Heart Failure: Symptoms, Causes, and Types
Types Of Heart Failure
Left-sided heart failure is the most common type of heart failure. There are two main types of left-sided heart failure: diastolic and systolic.
The Centers for Disease Control and Prevention (CDC) estimates that heart failure affects 6.2 million adults in the United States. It's most common in people 65 years old and over.
If you have heart failure, your heart can't pump enough blood to meet the demands of the other tissues and organs in your body.
Your outlook and recommended treatment plan depend on the underlying cause of your heart failure as well as the severity of your condition.
If you have left-sided heart failure, the left ventricle or lower left chamber of the heart has difficulty pumping oxygenated blood from the lungs to the rest of the body.
This causes blood to back up in your pulmonary veins, which carry blood from your lungs to your heart.
Left-sided heart failure may cause the following symptoms:
There are two main subcategories of left-sided heart failure: diastolic and systolic. Both affect the left ventricle.
Diastolic heart failureDiastolic heart failure is also known as heart failure with preserved ejection fraction (HFpEF).
According to a 2017 review, roughly half of people worldwide with heart failure have diastolic heart failure. And the number of individuals with this type of heart failure is increasing.
In this type of heart failure, the muscle of your left ventricle stiffens and can no longer relax properly. This prevents your heart from filling with enough oxygenated blood from your lungs to pump to the rest of your body.
HFpEF is often linked to:
The same 2017 review estimates that the other half of people with heart failure have systolic heart failure. It's also called heart failure with reduced ejection fraction (HFrEF).
In this condition, the muscle of your left ventricle becomes weakened and can no longer contract properly. As a result, your heart doesn't pump with enough force to push oxygenated blood through your body successfully.
HFrEF is commonly linked to coronary artery disease or blockages in the arteries around the heart.
Right-sided heart failure is less common than left-sided heart failure.
It's most commonly caused by damage to the right side of the heart due to left-sided heart failure. But it can be caused by other conditions, such as leaky heart valves.
If you have right-sided heart failure, your right ventricle can't pump enough blood from your heart to be oxygenated by your lungs. As a result, the blood backs up in your veins.
This can push fluid from your veins into surrounding tissues, which may cause swelling in your feet, ankles, legs, or abdomen. Fluid buildup may lead to weight gain.
Right-sided heart failure may also cause:
Biventricular heart failure affects both sides of your heart. It can cause symptoms of both right-sided and left-sided heart failure, such as:
Many people with heart failure can start out with left-sided heart failure and go on to develop biventricular heart failure. This is due to the effects of left-sided heart failure on the right side of the heart.
When heart failure develops over the course of multiple months or years, it's called chronic heart failure. Most cases of heart failure are chronic.
Chronic heart failure may result from other chronic health conditions or risk factors that weaken or damage your heart.
The odds of developing chronic heart failure increase if you have:
The symptoms of chronic heart failure tend to develop gradually and can be subtle.
It's important to pay attention to small changes in exercise tolerance and report them to your doctor. Getting early treatment can help improve your outlook.
When heart failure develops suddenly, it's called acute heart failure. This type of heart failure is less common than chronic heart failure.
Some potential causes of acute heart failure include:
The symptoms of acute heart failure may develop quickly, over the course of a few hours or days. Common symptoms include:
Acute heart failure is often a life threatening condition. If you think you're experiencing symptoms of acute heart failure, it's essential to get treatment right away.
Heart failure may affect the right side, left side, or both sides of your heart. It may change and gradually worsen over time.
To treat heart failure, your healthcare professional may prescribe medications, surgery, or other treatments.
They may also advise changing your diet, fluid intake, exercise routine, or other lifestyle habits. This may help you lead a longer and healthier life with heart failure.
If you notice changes in your symptoms or overall health, let a healthcare professional know.
Contact them immediately if you experience sudden weight gain, swelling in your legs, or other sudden changes in your symptoms.
Read this article in Spanish.
