WHAT IS HEART FAILURE?

Heart failure is a serious condition in which the heart cannot pump enough blood to meet the body’s needs, resulting in fluid accumulation in the lungs and various parts of the body. Heart failure is not a single disease but a clinical syndrome that can occur due to many different causes; in other words, it is a combination of symptoms and physical findings.

According to the HAPPY study reflecting the situation in Turkey, more than 2 million people in our country live with heart failure. The survival rates of these patients are even worse than those of colon, breast, or prostate cancers.

Today, it is estimated that there are 15 million heart failure patients in European countries and 6 million in the United States. This number is expected to increase by at least 2–3 times in the next 10 years.

The prevalence of heart failure is increasing in both developed and developing countries. It is predicted to reach levels that will threaten public health in the next 15–20 years. Because it requires lifelong treatment, frequent hospitalizations, and the use of complex and expensive device therapies, it also imposes a significant financial burden on healthcare systems.

Among individuals over the age of 65, heart failure is the most common and increasingly frequent cause of hospitalization. Although some patients may live for many years, the overall prognosis is usually poor. In stable HF patients, 1-year mortality is 7.2%; in advanced-stage patients it is 13.5%; and the 5-year mortality rate is approximately 50%. Since heart failure is a chronic disease, most patients require hospitalization due to worsening clinical status.

The outlook for patients hospitalized with heart failure is also poor. In a recent registry study, the mortality rate in hospitalized HF patients was 17.4%.

WHAT CAUSES HEART FAILURE?

• Heart attack is the most common cause of heart failure.
  
• Coronary artery disease occurs when cholesterol-containing plaques narrow one or more arteries that supply the heart.
  
• Hypertension forces the heart to work harder to maintain circulation. Poor blood pressure control increases the risk of heart failure.
  
• Other causes include heart valve disease, cardiomyopathy, inflammatory or congenital heart diseases, lung and kidney diseases, infections, anemia, arrhythmias, diabetes, and thyroid disorders.

WHAT ARE THE SYMPTOMS OF HEART FAILURE?

Shortness of breath

Occurs due to fluid accumulation in the lungs. It usually appears after exertion in the early stages but may occur even at rest in advanced stages. If shortness of breath or a feeling of air hunger occurs at night or while lying down, sleeping with extra pillows may help.

Cough or wheezing

Typically caused by fluid in the lungs, but may also be seen in asthma or chronic bronchitis.

Changes in body weight

Rapid weight gain (due to fluid retention) or weight loss (due to treatment) is common. You should weigh yourself every morning, and if you gain more than 2 kg in 3 days, consult your doctor.

Swelling in the ankles

Fluid accumulation may cause swelling in the ankles; if severe, the thighs, legs, and abdomen may also swell.

Loss of appetite

Fluid accumulation in the liver and abdomen may lead to loss of appetite, bloating, and indigestion. Eating small, frequent meals is recommended.

Increased nighttime urination

Lying down allows the fluid accumulated in the legs during the day to return to circulation, increasing urine production. Limiting fluid intake in the evening and using the bathroom before bed may help. Diuretics are best taken in the morning.

Depression and anxiety

Feelings of sadness, restlessness, and irritability are common and may limit participation in normal activities.

Fatigue

Inadequate oxygen delivery to the muscles causes easy fatigue. Moderate, regular exercise can help.

Dizziness or lightheadedness

Often caused by medications, but may also occur due to arrhythmias or standing up suddenly.

Increased heart rate

The heart beats faster to compensate for decreased pumping efficiency.

DIAGNOSIS AND TESTS IN HEART FAILURE

Diagnosis is based on medical history, physical examination, ECG, blood tests, chest X-ray, and echocardiography (heart ultrasound). To gain more detailed information, additional tests such as lung function tests, exercise testing, MRI, cardiac catheterization, angiography, nuclear imaging, and CT scans may be needed.

Heart failure is a chronic and serious condition that tends to worsen over time and may shorten life expectancy. Careful and appropriate treatment improves both quality of life and survival.

TREATMENTS AND RECOMMENDATIONS FOR HEART FAILURE

Depending on the severity of the disease and symptoms, the following medications may be used:

• Diuretics
  
• ACE inhibitors
  
• Angiotensin receptor blockers
  
• Beta-blockers
  
• Aldosterone antagonists
  
• Digoxin
  
• Antiarrhythmics
  
• Vasodilators
  
• Blood thinners
  
• Cholesterol-lowering drugs
  

If there is an abnormal heart rhythm or electrical conduction problem, special devices such as pacemakers may help reduce symptoms and prolong life. In some cases, stenting, bypass surgery, valve surgery, or even heart transplantation may be necessary.

Weight changes

Rapid, unintentional weight loss may indicate a serious condition. It may result from insufficient calorie intake, inactivity, loss of muscle mass due to heart failure, or excessive diuretic use.

Salt restriction

Reducing salt intake is essential. Remove saltshakers from the table, increase fruit and vegetable consumption, choose low-fat and unprocessed foods, and increase whole grains and fish.

Fluid intake

Most HF patients should limit daily fluid intake to 1.5–2 liters, including water, tea, coffee, juices, soups, milk, and soft drinks. Using small cups, spreading fluid intake throughout the day, and consuming cold water and fruits may help.

Alcohol

Alcohol increases heart rate and blood pressure. Chronic heavy drinking can cause alcoholic cardiomyopathy, leading to heart failure.

Diet

A balanced diet should include sufficient fruits, vegetables, fish, poultry, lean meats, grains, and soy. Prefer unsaturated fats.

Activity and exercise

Exercise is beneficial for most HF patients. Consult a doctor before starting or intensifying an exercise program. Walking is a good start. Stop exercising if you experience shortness of breath, dizziness, chest pain, nausea, or cold sweats. Avoid exercising right after heavy meals or prolonged fasting. Avoid breath-holding and sudden, strenuous movements.

Smoking

Smoking reduces blood oxygen-carrying capacity, increases blood pressure, and promotes plaque buildup and vascular blockage. Quitting smoking improves heart failure outcomes.

Methods to quit smoking:

1. Nicotine patches, gum, or sprays
   
2. Gradually reducing daily cigarette consumption
   
3. Brushing teeth after meals instead of smoking
   
4. Avoiding smoking environments
   
5. Keeping hands and mouth busy with gum or doodling
   
6. Increasing exercise and activity
   
7. Not emptying ashtrays (to remember how much and how bad smoking is)
   
8. Involving family—especially smokers—for support
   
9. Certain medications
   
10. Acupuncture
    

Vaccination

Influenza and pneumonia infections can worsen heart failure. Safe vaccines are available to protect against these diseases.