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The chief function of the heart is to ensure that all parts of the body get the blood supply they need in order to perform their functions at different levels of workloads. When a heart fails to pump blood to adequately meet the needs of the body, a constellation of signs and symptoms ensue that may indicate heart failure.
Causes of heart failure:
Although there is a multitude of causes for this situation to arise, one of the chief causes is heart attack. When a person suffers a heart attack and if as a result a large portion of the heart muscle is damaged, then the pumping capacity of the heart decreases. The degree of compromise to the pumping capacity of the heart depends on the amount of heart muscle damage. A greater degree of damage to the heart muscle will predict a worse outcome for a patient than somebody with minor damage or no damage at all. This is one of the reasons for conducting tests to define the pumping capacity of the heart after a person suffers a heart attack. This helps your cardiologist to apply as optimal a treatment protocol as possible while you are in the hospital and when you are managed as an outpatient subsequently.
Uncontrolled high blood pressure, presence of any abnormality in the heart valves, heavy consumption of alcohol and infections of the heart due to some viruses are some of the other causes of heart failure.
Symptoms of heart failure:
Shortness of breath:
Early on in the evolution of heart failure, shortness of breath may occur only with significant physical activity. Once the person rests for a few minutes, the shortness of breath will be relieved. Over time, the ability to physically exert oneself may keep decreasing and eventually, in advanced situations, the shortness of breath may persist even when one is just resting.
As the heart is unable to pump forward at an adequate level the fluid backlogs in the lungs making it soggy and difficult to expand which results in the activity limitation. This mechanism may also be responsible for causing persistent coughing and wheezing. Some patients may wake up in the middle of the night feeling breathless as there is increased flow of blood from the legs to the heart in the lying down position and the heart is incapable of handling the additional load. This is also why some patients with heart failure, tend to sleep in a reclining chair rather than on a bed.
Fatigue and tiredness:
As the heart is incapable of sending adequate amount of blood to all the organs, the body prioritises the blood usage. The heart muscle and brain get most of the blood supply they need to function, at the cost of other organs. Blood blow to the muscles of the arms and legs are decreased along with other organs of the body. This leads to easy fatiguability and tiredness.
Appetite loss:
Blood supply to the digestive organs is reduced as well and they function at reduced level as well. This results in loss of appetite.
Confusion and loss of memory:
This usually happens with advancing stages of heart failure or as a result of side-effects of some medications that are used in the treatment of heart failure. Heart failure itself or the effects of the medications can cause changes in levels of the electrolytes in the body. Kidney failure that commonly occurs in patients with advancing heart failure can further worsen this electrolyte imbalance and cause symptoms of confusion, disorientation and memory loss.
Increased heart rate:
As the heart is weakened, it tries to compensate for its weakness by increasing the number of times it beats per minute to improve blood supply to the body. This can result in increased heart rate. People with heart failure are also at risk for abnormal heart rhythms and this can cause a symptom called palpitations (‘Nenju Padapadappu’ as it would be expressed in Tamil).
Leg swelling:
I would like to emphasise that swelling of the legs with fluid should be ascribed to heart failure only after consulting with a doctor. There are several causes for this condition and it would not be wise to assume that it is a result of heart failure, without medical opinion. But, this is a common symptom of heart failure and is aggressively treated by doctors with medications that increase elimination of water through urination.
The above mentioned are the common symptoms of heart failure. Since heart attack is a chief cause of this serious condition, it is imperative that heart attacks be treated early and aggressively to reduce the future risk of heart failure in that person. I will elaborate further on heart failure in the subsequent weeks.
Dr G Balachander
Cardiologist
Illinois, USA
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Heart failure
