HEART FAILURE: It is real!!!

Heart failure is said to happen when a heart is in a state wherein it cannot pump blood at a rate commensurate with the demand of the body and/ or the heart is able to do so only with elevated filling pressure. 10% elderly people are affected by it worldwide with 50% mortality, 5 years after the onset of symptoms.


CLASSIFICATION AND SYMPTOMS

  1. Right sided heart failure: Symptoms are ankle swelling, right upper abdominal swelling, abdominal distension, anorexia, fullness after little food.
  2. Left sided heart failure: Symptoms include difficulty in breath even at rest or when little work is done.
  3. Congestive heart failure: There is combination of both right and left sided heart failure.

NEW YORK HEART ASSOCIATION CLASSIFICATION OF HEART FAILURE
Class 1: No symptom is seen
Class 2: Slight limitation to activity. Patient is comfortable at rest but ordinary physical activity results in difficulty in breathing, palpitation (feeling of one’s heart-beat) and fatigue.
Class 3: Significant limitation of physical activities.
Class 4: Unable to carry out any physical activity

RISK FACTORS (Things that can make you have heart failure)
Age: the risk of having heart failure increases with age.
Hypertension
Myocardial infarction
Diabetes mellitus
Overweight/obesity:- Watch your weight please
Smoking
Excessive salt intake
Alcohol intake
Depression
Kidney problems
Sedentary/inactive lifestyle
Dietary indiscretion
Anaemia including anaemia.

INVESTIGATIONS
Your doctor will request for the following investigations of which clinical diagnosis of heart failure is Made;
Electrocardiogram
Echocardiogram
Chest x-ray: This will show Alveolar edema, Kerley B line, cardiomegaly, upper lobe diversion and pleural effusion.
B-type natriuretic peptide (BNP); this is usually raised in heart failure.

TREATMENT
Treatment of heart failure is directed to removing the underlying cause, prolonging life and improve its quality.
Treatment adopt both pharmacological and non-pharmacological method.
Pharmacological Method:

  1. Use of ionotropics to increase force of contraction of the heart e.g. digoxin, dopamine, dobutamine and dopexamine.
  2. Use of diuretics especially loop type e.g. frusemide, bumetamide or torsemide to remove excess fluid in the body.
  3. Reduction of vascular resistance with ACE inhibitor e.g. Captopril, enalapril, lisinopril.
  4. Anticoagulant; this is indicated when heart failure is complicated by artrial fibrillation.

FINAL NOTE
In USA, heart failure is responsible for in 1 in 8 death. Hence, where possible, risk factors for heart failure should be avoided-
i. If you are hypertensive, be drug compliant that is take your drugs regularly.
ii. Avoid smoking
iii. Avoid excessive alcohol intake
iv. Be active! Don’t live a sedentary life
v. Avoid sprinkling salt in your cooked food
vi. Use cholesterol free oil when cooking
vii. Eat very less of animal fat
viii. Depression is dangerous to your health, avoid it.