Health Tips

Your heart is probably one of the most important organs of the body. With the help of the blood circulatory system, our heart pumps the fresh blood filled with oxygen from the lungs to every corner of the body, and returns the “used blood” carried with wastes to the lungs and kidneys for expulsion. 

But what if such a vital organ fails?

Heart failure is a clinical syndrome (a collection of signs and symptoms) that represents the end stage of most heart diseases. The most common cause of heart failure is ischemic heart disease (68%). This is one of the important reasons why you should always take care of your blood pressure, blood lipid levels and blood sugar level — because worsening high blood pressure and diabetes can contribute to ischemic heart disease, which makes you more likely to develop heart failure.

Oh, and did we mention heart failure is highly lethal? Data has shown that the death rate after diagnosis of HF in the United States was around 10% at 30 days, 20-30% at 1 year and 45-60% over 5 years of follow-up. Heart failure is even deadlier than many cancers such as colorectal cancer, non-Hodgkin’s lymphoma and breast cancer!

Image credit to Theresa Chiechi / Verywell

How does heart failure develop?

Most heart failure cases are long-term in nature, and are commonly seen in elderly. 

The development process of heart failure is complex. But to put it simply, let’s be reminded that how a heart pumps is through contraction and relaxation. Therefore, heart failure is said to be driven mainly by two things:

• The heart muscle does not contract properly (called systolic dysfunction)

• The heart cannot relax properly and thus leads to impaired filling of blood into the heart during relaxation. (called diastolic dysfunction)

These two phenomena can happen as a result of your underlying cardiovascular disease. When they happen, the amount of blood pumped through your heart is reduced.

Your heart would not let that happen, however; the heart muscle would stick to its duty to keep you alive. Hence, the heart compensates, for better or worse, through the following mechanisms:

• Your heart grows itself to develop more heart muscles to increase the pumping force, so that more blood can be pumped through the heart. This may work for a while; but after some time, the heart becomes bigger and thicker (called cardiac hypertrophy), which actually leads to deterioration of heart function, because those newly developed muscles are weak. This process of the heart muscle becoming bigger is called cardiac remodelling, and is commonly seen after a heart attack.

• Your body’s nervous and hormone systems work together to increase the amount of blood pump through the heart:

  • Sympathetic nervous system (the ‘fight-or-flight’ response)

  • Renin-angiotensin-aldosterone system, which leads to higher blood pressure

  • Vasopressin, in which makes your kidney to retain more salt and water

These compensatory mechanisms are just our body’s ways to try to protect ourselves when it senses a drop in the amount of blood pumped through the heart. Yet, they can do more harm than good in the long run, thus leading to heart failure.

Image from: https://watchlearnlive.heart.org/index.php?moduleSelect=hrtflr

Treatment of long-term heart failure

Non-pharmacological treatment 

Patient education

• If you have long-term heart failure, make sure you know how to self-manage your condition. This includes recognising the change in your heart failure signs and symptoms. E.g. a sudden weight gain of more than 2kg in 3 days may indicate a worsening in heart failure.

• Discuss with your healthcare provider and family members on your condition’s prognosis and make realistic decisions and plans. This is important for severe heart failure, which is more deadly than many cancers.

Exercise

It has been shown to reduce the risk of hospital admissions, improve quality of lives and enhance exercise capacity among heart failure patients.

Fluid restriction

Some heart failure patients are required to restrict their fluid intake to 1 to 1.5 litres per day to reduce the burden of the heart.

Healthier lifestyle choices

This include quit smoking, monitoring weight and lose weight if obese and avoiding alcohol. 

Sexual activity, pregnancy and contraception

It’s common for heart failure patients to experience sexual dysfunction due to physiologic and psychological changes. Have this conversation with your doctor and explore various approaches that may be useful, don’t be shy!

Image credit to https://www.heart.org/-/media/files/health-topics/heart-failure/hf-symptom-tracker.pdf?la=en

Pharmacological treatment

Heart failure is a complex medical condition that requires various medications for treatment, such as:

• Diuretics (E.g. frusemide, spironolactone) — To help your body get rid of excess fluids and thereby reducing the burden of your heart

• Inhibitors of the Renin Angiotensin System - Angiotensin Converting Enzyme Inhibitors (ACE-I) and Angiotensin Receptor Blockers (ARB) (E.g. perindopril, enalapril, losartan, telmisartan) — These medications should be given to all heart failure patients, as it is supported by scientific evidence that they could increase the livelihood of heart failure patients. They lower blood pressure and lessen the burden on the heart. However, do take note that you should only take either ACEI-I or ARB; the combination of both is not required and can lead to adverse effects.

• Beta-blockers (E.g. bisoprolol, carvedilol) — Beta-blockers slow down the heart rate and have been found to be beneficial for patients with moderate heart failure.

• Others, such as sacubitril/valsartan (Entresto), ivabradine, isosorbide dinitrate and digoxin

A word from DOC2US

If you have any questions related to heart failure, you can consult our professional doctors and healthcare professionals on DOC2US DOC2US is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.

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Disclaimer: As a service to our users and general public, DOC2US provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1. Ministry of Health, Malaysia - CPG Management of Heart Failure 4th ed. 2019

2. UpToDate - Pathophysiology of heart failure with reduced ejection fraction: Hemodynamic alterations and remodeling

Written by

Ms Joyce Toh