Larry E. Smith, MD, FACP
Heart failure is a prevalent condition of various causes resulting in the inability of the heart to effectively supply blood to the vital organs of the body. This is now the most common reason individuals above the age of 65 are admitted to the hospital.
Coronary artery disease is the most prevalent source of heart failure, with hypertension (high blood pressure) being the second highest reason. Other less common sources include excessive alcohol use, valvular heart disease, congenital heart disease, and others. In addition, there are two types of heart failure: systolic and diastolic. Systolic heart failure involves damage to the heart muscle with decreased pumping ability whereas diastolic heart failure involves preserved pumping ability with decreased ability to relax. This article emphasizes the diagnosis and management of individuals with systolic heart failure. Damaged Heart Muscle + Decreased Pumping=Systolic Heart Failure
Most individuals with heart failure generally present with difficulty breathing, fatigue and leg edema (leg swelling). Those with coronary artery disease or valvular heart disease may also present with chest pain and syncope (fainting). Thus, this condition may be easily suspected just by talking to the patient. However, an adequate diagnosis of heart failure may require a detailed history, thorough physical examination, chest X-ray, electrocardiogram (EKG/ECG), echocardiogram, stress study as well as cardiac catheterization. Echocardiogram is important in confirming the diagnosis of heart failure and in following the progress of the condition over time. Treatment of the patient with heart failure depends on the source of the condition with emphasis on improving symptoms, quality of life and long-term outcome. This involves education, prescribed medications and referral for procedures as needed. Education involves information on heart failure, sodium restriction, therapeutic effects and side effects of relevant medications and stressing the importance of compliance and daily weight-taking. What Can Be Done to Manage Heart Failure? Medical management is important in heart failure and involves the prescription of various medications. ACE inhibitors, beta blockers and diuretics are essential in managing the patient in heart failure. ACE inhibitors and beta blockers slow the worsening of heart failure, decrease the chance of being admitted to the hospital for heart failure and also reduce the chance of dying from this condition. Other medications used to treat heart failure include digoxin, hydralazine, nitroglycerin, angiotensinogen II blockers, aldosterone antagonists and Entresto.
Some patients with heart failure may not respond adequately to medical management and may benefit from a variety of interventions. The patients with significant coronary artery disease may benefit from angioplasty with stent placement and some may also require coronary artery bypass grafts. The patients with significant valvular heart disease may benefit from repair of the heart valves whereas others may require replacement of the damaged valves. Individuals with a history of myocardial infarction (heart attack) and heart failure may benefit from resynchronization therapy (CRT, or biventricular pacing). Other patients with resistant heart failure may benefit from an artificial heart or left ventricular assist device. Others may require heart transplantation.
Heart failure is a common condition with various causes. Timely diagnosis and adequate management may improve symptoms and quality of life and prevent additional problems in the future. Most patients improve with medical management while others may require additional interventions.
For more information please contact:
Larry E Smith, MD, FACP
5116 Northwind Blvd
Valdosta, GA 31605