Heart failure is a serious disease in which the amount of blood pumped by the heart each minute (cardiac output) is insufficient to meet the needs of oxygen and nutrients from food.
The term heart failure means the heart has stopped, as some people think, but actually refers to reducing the heart’s ability to maintain their effectiveness. Heart failure has many causes, among which there are a number of diseases is much more common in older people because they have a higher chance of contracting the diseases that cause it. Although it is a process that slowly gets worse over time, people with this disorder can live for many years. However, 70 percent of patients with this condition die within 10 years from diagnosis.
Causes
Any disease that affects the heart and interfere with the circulation can cause heart failure. Certain diseases can act selectively affecting the heart muscle, impairing its ability to contract and pump. The most common of these is coronary artery disease, which restricts blood flow to the heart muscle and can lead to stroke. Myocarditis (heart muscle infection caused by bacteria, viruses or other microorganisms) also causes serious injury to the heart muscle, as well as diabetes, hyperthyroidism or extreme obesity. A heart valve disease can block blood flow between the chambers of the heart or between the heart and major arteries. Moreover, a valve that does not close properly and allow blood to escape, may cause a backup of it. These situations cause the overload of the heart muscle and thus weaken the force of heart contractions. Other diseases mainly affect the electrical conduction system of the heart and cause heart rates slow, fast or irregular heartbeat, which prevent adequate blood pumping.
If the heart is subjected to a great effort for months or years, is enlarged, as is the case with the biceps after several months of exercise. In principle, this enlargement is accompanied by stronger contractions, but eventually an enlarged heart may decrease its pumping ability and cardiac insufficiency. Likewise, high blood pressure (hypertension) can cause the heart must work harder. This also happens when you must fight to expel the blood through a narrow orifice, usually tight aortic valve. The situation is similar to the extra burden that supports a water pump, when forced to push the water through narrow pipes.
In some people it hardens the pericardium (the thin transparent cover of the heart). This prevents the heart to dilate completely between beats, so the blood is insufficient filling. Although much less frequently, it can also happen that certain diseases that affect other parts of the body excessively increase the demand for oxygen and nutrients by the body, so that the heart, even if normal, is unable to meet this demand higher . The result is the occurrence of heart failure.
The causes of heart failure vary in different regions of the world due to the different diseases that develop in each country. For example, in tropical countries there are some parasites that can lodge in the heart muscle, this causes heart failure at a much younger age than in developed countries.
Clearing
The agency has a number of response mechanisms to compensate for heart failure. The mechanism of initial emergency response (in minutes or hours) is the ‘excitatory state before the action “caused by the release of epinephrine and norepinephrine from the adrenal gland into the blood circulation, norepinephrine is also released by the nerves. The adrenaline and noradrenaline are the main defenses against any sudden stress. In compensated heart failure, make the heart work harder, helping to increase cardiac output and to compensate, to some extent, the problem of pumping. Minute volume can return to normal, although usually at the expense of an increase in heart rate and a stronger heartbeat.
These responses are beneficial to a patient without heart disease who needs short-term increase in cardiac function. But in the case of a person with chronic heart failure, these responses produce a constant demand on the cardiovascular system is already severely injured. In the long term, these growing demands impair heart function.
Another additional corrective mechanism is the retention of salt (sodium) by the kidneys and therefore simultaneously also retains water to keep constant the concentration of sodium in the blood. This additional amount of water increases blood volume in circulation and, in principle, improves cardiac performance. One of the main consequences of fluid retention is that the increased blood volume causes a stretch of heart muscle. This muscle tension undergone more contracts more strongly, as do both an athlete’s muscles before exercise. This is one of the main mechanisms available to the heart to increase its role in heart failure.
However, as it worsens, excess fluid escapes from the circulation and accumulates in various parts of the body, causing swelling (edema). The place is dependent accumulation of excess fluid and the effect of gravity.
Standing, fluid accumulates in the legs and feet. If the person is lying, it accumulates in the back or abdomen. Typically, the sodium and water retention result in increased weight.
The other main mechanism of compensation is the thickening of the heart muscle (hypertrophy). The enlarged heart muscle and can contract with greater force, but ultimately wrong and aggravates heart failure.
Symptoms
People with decompensated heart failure often feel tired and weak when performing physical activity, because the muscles do not receive an adequate blood volume. On the other hand, the swelling can also cause many symptoms. Besides the influence of gravity, the location and the effects of swelling depend also on the side of the heart that is most affected.
Although a disease of one side of the heart always cause heart failure on both sides, often dominated by symptoms of either side.
Right heart failure tends to produce a stagnation of blood that goes to the right side of the heart. This causes swelling in the feet, ankles, legs, liver and abdomen. In contrast, left-sided failure causes fluid accumulation in the lungs (pulmonary edema), causing severe breathlessness. At first, it occurs during physical exertion, but as the disease progresses, it also occurs even at rest. Sometimes the breathlessness is nocturnal, and the fact that lie favored the displacement of fluid into the lungs.
You wake up often struggling for breath or wheezing. The act of sitting causes the liquid out of the lungs and breathing is facilitated. People with heart failure often have to sleep sitting to avoid this effect. Severe fluid buildup (pulmonary edema) is an urgent situation that can be fatal.
Diagnosis
Usually, symptoms are usually sufficient to establish the diagnosis of heart failure. The following findings confirm the initial diagnosis: a weak pulse and often rapid, low blood pressure, certain abnormal heart sounds, an enlarged heart, swollen neck veins, fluid in the lungs, an enlarged liver, rapid weight gain and swelling in the abdomen or legs.
A chest x-ray may show heart enlargement and accumulation of fluid in the lungs.
