What is Heart Failure? What are its stages? How to Treat?

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What is Heart Failure? What are its stages? How to Treat? You can get information about the subject in our article titled. Heart failure is a long-term disease in which the heart does not always pump blood well enough to meet the body's needs. Treatment; It includes exercise and medication initially, and possible surgical procedures when heart failure worsens. The course of the disease depends on a number of factors, including how well the person takes care of themselves.

What is Heart Failure?

Heart failure or congestive heart failure is a long-term disease that worsens over time. Although the name of the disease may indicate that the heart has stopped working, heart failure means that the heart cannot pump blood as it should. When the heart has less pumping power, this can damage a person's organs and cause fluid accumulation in the lungs.

How Common Is Heart Failure?

Approximately 6 million Americans experience heart failure, and more than 870,000 people are diagnosed with heart failure each year. Heart failure (congestive heart failure) is one of the leading causes of hospitalization in people older than 65 years.

What are the Types of Heart Failure?

There are many causes of heart failure, but the disease is generally divided into the following types:

  • Left-sided heart failure
  • Heart failure with reduced left ventricular function (HF-rEF): The lower left chamber of the heart (left ventricle) becomes enlarged and cannot contract tightly enough to pump the right amount of oxygen-rich blood to the rest of the body.
  • Heart failure with preserved left ventricular function (HF-pEF): The heart contracts and pumps blood normally, but the lower chambers of the heart (ventricles) are thicker and stiffer than normal. Therefore, the ventricles cannot fully relax and fill completely. Because there is less blood in the ventricles, when the heart contracts, it pumps less blood to the rest of the body.
  • Right-sided heart failure: Heart failure can also affect the right side of the heart. Left-sided heart failure is the most common cause. Other causes include certain lung problems and problems in other organs.

What is Congestive Heart Failure?

Congestive heart failure is a condition in which the heart cannot handle the volume of blood. Congestive heart failure causes accumulation in other parts of the body, most commonly in the lungs and lower extremities (feet/legs).

What Are The Complications of Heart Failure?

Some of the complications resulting from heart failure include:

  • Irregular heartbeat.
  • Sudden cardiac arrest.
  • Heart valve problems.
  • A collection of fluid in the lungs.
  • Pulmonary hypertension.
  • Kidney damage.
  • Liver damage.
  • Malnutrition.

What are the Stages of Heart Failure?

Heart failure is a chronic condition that worsens over time. There are 4 stages of heart failure (Stage A, B, C and D). The stages range from "high risk of developing heart failure" to "advanced heart failure."

Stage A: Stage A is considered pre-heart failure. Stage A means a person is at high risk of developing heart failure because they have a family history of heart failure or have one or more of the following medical conditions:

  • Hypertension.
  • Diabetes.
  • Coronary artery disease.
  • Metabolic syndrome.
  • Excessive alcohol consumption.
  • History of rheumatic fever.
  • Family history of cardiomyopathy.
  • History of using medications that can damage the heart muscle, such as some cancer drugs.

Stage B: Stage B is considered pre-heart failure. This means that the doctor diagnosed systolic left ventricular dysfunction, but the patient never had symptoms of heart failure. Most people with stage B heart failure have an echocardiogram (echo) that shows ejection fraction (EF) of 40% or less. This category includes people with heart failure and reduced EF (HF-rEF) from any cause.

Stage C: People with Stage C heart failure are diagnosed with heart failure and have signs and symptoms of the condition now or in the past. There are many possible symptoms of heart failure. The most common are:

  • Shortness of breath.
  • Feeling tired (exhaustion).
  • Difficulty exercising.
  • Weak legs.
  • Waking up to urinate.
  • Swollen feet, ankles, lower legs and abdomen (edema).

Stage D and Reduced EF: People with Stage D HF-rEF have advanced symptoms that do not improve with treatment. This stage is the final stage of heart failure.

What Are The Symptoms of Heart Failure?

The main symptoms of heart failure are:

  • Shortness of breath.
  • Feeling tired (exhaustion) and experiencing leg weakness when being active.
  • Swelling in ankles, legs and abdomen.
  • Gaining weight.
  • Need to urinate at night.
  • Fast or irregular heartbeats (palpitations).
  • Dry cough.
  • A full (bloated) or hard stomach, loss of appetite, or upset stomach (nausea).

There may be times when symptoms are mild or no symptoms at all. This does not mean that heart failure no longer exists. Heart failure symptoms can range from mild to severe and may appear and disappear from time to time.

