Chronic heart failure hits more and more people

By professor dr. med. Stig Haunsø; speciality in cardiology

Heart failure is a condition in which the heart is weak and pumps with reduced power. This leads to fluid retention in the body and shortness of breath during physical exhaustion. Heart failure is becoming more and more common. It is estimated that around 100,000 Danes are receiving treatment for this disease. Heart failure can occur suddenly in connection with a massive embolism in the heart or in the lungs, but most commonly the condition develops over a number of years into a chronic disease.

Symptoms
The symptoms are different degrees of shortness of breath, during physical exhaustion, and later when the disease worsens also during rest. Fits of coughing can occur and also often an overwhelming fatigue. Fluid in the lungs, in the liver and in the legs (oedema) is possible. Palpitation (arrhythmia) or angina pectoris is also common.

The most common cause of heart failure is contraction, arteriosclerosis, of the arteries in the heart, which supply the heart with oxygen and nutrients. During physical exercise, the heart needs fuel and therefore pumps less efficiently.

Another common cause is an embolism in the heart, which leaves a scar (connective tissue instead of muscles). The heart becomes weak which causes hypertrophy.

Other causes are long standing untreated high blood pressure and year old diabetes. Heart valve dysfunction, arrhythmia, congenital and hereditary heart diseases and chronic alcoholism can also lead to chronic heart failure.

The rigid heart
It is relatively rare that the heart muscle becomes rigid due to other diseases. The rigid heart leads to heart failure because the blood has difficulty entering the heart. The heart pumps with normal strength, but when less blood enters the heart, less blood exits per beat. The rigid heart cannot live up to an increased demand, water palpitates in the legs and the liver, and fatigue sets in. The treatment is slightly different than with the weak heart.

On the basis of information of previous illnesses and symptoms along with examinations including measurement of blood pressure, stethoscopy of heart and lungs, electrocardiogram, x-ray of the heart and lungs and a few blood samples, the doctor attempts to confirm or deny the suspicion of heart failure.

If the diagnosis is confirmed, an ultrasound scan of the heart should be carried out, which will provide information regarding the heart valves and if he heart is weak or rigid. The damage after an embolism can be localised and the pumping capacity of the heart can be determined with great accuracy. Furthermore it can be necessary with x-rays of the blood vessels of the heart, to determine the extent and severity of possible contractions.

Medical treatment
Treatment of chronic heart failure is most often done with various medications, serving the purpose of removing the symptoms and prolonging life. In certain cases, the disease can be alleviated through heart surgery. Palpitation and shortness of breath is treated with diuretic medicine and potassium supplements. Arrhythmia is treated with dioxin, which stabilises the rhythm and improves the pumping ability of the heart. In case of chest pain, nitro-glycerine is tried, and in case of arteriosclerosis aspirin is administered.

The life prolonging medicine makes the heart work more economic by changing the shape, size and rigidity of the heart towards the normal, thus improving the pumping capacity of the heart and in the long run prevent or postpone a worsening of the disease.

Three types of medicine should be included in the ideal treatment: ACE-inhibitors, beta blocks and Spironolactone (a special form of diuretic medicine).

Surgical treatment
Side effects to the medicine can be an imbalance in the body’s salt reserves (diuretic medicine), fatigue, dizziness and depression (beta blocks), dry cough (ACE-inhibitors) and slow pulse (dioxin). Sometimes it is necessary to accept slight side effects for the symptom reducing and life prolonging effect to the disease, but it can also be necessary to change medication.

The important thing in treating heart failure is removing the basic cause. It can be a dysfunctional heart valve, which strains the heart, and can be replaced with a mechanical heart valve. It can be contractions in the arteries, which reduce the oxygen flow to the heart, which can be improved by a by-pass operation. In rare situations a heart transplant could be an option.

A new lifestyle necessary
Most patients with chronic heart failure must live the rest of their lives with the physical limitations of their hearts, and they have to adjust their lifestyles accordingly. Once the fear and frustration of the diagnosis have been dealt with, one can begin influencing the course of the disease.

It is necessary to make lifestyle changes by minimising risk factors such as smoking, high cholesterol, high blood pressure and stress. If one is overweight, one should lose the weight. A couple of glasses of wine a day are not harmful, whereas a large consumption of alcohol will make the disease progress. Daily exercise strengthens the heart.

Note that fatigue can be caused by the lack of potassium due to the diuretic medicine. This is why the body’s salt reserves and the kidney functions must be checked regularly. Daily weight control is important. If the weight increases, it could be caused by retention of fluids in the body and it may be necessary to increase the diuretic medicine. If the weight increases considerably within a few days, it is a sign that the medicine is not working. See your physician immediately.

Work does not damage the heart, but the heart’s ability to pump may limit the number of hours one can work. Reduced working hours may be necessary. Sex does not damage the heart, but psychological causes and side effects to the medicine (beta blocks) can lead to impotence. Seek advice from your physician.

Most patients with chronic heart failure can undertake long trips once the disease is stabile and the treatment has been stabile for 2 to 4 months. Make sure to obtain approval from your insurance company before you travel.