Often the heart function is evaluated with additional tests, such as an echocardiogram, which uses sound waves to provide an image of the heart, and an electrocardiogram, which examines the electrical activity. You can perform other tests to determine the underlying cause of heart failure.
Treatment
There is no curative treatment in most cases, but may facilitate physical activity, improve the quality of life and prolong survival. The treatment is approached from three angles: the treatment of the underlying cause, the elimination of the factors that contribute to worsening heart failure and his own treatment of it.
Treatment of the underlying cause
By surgery can correct a heart valve close or failure, an abnormal communication between the heart chambers or coronary artery obstruction, all of which can lead to heart failure development. Sometimes the cause can be removed completely without having to resort to surgery. For example, antibiotics can cure an infection. The drugs, surgery or radiotherapy are effective in treating hyperthyroidism. Similarly, the drugs reduce and control high blood pressure.
Elimination of the contributing factors
The factors that aggravate heart failure include smoking and eat too much salt, overweight and alcohol consumption, as well as extreme environmental conditions. We recommend a program to help people quit smoking, make appropriate changes in diet, stop drinking or moderate exercise regularly to improve fitness. In case of more severe heart failure, rest for a few days is an important part of treatment.
Excess dietary salt (sodium) can cause fluid retention that makes ineffective medical treatment. The amount of sodium in the body decreases by limiting the table salt in cooking food and eating salty foods. People with severe heart failure may know the salt content of packaged food by reading labels carefully.
A simple and safe way to see if fluid is retained control weight daily. Fluctuations of more than one kilogram per day should be almost certain to fluid retention. A consistent weight gain and fast (1 kg per day) is a sign that heart failure is worsening. Thus, patients with heart failure should carefully control their weight every day, mainly on rising in the morning after urinating and before breakfast. The variations are easier to observe when using always the same scale and similar clothes and daily weight points in a notebook.
Treatment of heart failure
The best treatment of heart failure is the prevention or control of the underlying cause. But even if this is not possible, the constant advances in the treatment improve the quality of life and prolonged.
Chronic heart failure: when the salt restriction alone does not reduce fluid retention, diuretic drugs are administered to increase urine production and remove the sodium and water from the body through the kidneys.
The reduction of fluids reduces the volume of blood to the heart and thereby reducing the effort it must perform. Usually, diuretics orally ingested when it comes to long-term treatment, but in an emergency are very effective intravenously. Because some diuretics cause an undesirable loss of potassium, can also be given a potassium supplement or a diuretic that does not eliminate potassium.
Digoxin increases the power of each heartbeat and reduces heart rate when it is too fast. The heart rhythm irregularities (arrhythmias), where the beats are too fast, too slow or irregular, are treated with drugs or with an artificial pacemaker. On the other hand, it is often the administration of vasodilators that dilate blood vessels, both arteries, veins, or both at once. Arterial vasodilators dilate the arteries and reduce blood pressure, which in turn reduces the heart’s workload. The venodilators dilate the veins and provide more space for blood that has accumulated and is unable to enter the right heart. This space accessory relieves congestion and reduces the load on the heart. Vasodilators are most commonly used ACE inhibitors (angiotensin converting enzyme). These drugs not only improve symptoms, but also prolong life. The ECA dilate both arteries and veins, while many of the older drugs dilate one or the other to varying degrees. For example, nitroglycerin dilates the veins, while hydralazine dilate the arteries.
The dilated heart chambers and limited contraction can promote blood clot formation inside. The greatest danger lies in the evolution of these clots in their move to the circulation can cause serious injury to other vital organs such as the brain and cause a stroke.
Anticoagulant drugs are important because they prevent the formation of clots in the cardiac chambers.
We are researching a number of new drugs. Like ACE inhibitors, milrinone and amrinone dilate both arteries and veins, likewise, like digoxin, they also increase the contractile force of the heart. These new drugs are used only for short periods in patients who are closely monitored in the hospital because they can cause dangerous irregular heartbeat.
Heart transplantation is indicated in some cases of severe heart failure who do not respond adequately to drug treatment. The mechanical hearts temporary, partial or complete are still in experimental stage and is working hard on performance problems, infections and blood clots.
The cardiomyoplasty is an experimental operation in which a muscle is removed along the back that wraps around the heart and is stimulated by an artificial pacemaker to produce rhythmic contractions. This is the latest operation shows promising experimental and very specific in patients suffering from severe heart failure (ie, cardiac muscle, very weak, has stopped functioning as such).
Acute heart failure: when a sudden buildup of fluid in the lungs (pulmonary edema), breathing is very difficult, so that high concentrations of oxygen delivered through a mask.
The administration of intravenous diuretics and drugs such as digoxin may produce a rapid and dramatic improvement.
Intravenous nitroglycerin or placed under the tongue (sublingual) dilates blood vessels and thus reduces the volume of blood through the lungs. When these measures are unsuccessful, insert a tube into the airways so that breathing can be assisted with a ventilator. In rare situations, apply a tourniquet to three of the four members of the blood temporarily imprison them and reduce the volume of blood returning to the heart, these tourniquets should be exchanged between the members every 10-20 minutes to avoid injuries extremities.
The administration of morphine relieves the anxiety that usually accompanies acute pulmonary edema, decreasing the rate of breathing, reduces heart rate and therefore reduces the overload of the heart. Drugs similar to adrenaline and noradrenaline (such as dopamine and dobutamine) are used to stimulate heart contractions in patients who are hospitalized and need a quick improvement. However, if stimulation of the internal emergency system of the organism itself is too large, sometimes used drugs that have the opposite action (beta-blockers).
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