Heart failure – symptoms, diagnosis, treatment methods. Heart failure prophylaxis

Proven content

Shortness of breath, initially caused by exertion – such as climbing stairs, and later even when you are resting. Weakness. Swelling. Heart arythmia. This is how heart failure can manifest – a disease that becomes the main cause of death in Poland.

1. Heart failure is a problem that up to a million Poles struggle with
2. It is estimated that every fourth of us will die because of it
3. With proper management and rehabilitation, the disease can be stopped
4. Heart failure can be prevented
5. Systemic changes in patient care are necessary

Heart failure – morbidity

In fact, we all know that when someone experiences chest pain, we should immediately call an ambulance. It is completely different with the symptoms of heart failure, which are usually neglected to the point where they make life impossible. And we are talking about a disease that affects more and more Poles.

We have between 700 and a million patients with heart failure in Poland. We know that in the next 10 years this number will increase by a minimum of 25 percent – says Prof. Andrzej Gackowski at the Jagiellonian University, cardiologist, specialist in the treatment of heart failure.

Why are we seeing an increase in the incidence? – We live longer and longer. Thanks to interventional cardiology, patients experience heart attacks that would lead to death for another 15 years. But a heart that is damaged after such a heart attack works much less. In addition, the heart ages naturally, and therefore it functions less efficiently and cannot provide normal blood flow.

Heart failure is a serious disease that is progressive, significantly worsening the quality of life and can lead to death. It is worth emphasizing that it can be avoided and can be treated. Unfortunately, many changes in the management of patients with heart failure are necessary in Poland, and the awareness of the importance of this disease is insufficient – says Prof. Andrzej Gackowski at the Jagiellonian University.

See also: Can heart failure be prevented? Experts on heart disease

Who is at risk of heart failure?

Anyone and at any age can get sick, but the disease most often affects people over 65 years of age. The most common cause is atherosclerosis and the resulting heart attack. Less frequently, heart failure results from arterial hypertension, diseases of the heart valves (aortic valve stenosis, mitral or tricuspid valve regurgitation, or aortic valve regurgitation), myocarditis or cardiomyopathies (mainly hypertrophic cardiomyopathy). Diabetes can also be a cause of heart failure.

People who abuse alcohol are also at risk of heart failure. In addition, people taking medication and radiation therapy for mediastinal tumors are at risk of heart failure. Moreover, heart failure may also result from the development of chronic lung diseases (such as chronic obstructive pulmonary disease or asthma), cirrhosis of the liver, severe anemia, and hyperthyroidism.

Worth knowing: Diet in heart disease

Heart failure – classification

Heart failure can be very complex, so several terms are used to describe it:

1. Acute heart failure, which is a condition where symptoms of heart failure appear suddenly and increase rapidly.
2. Chronic heart failurein this case the symptoms have been present for at least a month and the condition may be stable, not corrected or worsening.
3. Congestive heart failure, i.e. a condition in which there are features of body fluid overload, which in turn causes, for example, edema of the lower limbs, shortness of breath due to lung congestion, dilation of the jugular veins or enlargement of the liver.

In turn, based on the results of the echocardiographic examination, the following are distinguished:

1. heart failure with a reduced ejection (or systolic) fraction;
2. heart failure with a moderately reduced ejection fraction;
3. heart failure with preserved ejection (or diastolic) fraction.

In addition, depending on the dominant symptoms: small (pulmonary, responsible for the right ventricle) or large (systemic, responsible for the left ventricle), the following terms are used:

1. left ventricular heart failure;
2. right ventricular heart failure;
3. biventricular heart failure.

Also read: Heart failure takes away your appetite

Heart failure – prevention

All the factors that lead to atherosclerosis automatically put us at risk of heart failure. That is why it is so it is important to take care of systematic physical activity from youth, a diet containing a lot of vegetables, fruit and fish. You should limit the amount of calories, meat and fat. It is imperative to avoid tobacco smoke, periodically measure blood pressure and if hypertension occurs – treat it immediately.

Cholesterol should be tested, especially in families with heart attacks or strokes. If we find elevated cholesterol, we should lower it to normal with diet and possibly medications.

