Heart Failure Causes and Treatment

Heart failure occurs when the heart is no longer capable of pumping blood around the body effectively. Many conditions can cause heart failure. These include heart attacks (which damage the heart muscle), heart infection (see endocarditis; myocarditis; pericarditis), narrowing or leaking of heart valves, high blood press­ure, narrowing of the aorta (see aortic stenosis), irregular heart rhythm (see fol­lowing entry), alcoholic heart damage, severe anaemia (inadequate oxygen being transported by the blood) and an overac-tive thyroid gland (increased rate of body activity results in greater demands for blood).

Patients with cardiac failure ('cardiac' means 'of the heart'), complain of being short of breath when exercising or climb­ing stairs, but as the condition worsens they are constantly out of breath, particu­larly when lying down at night. Other symptoms include a hard dry cough, having to get out of bed to pass urine at night, general tiredness and weakness, a rapid heart rate, chest and abdominal dis­comfort and swelling of the feet, ankles and hands. These patients may be noticed by others to be losing weight, unable to speak a full sentence without taking a breath, and in advanced cases a blue tinge develops on and around the lips.

The diagnosis can often be made by a doctor without resorting to any sophisti­cated tests, but it is important to discover the cause of the heart failure, particularly in younger patients, and this may involve extensive investigations over a consider­able period. Blood tests, chest X-rays and electrocardiograms are the main tests performed. Further tests may be indicated after the results of these are obtained. Echocardiogams and cardiac catheterisation (passing a tube through a vein into the heart) are some­times undertaken if surgical treatment of a heart defect is being contemplated.

Treatment involves correction of any spe­cific cause for the heart failure if possible. If the thyroid is overactive or the patient is anaemic, these can be treated and the heart failure may disappear. Correction of high blood pressure, controlling an irregu­lar heart rhythm and treating heart infec­tions are other methods of dealing with a specific cause of heart failure. Sometimes surgical correction of a heart valve defor­mity is also possible.

A diet low in salt, and avoiding strenu­ous exercise can often be beneficial. Med­ications to remove excess fluid from the body and to strengthen the action of the heart (e.g. digoxin) are in common use. A number of more sophisticated drugs are available for use in resistant or difficult cases. Oxygen may be supplied to seriously ill patients.

In many elderly patients, there can be a multitude of causes, or no specific cause at all for the heart failure. In these cases, the condition is treated as a disease in itself.

Unless an underlying correctable cause can be found, heart failure cannot be cured, only controlled. As the years pass, the condition usually slowly worsens and becomes steadily harder to control. Some patients succumb to heart attacks, while others become more and more incapaci­tated so that they cannot leave a bed, and develop pneumonia. The actual outcome in any individual is very difficult to pre­dict, but it may take many years before serious incapacitation or death occurs.

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