Summary
Heart failure refers to a chronic and complex disease characterized by inadequate pumping of blood by the heart. It is a common condition, affecting over 20 million people globally, and it has a prevalence of 2% among adults in developed countries (Kasper et al., 2018). Women have relatively higher incidences of heart failure than men due to their higher life expectancy. Overall, this disease’s prevalence has been increasing due to the current treatment options used to manage cardiovascular disorders such as arrhythmias, myocardial infarction, and valvular heart disease. Patients with this condition can be classified into heart failure with reduced ejection fraction (EF) (HFrEF) or heart failure with preserved EF (HRpEF).
Etiology
Persons are predisposed to this disease by conditions, which alter the function or normal morphology of the left ventricles. For example, coronary artery disease accounts for 60-75% of heart failure conditions in men and women (Kasper et al., 2018). In Africa and Asia, the disease is mainly caused by rheumatic disease, especially in young adults. Hypertension also contributes to the development of the disease among Africans and African Americans.
Signs and Symptoms
The cardinal symptoms of heart failure include shortness of breath and fatigue. The patients also experience dyspnea, and in the early stages of the disease, it only occurs during exertion. As the condition progresses, dyspnea can ensue even when the patients are at rest. It is mainly caused by pulmonary congestion, and it is characterized by intra-alveolar or interstitial fluid, which initiates the juxtacapillary receptors leading to rapid and shallow breathing (Kasper et al., 2018). However, cases of dyspnea decrease in tricuspid regurgitation or right ventricular failure.
At night, the patients experience paroxysmal nocturnal dyspnea, while orthopnea occurs when they are in a recumbent position. 40% of patients with advanced heart failure experience Cheyne-Stokes respiration (Kasper et al., 2018). It is due to the amplified sensitivity of the respiratory center to the partial pressure of carbon dioxide (pCO2) and an increased circulatory period. Other symptoms include nausea, anorexia, and abdominal pains. In severe heart failure, there are disorientation, confusion, mood, and sleep disturbances.
There are signs of this disease, which are identified during a physical examination. In mild cases, the patients experience no discomfort at rest, except when they lie flat for some minutes. In severe heart failure, the patients have labored breathing, an inability to complete sentences and have to sit upright. The systolic blood pressure is also reduced due to extreme dysfunction. There are pulmonary crackles on examination of the respiratory system due to fluid transudates accumulating in the alveoli. If pulmonary edema is present, the rales can be heard over a wide field on both lungs. There is a prolonged left parasternal impulse on cardiac examination, which occurs during systole (Kasper et al., 2018). In advanced heart failure, murmurs of tricuspid and bicuspid valves regurgitation become frequent. Hepatomegaly is also present, and the enlarged liver is tender.
Treatment
Heart failure disease cannot be cured, but it can be managed. Diuretics are the mainstay in the treatment; however, they are mainly used to manage the presenting symptoms. They prevent the buildup of fluid, easing congestion in the lungs. β-blockers and angiotensin-converting enzyme inhibitors (ACEIs) are used to reduce mortalities associated with this illness. The conditions related to the illness should also be managed. Patients with mild to moderate forms of the disease should have a healthy lifestyle, including exercise programs. In end-stage disease, surgical options such as ventricular assist devices or transplantation options are available (Choi et al., 2019). However, they are contraindicated in comorbidities such as diabetes mellitus, pulmonary hypertension, or vasculopathy. As the disease progresses, its prognosis becomes poor, and hospice care is indicated for the patients.
Medical Terms
References
Choi, H. M., Park, M. S., & Youn, J. C. (2019). Update on heart failure management and future directions. The Korean Journal of Internal Medicine, 34(1), 11-43. Web.
Fremgen, B., & Frucht, S. S. (2018). Medical terminology: A living language. Pearson.
Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalzo J. (2018). Harrison’s principles of internal medicine. McGraw-Hill.