People who develop a heart attack are at high risk – they must be particularly careful in following the above-mentioned recommendations and very intensively lowering cholesterol, controlling blood sugar and taking the prescribed medications systematically, although at first glance they do not affect everyday well-being. The idea is to slow down the development of atherosclerosis, which is asymptomatic for many years, and then suddenly attack and damage the heart again.

It should be added here that the New York Cardiac Society has developed a special scale (NYHA scale), which is used all over the world, and which is used to determine the severity of symptoms of heart failure. There are four classes of heart failure on this scale:

1. Class I – the patient can observe no limitations in physical activity, and the usual physical activity and daily activities do not cause shortness of breath, fatigue or palpitations.
2. Class II – the patient may notice slight restrictions in physical activity, and symptoms worsen with exercise, although they disappear when the patient rests.
3. Class III – the patient can notice a significant limitation of the possibilities of physical activity, which means that even a small effort (e.g. dressing, washing or preparing a meal) aggravates the symptoms of the disease, mainly dyspnoea. However, symptoms of the disease do not appear at rest.
4. Class IV – the patient may not be able to perform even the simplest activity without exacerbating the symptoms of the disease. In this case, these problems occur not only during physical activity, but also at rest, which makes the patients dependent and requires constant care and help from third parties.

It should be added that among Poles over 65, approximately 39 percent of patients with heart failure are classified as NYHA class III or IV, which in turn increases the cost of treating this disease.

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Heart failure – diagnosis

Diagnostics for heart failure include first, a thorough interviewin which the doctor informs the patient about the symptoms experienced by the patient (e.g. dyspnea, palpitations or dizziness). Initially, the doctor also conducts an ECG test with blood pressure measurements. If no abnormalities are found in the tests, it is a sign that heart failure is not the cause of the patient’s symptoms.

However, if deviations are noticed in at least one study, then diagnostics is extended to include further tests, which are the second important element in the diagnosis of heart failure. In the event of deviations, echocardiography is performed, thanks to which the volume of the heart cavities, systolic and diastolic functions of the ventricles, the thickness of the heart walls, valve function and the presence of pulmonary hypertension can be directly assessed. In addition, blood tests are frequently performed to assess the concentration of plasma natriuretic peptides. However, it should be added that the high concentration of natriuretic peptides requires verification in the aforementioned echocardiographic examination, because their increase does not necessarily mean that the patient has heart failure.

In the diagnosis of heart failure, in case of doubt, the following are also performed: coronary angiography (coronary angiography), scintigraphy, computed tomography, magnetic resonance imaging, stress test, right heart catheterization with assessment of hemodynamic parameters and myocardial biopsy.

Read more: Magnetic resonance imaging of the heart – diagnostics of heart defects and diseases

What are the symptoms of heart failure?

The most important symptom is dyspnoea, which in the initial stage of the disease may occur during exercise and disappear during rest. When the disease worsens, shortness of breath may appear at rest, especially after going to bed – it then forces the patient to get up during the night to breathe.

The second common symptom of water retention is ankle swelling that gradually progresses to the calves. Pressing down on the skin causes a dimple, which is why we call them pasty swellings.

Heart failure also causes progressive fatiguewhich in the later stages of the disease causes great difficulty in moving. Depression is often included and reduces the incentive for treatment. Patients often experience serious exacerbations of the disease, which necessitate urgent hospitalization. Advanced disease leads to loss of appetite, muscle wasting and wasting.

Read: Expert: Heart failure more dangerous than many cancers

Heart failure and lifestyle changes

Do not panic – it is a syndrome that is subject to modern treatment. However, close cooperation is required by the patient who must understand the disease. Cardiology offers drugs that significantly prolong life and improve its quality, although not all of them are reimbursed, which significantly reduces their availability. These drugs should be taken very systematically.

Cardiac procedures, such as stenting coronary arteries, are often required. by-passes, valve surgery, implantation of special pacemakers and defibrillators. Some of these procedures are available, but the financing of the latest, costly treatments is not sufficient in Poland.