Digitalis Could Be Safe In Diastolic Heart Failure
Digitalis is a drug that is widely used in heart failure. Some experts believe that prescribing it in diastolic heart failure is contraindicated. However a new analysis shows that the drug could be safe even in this form of heart failure. "Contrary to conventional wisdom, digitalis did not have an overall detrimental effect. The study advances our understanding of both digitalis, the oldest known heart medicine, and of diastolic heart failure, the newest form of heart failure," said Dalane Kitzman, M.D., a professor of cardiology at Wake Forest University School of Medicine and a co-author on the report, published on-line today in the journal Circulation.Kitzman said the study, which involved 988 patients, is significant because it is one of the first to evaluate a treatment for diastolic heart failure, the most common type in older adults, which is expected to increase as the population ages.
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There are an estimated 5 million heart failure patients in the United States, and about half have diastolic heart failure, in which the heart muscle is stiff and doesn't take in enough blood with each beat. The other type, systolic heart failure, is when the heart muscle is too weak to effectively pump blood out into the body.In systolic heart failure, digitalis has been shown to have a number of benefits, including improving symptoms, quality of life, exercise tolerance, heart muscle contraction, and controlling atrial fibrillation, the most common heart rhythm abnormality in heart failure.
"However, its use in diastolic heart failure has been discouraged due to concerns based on small, anecdotal studies that it might precipitate early death," said Kitzman. "Our findings that it is relatively safe in this disorder allow it to be prescribed if needed for atrial fibrillation, and to be evaluated further to see if it has other benefits, such as improving symptoms, as it does for systolic heart failure."
Few drugs for diastolic heart failure have been tested in randomized studies of patients – largely because it wasn't recognized as a separate form of heart failure until more recently. "There are few evidenced–based recommendations for these patients," wrote the authors.
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The results reported in Circulation are from a larger study conducted in the United States and Canada from 1991 to 1993 and had not been previously published.The study involved patients with diastolic heart failure who were assigned to receive either digitalis, also known as digoxin, or a placebo. Digitalis slows the heart rate, helps eliminate fluid from body tissues, and strengthens the contraction of the heart muscle. Most patients were also receiving two common treatments for heart failure: diuretics and angiotensin-converting enzyme inhibitors.
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Patients were followed for a mean of 37 months. The team of researchers, from 10 different medical centers, analyzed data from the study and found that digitalis had no effect on death from heart failure or any cause, or on hospitalizations related to heart failure or any cause.There was a trend, which wasn't strong enough for researchers to know if it occurred by chance or was associated with use of digitalis, for patients to have reduced hospitalizations from worsening heart failure, but there was also a trend of increased hospitalizations for unstable angina.
The lead author on the report is Ali Ahmed, M.D., M.P.H., from the University of Alabama at Birmingham. Senior author is Mihai Gheorghiade, M.D., from Northwestern University.
"These results are somewhat of a paradigm shift," said Kitzman. "They show that although digitalis has no definite significant net benefit for diastolic heart failure, it also does no net harm. There is no need to avoid prescribing it, such as for atrial fibrillation, though other newer drugs are often used first."
Contact: Karen Richardson krchrdsn@wfubmc.Edu 336-716-4453 Wake Forest University Baptist Medical Center Source: Eurekalert
Cut Systolic BP Targets For Heart Failure Risk Patients
Previous studies have supported the introduction of 130/80mmHg targets for high-risk patients with diabetes or cardiovascular disease. However, there is little evidence to support current BP targets for hypertensive patients who do not have other conditions, the researchers said.
Paolo Verdecchia from Hospital Santa Maria della Misericordia in Italy and colleagues studied 1,111 non-diabetic patients who had systolic BPs of 150mmHg. The researchers randomised patients to a systolic BP goal of under either 140mmHg or 130mmHg.
For two years they followed the patients and recorded the rate of left ventricular hypertrophy, which can lead to heart failure and heart rhythm problems.
The targets were achieved in 72% of patients assigned to the 130mmHg target and in 67% of patients assigned to the 140mmHg targets.
Patients in the two groups were similarly likely to receive antihypertensive drugs. However, patients in the 130mmHg group were more likely to be given diuretics and angiotensin-receptor blockers.
The researchers found that patients in the 130mmHg group were 37% less likely to develop left ventricular hypertrophy and half as likely to experience other cardiovascular outcomes.
Dr Verdecchia and his team said the findings lent support to the use of lower BP goals for non-diabetic patients.
tom.Moberly@haymarket.Com
Lancet 2009;374;525-533.
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