Unfortunately, heart failure often gets worse over time. As it gets worse, more or different symptoms appear. Those who have new symptoms or whose existing symptoms worsen should definitely report this to their doctor.

What are the Causes of Heart Failure?

Although the risk of heart failure does not change as you get older, the likelihood of experiencing heart failure is higher as you get older.

Many medical conditions that damage the heart muscle can cause heart failure. Diseases that can commonly cause heart failure include:

  • Coronary artery disease.
  • Heart attack.
  • Cardiomyopathy.
  • Heart problems present at birth (congenital heart disease).
  • Diabetes.
  • High blood pressure (hypertension). This condition is more common in women.
  • Arrhythmia (abnormal heart rhythms, including atrial fibrillation).
  • Kidney disease.
  • Having obesity.
  • Tobacco and drug use.
  • Medicines. Some drugs used to fight cancer (chemotherapy) can lead to heart failure.

How Is Heart Failure Diagnosed?

To determine whether a person has heart failure, the doctor needs to know the person's symptoms and medical history. To diagnose heart failure, the doctor may ask questions such as:

Do you have health conditions such as diabetes, kidney disease, chest pain (angina), high blood pressure, high cholesterol, coronary artery disease or other heart problems?

  • Is there a family history of heart disease or sudden death?
  • Is there any smoking or tobacco use?
  • Is there alcohol consumption, if so, how much?
  • Have you received chemotherapy and/or radiation?
  • What are the medications used?

The doctor will also perform a physical examination on the patient and look for signs of congestive heart failure and heart disease, which can cause your heart muscle to weaken or harden.

What is the Importance of Ejection Fraction?

Ejection fraction (EF) is one way to measure the severity of the condition. If the EF is below normal, it may mean that you have heart failure. Ejection fraction tells the doctor how good a job the left or right ventricle is doing at pumping blood. Generally, the EF value relates to how much blood the left ventricle pumps since it is the main pumping chamber of the heart.

Several non-invasive tests can measure EF. With this information, the doctor can decide how to treat the patient or understand whether a treatment is working as it should.

A normal left ventricular ejection fraction (LVEF) is 53% to 70%. For example, an LVEF of 65% means that 65% of the total amount of blood in the left ventricle is pumped out with each heartbeat. EF may increase and decrease depending on the condition of the heart and how well the treatment is working.

What Tests Are Used to Diagnose Heart Failure?

There are various tests to see how bad your heart failure is and what is causing it. Commonly used tests include:

  • Blood tests.
  • NT-pro B type Natriuretic Peptide (BNP) blood test.
  • Cardiac catheterization.
  • Chest x-ray.
  • Echocardiogram (echo).
  • Magnetic resonance imaging (MRI).
  • Electrocardiogram (ECG).
  • MUGA scan.
  • Stress test.

How Is Heart Failure Treated?

Treatment depends on the type of heart failure you have and, in part, what is causing it. Medications and changes in lifestyle behaviors are part of every treatment plan. The doctor will talk to him about the best treatment plan for the patient. The form of treatment is the same for men and women, regardless of gender.

As heart failure worsens, the heart muscle pumps less blood to the organs and the next stage of heart failure progresses. Since it is not possible to go backwards in the stages of heart failure, the aim of the treatment is to prevent the patient from progressing through these stages or to slow down the progression of your heart failure.

Heart Failure Stage A Treatment

The usual treatment plan for people with stage A heart failure is as follows:

  • Exercising regularly, being active, walking every day.
  • Stopping the use of tobacco products.
  • Treatment of high blood pressure (medication, low sodium diet, active lifestyle).
  • Treatment of high cholesterol.
  • Not using alcohol and drugs.
  • Those with coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions should use an angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB).
  • Those with high blood pressure should use beta blockers.

Heart Failure Stage B Treatment

The usual treatment plan for people with stage B heart failure is as follows:

  • Treatments listed in Stage A.
  • Using an angiotensin converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) if not already used.
  • Using beta blockers if the person has had a heart attack and their EF is 40% or lower (if not already using them).
  • Using an aldosterone antagonist if the person has had a heart attack or has diabetes and their EF is 35% or less.
  • Possible surgery or intervention to treat coronary artery blockage, heart attack, valve disease (valve repair or replacement), or congenital heart disease.

