Heart Failure: Causes, Symptoms, and Risk Signal Prevention

     When the heart fails, just a fraction of a minute can transform a life, causing the heart to stand still momentarily. It is as if the line between life and death overlaps, occurring either acutely or chronically, regardless of age. Learn the causes of heart failure, understand the warning signs, and prevent it in time—even in critical moments.

Heart Failure

     Heart Failure (Congestive Heart Failure) is a clinical syndrome resulting from structural or functional cardiac abnormalities that impair the heart's ability to pump sufficient blood to the body. This causes the heart to overwork until it becomes exhausted, leading to chest pain and tightness. Generally, causes include abnormalities of the pericardium or heart valves, substance abuse, viral infections, certain types of chemotherapy, or complications from pre-existing conditions such as Coronary Artery Disease, Hypertension, Rheumatic heart disease, Arrhythmia, and Congenital heart defects.

4 Stages of Heart Failure

• Stage A: No symptoms yet, but presents high-risk factors from underlying conditions such as obesity, diabetes, coronary artery disease, and hypertension.
• Stage B: Beginning to feel fatigue and shortness of breath, which can occur even in those who have never shown symptoms before.
• Stage C: Clear symptoms manifest, such as chest tightness, palpitations, exhaustion, and shortness of breath, making daily activities difficult.
• Stage D: Symptoms escalate in severity, including intense chest tightness, severe difficulty breathing, and total loss of energy to move the body.

Types of Heart Failure

While the American Heart Association classifies heart failure by left-sided and right-sided dysfunction based on an ejection fraction of less than 40%, it can also be categorized by the onset of symptoms:

• Acute Heart Failure: Occurs suddenly and symptoms rapidly worsen depending on the individual's heart condition. It is frequently found in patients with myocardial infarction (heart attack).
• Chronic Heart Failure (CHF): Symptoms do not appear immediately and are non-specific, requiring further tests for diagnosis. Some cases are complications of other chronic diseases like diabetes.

Signs of Heart Failure

• Easily fatigued during exertion; as symptoms worsen, fatigue may persist even at rest.
• Facial numbness and leg swelling; pressing a finger on the feet or shins leaves a persistent indentation (pitting edema).
• Nausea and loss of appetite.
• Abdominal swelling due to fluid and blood congestion.
• Dizziness, exhaustion, and difficulty breathing when lying flat; some cases may involve concurrent kidney failure.

Diagnosis of Heart Failure

     When symptoms occur, physicians will begin with blood tests and echocardiograms to investigate the condition, specifically looking at the Left Ventricular Ejection Fraction (LVEF). If this value is decreased, it indicates heart damage, which results in the patient having less stamina and facing difficulties in daily life.

Treatment of Heart Failure

1. Medication Therapy

     Physicians assess the condition before selecting appropriate medications based on symptoms, such as Diuretics, ACE Inhibitors, Beta-blockers, Digitalis, or Nitrates. These are used to slow down organ deterioration and prevent further complications (Reference: Piyamaharajkarun Hospital, Faculty of Medicine Siriraj Hospital).

2. Pacemaker/ICD Therapy

     Physicians may use pacemakers to control heart rhythm, detect abnormalities, and prevent complications. This is often used to treat ventricular dyssynchrony and may be used in conjunction with a defibrillator.

3. Ventricular Assist Devices (VAD)

     Mechanical heart support is a method to maintain the heart's ability to pump blood throughout the body at near-normal levels. This is used for patients awaiting surgery or as a long-term solution for those ineligible for a heart transplant.

4. Coronary Artery Bypass Grafting (CABG)

     Since heart failure can be caused by ischemia (lack of blood flow), bypass surgery is a treatment that helps blood flow more easily to the heart. This is typically used in cases of coronary artery disease, subject to the physician's discretion.

5. Heart Transplant

     In severe cases where other treatments are ineffective, physicians will consider a heart transplant from a donor, weighing the benefits against the risks to ensure the best outcome for the patient.

Self-Care for Heart Failure

• Avoid extreme activities that risk overworking the heart, such as riding roller coasters.
• Reduce salt intake (high sodium), as it increases blood pressure and leads to heart failure.
• Exercise regularly and appropriately for your physical condition.
• Quit smoking and avoid alcohol consumption.
• Manage stress and ensure adequate sleep.

Take Care of Your Heart with RAM Hospital

     Peace of mind comes with being close to your doctor. Protect yourself from heart failure at the Heart Center, Ramkhamhaeng Hospital. We offer new hope for life to move forward happily, under the care of cardiologists with modern medical technology and cardiac rehabilitation programs that you can start today.