All these procedures are effective as long as you continue to take medications and prevent water retention in the body. The doctor determines the optimal body weight. Its sudden increase by 2-3 kg should be quickly corrected by increasing the doses of diuretics and improving discipline in limiting fluid intake. Usually, the daily amount of fluid intake should not exceed 1,5 liters. Education and rehabilitation are important at each stage of the disease.

In addition, you should lead a hygienic lifestyle, that is, exercise regularly, eat properly (limit salt intake), avoid stress, colds and infections, and get the flu vaccine regularly. As for the limited consumption of salt, it results from the fact that it causes water retention in the body, which in turn aggravates the symptoms of the disease (edema, shortness of breath, increased heart rate). It is also important to eat 4-5 small meals a day and of course to stop smoking and limit your alcohol consumption.

Find out more: Living with heart failure. What are LVAD?

Heart failure – treatment

In the treatment of heart failure, the most important thing is to keep the patient stable so that the so-called decompensation that requires immediate admission to hospital. Unfortunately, sudden hospitalizations are a common problem in Poland. They absorb as much as 95 percent. NHF expenditure on the treatment of heart failure. After the treatment, when the patient’s condition improves, he may be discharged home.

Before this happens, however, it is advisable to carefully educate the patient and his family regarding further everyday procedures. The so-called self-control and systematic use of drugs is a prerequisite for maintaining the stabilization of the disease.

Unfortunately, up to 30 percent. patients returned to the hospital within a month in even worse condition. It must be understood that each subsequent exacerbation is associated with damage to the heart and other hypoxic organs, which in turn leads to the progression of the disease – alarms Andrzej Gackowski.

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Treatment of heart failure – causal treatment

When treating heart failure, there are several types of treatment. The first is causal treatment, consisting in the elimination of the causes of heart failure. Treatment includes, for example, surgical correction of anatomical and valvular heart defects, removal of foci causing cardiac arrhythmias, and all revascularization techniques (techniques to restore normal blood supply to the heart in the course of coronary artery disease).

It should be noted here that the lifestyle of the patient is of key importance for the positive results of heart failure treatment. It is about following the doctors’ recommendations, that is:

1. Limiting the consumption of salt (up to 2-3 g per day) and fluids (up to 1,5-2,0 l per day);
2. Regular physical activity – it aims to improve the efficiency of the respiratory muscles, reduce the feeling of shortness of breath and increase the maximum capacity to exercise (isometric exercises are not recommended);
3. Limiting alcohol consumption – up to 10–12 g daily in women and ≤20–25 g daily in men (if alcoholic cardiomyopathy is suspected as the cause of heart failure, complete abstinence is obligatory);
4. Smoking cessation;
5. Avoiding the use of certain medications, if possible – these are painkillers from the group of non-steroidal anti-inflammatory drugs (e.g. ibuprofen, ketoprofen), glucocorticosteroids, class I antiarrhythmic drugs and tricyclic antidepressants etc .;
6. Influenza (annual) and pneumococcal vaccinations;
7. Avoiding travel to areas> 1500 m above sea level or hot and humid areas, and in the case of means of transport, airplane is preferred for long journeys to avoid the consequences of long-term traffic restrictions;
8. Regular weight control – it is very important, because thanks to it you can notice the symptoms of water retention in the body, i.e. rapid weight gain by several kilograms, even overnight.

Treatment of heart failure – drug treatment

The second type of treatment is pharmacological treatmentthe aim of which is to modify the harmful neurohormonal activation of concomitant heart failure. For this purpose, many different drugs are used, the actions of which are complementary.

There are three main groups of drugs used in heart failure.

Angiotensin-converting enzyme (ACEI) inhibitors – They work by expanding blood vessels, which in turn helps the heart to pump blood better around the body. These drugs are prescribed to most people with heart failure. Occasionally, side effects such as dry cough and low blood pressure may develop, which may make you feel dizzy.

Beta-blockers – These cause the blood vessels to widen, which slows down the heart rate, which lowers the blood pressure and relieves the heart. These drugs may not be given to people with asthma or other heart problems. The undesirable symptoms resulting from their use include: fatigue, cold hands and feet, sleep disturbances, and in men also impotence.

