Dr Swapnil Mate Cardiologist

Types Of Heart Failure

Three types of heart failure take place in individuals:-

The left side of the heart comprises the upper left and lower left heart chambers(left atrium and left ventricle) and two heart valves, Mitral Valve and Aortic Valve. The Mitral valve is located between the upper left and lower left chambers of the heart. The upper left chamber of the heart receives blood rich in oxygen from the pulmonary veins situated in the lungs. When the upper left heart chamber is filled with oxygen-rich blood, the mitral valve opens and blood flows to the lower left heart chamber. The aortic valve is the last valve of the heart, located between the lower left chamber of the heart and the aorta. This is one of the most important structures of the circulatory system since it originates from the lower left heart chamber and extends to the abdomen where it transports oxygenated blood to all parts of the body. Therefore, the left side of the heart is responsible for receiving oxygenated blood from the lungs through the pulmonary artery and transports it to the other parts of the body through the aorta. Failure on the left side of the heart causes the blood to flow back to the lungs, causing respiratory problems and fatigue due to less supply of the blood. Symptoms include an increase in the rate of breathing and make the lungs work harder. If it becomes severe, it causes a build-up of fluid in the lungs, which makes the individual cough blood. Late symptoms of left-sided heart failure include cyanosis, causing the skin to turn grayish-blue in color.

The right side of the heart comprises the right atrium, right ventricle, pulmonic, and tricuspid valve. The tricuspid valve is a boundary existing between the upper right heart chamber and the lower right heart chamber. The tricuspid valve is responsible for the transformation of deoxygenated blood into oxygen-rich blood. The blood flows from the upper right heart chamber to the lower right heart chamber, and it then exits the heart through the pulmonary artery. The pulmonic valve, also known as the pulmonary valve, is the valve that helps circulate blood in the body. The pulmonary valve is located between the lower right heart chamber and the pulmonary artery. The pulmonary valve opens when the pressure in the lower right heart chamber(right ventricle) rises above the pressure in the pulmonary artery, and the valve closes when the pressure in the right ventricle drops rapidly. The right side of the heart is responsible for the pulmonary circulation of blood. Failure on the right side of the heart increases pressure in the arteries of the lungs or causes obstruction of blood flow from the right ventricle to the pulmonary artery. Failure in the right ventricle develops fluid build-up in the body. This causes swelling of legs, feet, ankles, abdomen, etc.

This refers to the failure of both chambers of the heart. When the left ventricle fails to perform its function, fluid develops in the lungs, which puts pressure on the right ventricle.

Symptoms Of Heart Failure

The signs and symptoms indicating heart failure:-

Shortness of breath because of backflow of blood to the pulmonary veins. It is caused due to fluid build-up in the lungs.
Persistent coughing due to fluid in lungs. The individual coughs blood due to pulmonary edema.
Swelling of legs, ankles, feet, abdomen due to failure of the right ventricle, which causes fluid build up in the body tissues, resulting in swelling.
Fatigue and weakness due to lack of oxygen in the blood
Lack of appetite because, since the blood is not able to pump properly, the digestive system receives less blood, causing digestive problems
Impaired thinking or confusion due to changes in the substance present in the bloodstream.
Irregular heartbeat or Arrhythmias due to issues in the electrical conduction system of the heart.
Rapid gain in weight due to fluid build-up in the body tissues
Cyanosis, changing of the color of skin into grayish-blue due to lack of oxygen in the blood.
Chest pain if heart failure is caused by the death of the cardiac muscle
Increased heartbeat rate because, to make up for the lack of oxygen in the body, the heart works faster and harder.

Risk Factors Contributing To Heart Failure

Heart failure is caused due to a combination of factors leading to the possible occurrence of heart disease:-