Heart Failure Stage C Treatment

The usual treatment plan for people with stage C HF-rEF is as follows:

  • Treatments listed in Phases A and B.
  • Using beta blockers.
  • A vasodilator drug (ACE-I, ARB, or angiotensin receptor/neprilysin inhibitor combination) and aldosterone antagonist if beta-blocker does not relieve symptoms.
  • Hydralazine/nitrate combination if other treatments do not stop symptoms. Black patients should take this medication (even if they are taking other vasodilator medications) if they have moderate to severe symptoms.
  • Medicines to slow the heart rate if the heart rate is faster than 70 beats per minute and the person still has symptoms.
  • If symptoms persist, a diuretic (diuretic) may be prescribed.
  • Sodium (salt) restriction in the diet.
  • Tracking weight every day. If more than 1.8 kg is taken or given, the doctor should be informed.
  • Possible fluid restriction.
  • Possible cardiac resynchronization therapy (biventricular pacemaker).
  • Possible implantable cardiac defibrillator (lCD) therapy.

If treatment causes symptoms to improve or stop, continued treatment is necessary to slow progression to Stage D.

Heart Failure Stage D Treatment

The usual treatment plan for people with Stage D heart failure includes the treatments listed in Stages A, B, and C. Additionally, more advanced treatment options need to be considered, including:

  • Heart transplant.
  • Ventricular assist devices.
  • Heart surgery.
  • Continuous infusion of intravenous inotropic drugs.
  • Palliative care.
  • Investigational treatments.

Stage C and Stage D with Preserved EF in Heart Failure

For people with Stage C and Stage D heart failure and preserved EF (HF-pEF), treatment is as follows:

  • Treatments listed in Stages A and B, although they may not be suitable for some patients.
  • Medicines to treat medical conditions that can cause or worsen heart failure, such as atrial fibrillation, high blood pressure, diabetes, obesity, coronary artery disease, chronic lung disease, high cholesterol, and kidney disease.
  • Use of diuretics to reduce or alleviate symptoms.

It is also very important for patients to manage other health conditions, such as:

  • Diabetes.
  • Kidney disease.
  • Anemia.
  • Hypertension.
  • Thyroid disease.
  • Asthma.
  • Chronic lung disease (COPD).

Some diseases have signs and symptoms similar to heart failure. Those with new or worsening symptoms should report this to their doctor.

How to Prevent Heart Failure?

Although some risk factors such as age, family history or race cannot be controlled, the best thing a person can do to prevent heart failure is to change their lifestyle. Things that can be done are as follows:

  • Maintaining a healthy weight.
  • Eating foods that are good for the heart.
  • Exercising regularly.
  • Managing stress.
  • Stopping the use of tobacco products.
  • Not using alcohol.
  • Not using drugs.
  • Getting treatment for other health conditions that may increase the risk.

What is the Course of the Disease In Heart Failure?

Congestive heart failure does not prevent people from doing things they enjoy if proper care is provided. The course of the disease largely depends on the following.

  • How well the heart muscle works.
  • The person's symptoms.
  • How well he responds to the treatment plan.
  • How well he follows his treatment plan.

One study says people with heart failure have a life expectancy that is 10 years shorter than those without heart failure. Another study shows that survival rates for people with chronic heart failure are 80% to 90% in the first year, but this drops to 50% to 60% by the fifth year and 30% by 10 years

In a different study, it was found that people with heart failure who were discharged from the hospital had a life expectancy ranging from 3 to 20 years, depending on various factors such as age and gender. In addition to all these, it is important to look at the patient's specific condition when evaluating the course of the disease.

How Does Heart Failure Affect Quality of Life and Lifestyle?

With the right care and treatment plan, many adults can continue to enjoy life even though heart failure limits their activities. How well the patient feels depends on:

  • How well the heart muscle works.
  • The person's symptoms.
  • How well he responds to the treatment plan.
  • How well he follows his treatment plan.

The patient should take care of himself by doing the following.

  • Taking your medications.
  • Being active.
  • Having a low sodium diet.
  • Monitor and report new or worsening symptoms to your doctor.
  • Visiting the doctor with regular follow-up appointments.

Those with heart failure can take various steps to improve their heart health. The patient should take his medications as recommended, switch to a low-sodium diet, be physically active, notice sudden changes in his weight, adopt a healthy lifestyle, not neglect follow-up appointments, and monitor his symptoms. Those with questions or concerns about medications used, lifestyle changes, or other parts of the treatment plan should see a doctor.