repercussions such as raised blood pressure, cardiomyopathy, and weight gain which later lead to heart failure. Cigarette smoking, on the other hand, increases the cardiac workload by raising heart rate, constricting major vessels, and may cause arrhythmias. Quitting smoking also lowers the chances of heart failure and other illnesses in regular smokers.
Stress can adversely affect the function of the heart by releasing a storm of chemicals in the body such as adrenaline, cortisol, and other hormones that raise the heart rate, blood pressure, and sugar levels. Stress can also indirectly lead to bad lifestyle choices such as overeating, drinking alcohol, and smoking which are major risk factors for heart failure. The many ways of overcoming stress include physical activity, meditation, etc.
Control blood sugar levels:
Long term diabetes mellitus can damage vessels and nerves supplying the heart and can reduce the sensitivity to pain which increases the risk of silent myocardial infarction. Studies show that people with diabetes type 2 have a 2.5 times higher chance of heart failure than those without. Therefore constant monitoring of blood sugar levels is necessary to lower the risk of heart failure.
An adequate amount of sleep at night is necessary for good health and prolonged disturbed sleep can lead to many problems such as hypertension, obesity, and diabetes and later lead to heart disease. This is especially important for people with sleep apnea as they are at a higher risk of developing heart failure.
- Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. Jama. 2009 Jul 22;302(4):394-400.
- Spieker LE, Hürlimann D, Ruschitzka F, Corti R, Enseleit F, Shaw S, Hayoz D, Deanfield JE, Lüscher TF, Noll G. Mental stress induces prolonged endothelial dysfunction via endothelin-A receptors. Circulation. 2002 Jun 18;105(24):2817-20.
- He FJ, Burnier M, MacGregor GA. Nutrition in cardiovascular disease: salt in hypertension and heart failure. European heart journal. 2011 Dec 1;32(24):3073-80.
- Lightwood J, Fleischmann KE, Glantz SA. Smoking cessation in heart failure: it is never too late.
- Piña IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, Fletcher BJ, Fleg JL, Myers JN, Sullivan MJ. Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation. 2003 Mar 4;107(8):1210-25.