Aldosterone antagonists (aldosterone receptor blockers) – mostly eplerenone and spironolactone. Medicines work similarly to diuretics, i.e. they affect the water and salt content in the urine. It should be noted that with their use, nausea may appear, and these drugs may also affect the work of the kidneys.

In addition, in patients with symptoms of fluid overload (peripheral edema, pulmonary congestion, increased pressure in the jugular veins), diuretics are used in combination with the above-mentioned drugs. The action of diuretics reduces swelling in the feet and ankles and prevents the accumulation of fluid in the lungs, which translates into greater activity and easier breathing of the patient. Due to the fact that these drugs remove excess fluid from the body, patients have to urinate more often (less fluid in the body takes the strain off the heart).

However, it should be noted that diuretics can worsen gout symptoms and also lower blood pressure, which can make you feel dizzy.

In the pharmacological treatment of heart failure, the following are also used:

1. Angiotensin receptor antagonists (ARBs);
2. Neprilysin inhibitors (ARNI);
3. Ivabradine and digitalis glycosides.

Treatment of heart failure – other methods

Invasive methods are also used to treat heart failure, such as:

Resynchronization therapy (CRT) – involving the implantation of electrodes into the heart, which, thanks to electrical discharges, stimulate the work of the heart chambers and improve their function, while reducing the severity of symptoms and improving the patient’s quality of life. They are implanted under the skin in the upper part of the chest.

Cardioverter-defibrillator (ICD) – this is a device designed to restore normal heart function in the event of dangerous arrhythmias, especially if there is a risk of cardiac arrest and the patient’s death. It is placed in the skin under the collarbone and monitors the patient’s heart rhythm as a whole, and when necessary, it delivers small electrical pulses to the heart.

Heart failure and heart transplant

Sometimes, in extreme cases of heart failure, the only option for the patient is heart transplantation from a donor. Usually, the transplant is used by people in good health, who have an equally good prognosis, and the chance of a long life after surgery is high (these are also people in class IV of the previously mentioned NYHA classification).

It should be added that as far as leaf transplants are concerned, more than one hundred of them are performed annually in Poland and this is due to the limited number of donors (the demand is unfortunately high). While the patient is awaiting a heart transplant, left ventricular assist devices (LVAD) are sometimes used.

Although there is a 20% risk of death in the case of heart transplant (this is due to the possibility of transplant rejection, infection or the development of heart failure), if there are no complications, the patient has a chance for a better life, and sometimes even a chance to return to exercise. profession.

Heart failure – ketogenic diet

The ketogenic diet has grown in popularity in recent years, and research suggests it has a number of potential health benefits. These include helping you lose weight, improving your heart health, and preventing seizures (in some types of epilepsy).

By severely restricting the consumption of carbohydrates such as glucose and other sugars and starches, your diet forces your body to break down fat by producing molecules called ketones that it can use as fuel. Intermittent fasting can have similar effects, although it may be difficult to do so.

New research shows that the ketogenic diet promotes the breakdown of fatty acids in the cells of the heart muscle. This process produces an alternative fuel called acetyl-CoA that the mitochondria can use as an energy source instead of pyruvate. Therefore, these studies suggest that eating a diet richer in fat and lower in carbohydrate may counteract heart failure.

Heart failure – access to medical care

Every patient with heart failure, especially those discharged from the hospital, should have quick access to a cardiologist or internist and to a primary care physician. It is necessary to gradually increase the doses of drugs optimal for a given patient. Long lines at the clinics make this much more difficult.

Heart failure – patient education

In many countries it has long been found that the education of patients and the supervision of their condition, also at home, is best dealt with by trained nurses. They cooperate with doctors, coordinating the entire treatment process – not only for heart disease, but also for other coexisting chronic diseases. In Sweden, for example, they can prescribe a prescription and modify medication doses to some extent. A qualified nurse coordinates the patient’s transition from the hospital ward to the outpatient clinic.

