Heart Failure

Heart Failure
By Victor Montour

The term “heart failure” makes it sound like the heart is no longer working at all and there’s nothing that can be done. Actually, heart failure means that the heart isn’t pumping as well as it should be. The body depends on the heart’s pumping action to deliver oxygen- and nutrient-rich blood to the body’s cells. When the cells are nourished properly, the body can function normally.

With heart failure, the weakened heart can’t supply the cells with enough blood. This results in fatigue, shortness of breath and in some people coughing. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.

What is heart failure?

Heart failure is a chronic, progressive terminal condition in which the heart muscle is unable to pump enough blood through to meet the body’s needs for blood and oxygen. Basically, the heart can’t keep up with its workload.
At first the heart tries to make up for this by:

• When your heart chamber enlarges, it stretches more and can contract more strongly, so it pumps more blood. With an enlarged heart, your body may start to retain fluid, your lungs may get congested with fluid and your heart may begin to beat irregularly.
• Developing more muscle mass. The increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly, at least initially.
• Pumping faster. This helps to increase the heart’s blood output.

The body also tries to compensate in other ways:

• The blood vessels narrow to keep blood pressure up, trying to make up for the heart’s loss of power.
• The body diverts blood away from less important tissues and organs like the skin and kidneys, and diverts to blood to the heart and brain.

It is important to know that these temporary measures mask the problem of heart failure, but they don’t solve it. Heart failure continues and worsens until these substitute processes no longer work thus making heart failure a terminal disease.

Eventually the heart and body just can’t keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a trip to the doctor.

The body’s compensation mechanisms help explain why some people may not become aware of their condition until years after their heart begins its decline.

Types of Heart Failure

Heart failure can involve the heart’s left side, right side or both sides. However, it usually affects the left side first.

Left-sided heart failure

The heart’s pumping action moves oxygen-rich blood as it travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the rest of the body. The left ventricle supplies most of the heart’s pumping power, so it’s larger than the other chambers and essential for normal function. In left-sided or left ventricular (LV) heart failure, the left side of the heart must work harder to pump the same amount of blood.

There are two types of left-sided heart failure. Drug treatments are different for the two types.

• Systolic failure: The left ventricle loses its ability to contract normally. The heart can’t pump with enough force to push enough blood into circulation.
• Diastolic failure (also called diastolic dysfunction): The left ventricle loses its ability to relax normally (because the muscle has become stiff). The heart can’t properly fill with blood during the resting period between each beat.

Right-sided heart failure

The heart’s pumping action moves “used” blood that returns to the heart through the veins through the right atrium into the right ventricle. The right ventricle then pumps the blood back out of the heart into the lungs to be replenished with oxygen. Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, ultimately damaging the heart’s right side. When the right side loses pumping power, blood backs up in the body’s veins. This usually causes swelling or congestion in the legs, ankles and swelling within the abdomen such as the GI tract and liver (causing ascites).

 

Congestive heart failure

Congestive heart failure is a type of heart failure which requires seeking timely medical attention, although sometimes the two terms are used interchangeably.

As blood flow out of the heart slows, blood returning to the heart through the veins backing up, causing congestion in the body’s tissues. Often swelling (edema) results. Most often there’s swelling in the legs and ankles, but it can happen in other parts of the body.

 

Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down. This is called pulmonary edema and if left untreated can cause respiratory distress.

Heart failure also affects the kidneys’ ability to dispose of sodium and water. This retained water also increases swelling in the body’s tissues (edema).

Doctors usually classify patients’ heart failure according to the severity of their symptoms. The table below describes the most commonly used classification system, the New York Heart Association (NYHA) Functional Classification. It places patients in one of four categories based on how much they are limited during physical activity.

 

Class	Patient Symptoms
I	No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
II	Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
III	Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
IV	Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

 

Class	Objective Assessment
A	No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity.
B	Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.
C	Objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.
D	Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest.

For Example:

• A patient with minimal or no symptoms but a large pressure gradient across the aortic valve or severe obstruction of the left main coronary artery is classified:
  • Function Capacity I, Objective Assessment D
• A patient with severe anginal syndrome but angiographically normal coronary arteries is classified:
  • Functional Capacity IV, Objective Assessment A

Advanced Heart Failure

When heart failure (HF) progresses to an advanced stage, difficult decisions must be made by yourself or your loved ones. You may need to ask yourself, Do I want to receive aggressive treatment? Is quality of life more important than living as long as possible? How do I feel about resuscitation?

What is advanced heart failure?
Of the 5.7 million Americans living with heart failure, about 10 percent have advanced heart failure. The condition is considered advanced when conventional heart therapies and symptom management strategies no longer work. You feel shortness of breath and other symptoms even at rest.

In the American Heart Association and American College of Cardiology’s A-to-D staging system, advanced heart failure is stage D. Another classification system, developed by the New York Heart Association, grades the severity of symptoms on a 1-to-4 scale. Your symptom severity number can fluctuate, even within a single day, depending on how you feel.

In its early stages, heart failure can often be managed with medication and a healthy lifestyle. As the disease progresses and the heart becomes weaker, treatment gets more complex. This is the most common time people have the difficult, yet important, conversations with your family and doctor about the care you want to receive. We encourage you to have these conversations early in your disease process. You and your family will be under a large burden of stress and information overload hearing your disease has run its course. The less you and you’re your family have to worry about at this time the better.

The Highlights to take away from this blog are;

Heart Failure is a terminal disease

Heart Failure is treatable

Treatment options will be customized to the patients needs.

Conventional heart therapies and symptom management strategies may no longer work as the disease progresses.

If treatment fails, or if treatment is not an option, supportive care is available from Front Range Hospice, your heart failure symptom management experts.

If you would like more information about Heart Failure or Front Range Hospice please call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

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