Coronary Artery Disease - narrowing of the coronary arteries due to the hardening of the plaque deposits in the walls of the coronary arteries can obstruct the blood flow to the heart. This can cause stiffening of the heart muscle, resulting in the death of the cardiac muscle.
Heart attack - an episode of heart attack can affect the heart's ability to pump blood since heart attack is caused due to obstruction of blood flow to the heart muscle that causes stiffening of the cardiac muscle.
Valvular disorders - defects in any valves of the heart can reduce the ability to transport deoxygenated blood or receive oxygenated one, leading to heart failure.
Not getting proper sleep - sleep reduces blood pressure and keeps it at the optimum level. Not getting the required amount of sleep results in an increase in blood pressure, resulting in heart failure.
Hypertension - high blood pressure causes the heart to work faster and harder, till the limit when it cannot compensate further.
Congenital heart disorders - inherited disorders, either genetically or through unhealthy habits practiced by pregnant women, can lead to heart defects in infants, which might progress to a possible heart failure in the future.
Obesity - Obese individuals require more blood so that they can carry oxygen and nutrients to the tissues to function efficiently. This puts pressure on the heart to work harder, which stiffens the heart muscle, reducing blood flow and might cause heart failure.
Diabetes - When your body does not respond to insulin or does not produce much insulin, glucose remains in the bloodstream. This causes an increase in the blood sugar level. An increase in blood sugar damages the walls of coronary arteries due to fatty deposits in the walls. This reduces the heart's ability to pump blood efficiently.
Lack of physical exercise - Lack of physical activity increases blood cholesterol, blood pressure, and blood sugar levels, all contributing to a possible heart failure.
Stress - A person can react to stress in ways that can contribute to a possible heart failure, for example, smoking, alcohol consumption. Overeating, etc.
Smoking and alcohol consumption - actively smoking or consuming alcohol makes the blood sticky, and it is most likely to clot, which can obstruct the blood flow to the heart. It also lowers good cholesterol in the body.
High Cholesterol Level - The total number of cholesterol in the blood also affects the heart. Low-density lipoprotein, along with triglycerides, gets deposited in the arterial wall, obstructing the blood flow to the heart. This can cause possible heart failure. Cholesterol levels can be controlled by following a strict diet that does not contain saturated fats

Further Complications

If a heart disease is not treated on time, it can lead to further complications like:-
Kidney Damage - if proper treatment is not done, It can cause failure in the function of the kidney. Since the heart is not able to function properly, fluid, proteins, calcium, and substances like sodium get deposited in the bloodstream. This puts additional stress on the kidney to work harder until it cannot compensate further.
Heart Valve Disease - Heart failure can be caused due to improper functioning of the valves. Valves can only be cured by surgery or valve transplantation.
Liver Damage - Heart failure, if left untreated, can lead to liver failure since, during cardiovascular problems, the hepatic portal vein undergoes a lot of stress to compensate for the lack of oxygen and nutrients in the blood. The vein works harder until it can no longer perform its function

Preventive Measures

The prevention plan involves four main points:-

Lifestyle changes - this involves adhering to a strict diet plan that does not include foods that are high in cholesterol. Quitting consumption of alcohol and smoking can lead to a speedy recovery. Engaging in physical activities regularly can improve cardiac health. It can also help lose weight since weight loss can keep cholesterol, blood sugar, and blood pressure at optimum levels. The individual must also decrease their fluid intake since their bodies might have suffered from swelling due to fluid build-up in the body tissues. The individual also needs to manage stress, since stress can lead to engaging in such acts that can hamper cardiac health.
Medications - The medications include SGLT2 inhibitors or gliflozins which reduce blood glucose levels without activating the release of insulin from the pancreas. They also reduce blood pressure in diabetic patients. Medications like SGLT2 inhibitors and GLP-1 help reduce obesity, hypertension, and blood sugar levels since these three factors contribute to heart diseases. PCSK9 inhibitors are also given to reduce cholesterol levels or low-density lipoprotein in the patient's circulatory system.
Tests and scans - Low-Density Lipoprotein and High-Density Lipoprotein test to check the amount of good cholesterol and bad cholesterol in the blood. C-Reactive Protein test to check whether the immune system is performing its function of fighting illness. If not, CRP will be lowered. INR tests check the tendency of the blood to clot. Triglyceride test to check the number of fatty acids in the body, coronary calcium scan to check calcium deposits in the coronary arteries that cause narrowing of the arteries.
Cardiac Imaging - Electrocardiogram that checks the electrical activity of the heart. A Holter monitor is also used if the electrical activity of the heart has to be monitored for 24 hours. Cardiac stress test to check the heart response to vigorous and strenuous activities like running, swimming. Cardiac imaging techniques like ultrasound are done by placing a hand-held instrument called a transducer at the top of your chest cavity. This instrument sends ultrasonic waves that bounce off the heart and capture the live image of the heart, which is shown on a screen. MRI or magnetic resonance imaging is done by using hydrogen atoms to capture the image of the heart instead of using ultrasonic waves in the case of ultrasound or echocardiography. Invasive cardiac imaging includes coronary catheterization where a long, flexible tube called a catheter is inserted through the arteries of the wrist, thigh, or leg region to reach the heart and capture the image of it.