The implementation of this model requires a change in thinking and a change in law, as well as the education of such nurses. It’s just that there are not enough nurses in Poland. Unfortunately, the trend in training is the opposite – the nursing specialization in cardiology has recently been abolished. Nurses in Poland are in many respects underestimated, and this would be an opportunity for them to develop professionally – notes the cardiologist.

The patient must be looked after at the place of residence, he cannot constantly travel several dozen kilometers to the doctor, because it is too much effort for him. That is why it is so important to cooperate with primary care physicians, who should have quick and real support from specialists before they get worse – the cardiologist lists the next problems.

Patients often suffer from many diseases at the same time. In Poland, the role of internists, who can treat not only the heart, but also take care of the patient more comprehensively, is underestimated. We must rebuild the prestige of this specialization. The treatment process should also be attended by geriatricians who know best the specificity of treating an elderly person.

Heart failure – rehabilitation

Rehabilitation is extremely important at every stage of the treatment of heart failure. The physiotherapist must know the patient’s medical history and medications, observe how he reacts to the effort and decide how to individually select the loads to improve. If he sees disturbing symptoms, he should consult a nurse or a cardiologist. He may notice that the patient suffers from depression, common in this group, which takes away the motivation for treatment and should be treated early. Hence, the participation of psychologists in treatment is necessary.

However, in Poland, only four percent (!) Of patients with heart failure benefit from rehabilitation. – And practically everyone should, because this is the only way to regain and maintain fitness – says the cardiologist.

Heart Failure – Palliative Care

Another thing that must improve in Poland is palliative care. This statement is often misconstrued. You have to understand that for some time we are fighting for the health and life of patients, but there comes a moment when we need to ensure the comfort of dying. It is impossible to talk about heart failure if we are not talking openly about death and about palliative care. Saving a patient “at any cost” can be a torment for him. We must ensure better hospice care, patients should also be able to spend their last days at home, thanks to the help of a doctor or a nurse in the “home hospice” – says Andrzej Gackowski.

It should also be remembered that chronic heart failure is usually progressive, which means that it inevitably leads to the deterioration of myocardial function (overload of cardiomyocytes, i.e. the cells that make up the heart). It must not be forgotten that the annual mortality in the case of heart failure ranges from 10 to 15 percent, and in the case of asymptomatic left ventricular systolic dysfunction, this figure is about 5 percent.

Heart failure – social and economic costs

The total cost of heart failure in Poland is estimated at over PLN 3,9 billion and this number is growing. Heart failure in a person of working age often makes it impossible to continue working. Depending on the stage of the disease, a significant proportion of patients may return to the labor market. For this purpose, it is necessary to implement full treatment and rehabilitation and, possibly, professional retraining.

Currently, the Polish economy loses about PLN 1 billion a year due to the inactivity of patients with heart failure. Heart failure is very troublesome – it causes shortness of breath, fatigue, frequent visits to the hospital, requires constant medication, and some patients require constant social or psychological support. Proper long-term care, requiring the patient’s active participation in the treatment process, can significantly extend life and improve its quality.

Fig. The course of heart failure resembles a spiral towards disease progression.

The condition is serious but can be prevented or slowed significantly. In selected cases, it is possible to recover.

In view of the increasing number of patients, it is necessary to improve the financing and organization of care. The works of the Ministry of Health and the Polish Cardiac Society are underway to introduce a pilot program of comprehensive care for patients with heart failure (KONS).

How can I raise awareness of heart failure?

The Polish Society of Cardiology has created a special website dedicated to heart failure. You can find it at: www.slabeserce.pl. It contains all the important information about the disease for the patient and his family. What are the symptoms, what to do and how to live with the disease.

The issue of heart failure will be the main topic of the Polish National Insufficiency Conference, which will be held on June 15-16 in Krakow. It will be attended by cardiologists, doctors of other specializations, and nurses. On Sunday, June 17, at the Main Square in Krakow, there will be an educational open-air event organized in other European countries – Heart Failure Day.

All this to prepare for the epidemic of heart failure, which is already visible in our hospitals, as Andrzej Gackowski said. This disease is preventable – take care of your heart today.

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