Understanding what heart failure is and its causes

Heart failure and stroke are leading causes of death in adult South Africans; more than four times the number of people murdered and the leading causes of hospitalisation in people older than age 65.

Heart disease is one of the most serious threats to the health of our nation and it’s mainly due to our lazy, Western lifestyle.

In South Africa, a whopping 210 die of heart disease every single day.

Heart failure means the heart’s pumping power is weaker than normal and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body’s needs.

The chambers of the heart may stretch to hold more blood to pump through the body or become thickened.

This keeps the blood moving, but the heart muscle walls may weaken and be unable to pump as efficiently. The kidneys may respond by causing the body to retain water and salt.

If fluid builds up in the arms, legs, ankles, feet, lungs or other organs, the body becomes congested and congestive heart failure is the term used to describe the condition.

Diagnosis

The doctor will ask you about any conditions you have that may cause heart failure (such as coronary artery disease, angina, diabetes, heart valve disease and high blood pressure).

You will be asked if you smoke, take drugs, drink alcohol (and how much you drink), and what drugs you take. Your doctor may also order other tests. These include:

• Blood tests – This is to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anaemia.
• B-type Natriuretic Peptide (BNP) blood test – BNP is a substance secreted from the heart in response to changes in blood pressure when heart failure develops or worsens.
• Chest X-ray – This shows the size of your heart and if there is fluid build-up around heart and lungs.
• Echocardiogram – This is an ultrasound showing heart movement, structure and function.
• The Ejection Fraction – It is used to measure how well your heart pumps with each beat to determine if systolic dysfunction or heart failure with preserved left ventricular function is present.
• Electrocardiogram – An ECG records the electrical impulses traveling through the heart.
• Cardiac catheterisation – This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure.
• Stress test – Non-invasive stress tests provide data about the likelihood of coronary artery disease.

Causes

Heart failure is caused by many conditions that damage the heart muscle, including:

• Coronary artery disease – This is a disease of the arteries causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart is starved of oxygen and nutrients.
• Heart attack – This occurs when a coronary artery is suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that doesn’t function properly.
• Cardiomyopathy – Damage to heart muscle from causes other than artery or blood flow problems, such as from infections, alcohol or drug abuse.
• Conditions that overwork the heart – Conditions including high blood pressure, valve disease, thyroid disease, kidney disease, diabetes, or heart defects present at birth can all cause heart failure.

Symptoms

If you have heart failure, you may have one or all of these symptoms or none of them. They may or may not indicate a weakened heart. The symptoms can include:

• Congested lungs – Fluid backup in the lungs can cause shortness of breath and a dry cough or wheezing.
• Fluid and water retention – Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen and weight gain. Symptoms may cause an increased need to urinate at night. Bloating may cause a loss of appetite or nausea.
• Dizziness, fatigue, weakness – Less blood to major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
• Rapid or irregular heartbeats – The heart beats faster to pump enough blood to the body.

Prevention

• Control blood pressure: Monitor symptoms – Check fluid status by weighing yourself daily and checking for swelling.
• Maintain fluid balance – The more fluid in your blood vessels, the harder your heart works to pump excess through your body. Limiting fluid intake to less than two litres per day will decrease the workload of your heart.
• Limit salt intake – Then you should have less fluid retention.
• Monitor weight – Keep weight within 1.8kg of your dry weight.
• Take medications as prescribed – Medications improve the heart’s ability to pump blood, decrease stress on the heart, decrease progression of heart failure and prevent fluid retention.
• Avoid nonsteroidal anti-inflammatory medications – These include Brufen; some antiarrhythmic drugs; most calcium channel blockers; some nutritional supplements, such as salt substitutes and growth hormone therapies; antacids containing salt and decongestants.

Lifestyle changes

Stop smoking or chewing tobacco, exercise regularly, do not drink alcohol, eat a healthy diet and prevent respiratory infections.