Heart failure

In the event of a heart failure, the heart cannot pump enough blood into the body. This may be because the ability of the heart muscle to contract is weakened. The impaired pump function may also be due to the fact that the heart muscle cannot relax properly. Heart failure occurs at all ages, but is most common in the elderly.

Causes of heart failure can be, for example,  angina , myocardial infarction , high blood pressure , heart rhythm disorders,  heart valve failure  or heart muscle disease, so-called cardiomyopathy.

symptoms

Here are some common symptoms of heart failure:

  • You are tired and less able.
  • You are easily breathed.
  • You have swollen ankles and legs.
  • You have stomach ache and may be difficult to eat.
  • You have a palpitations.
  • You have trouble sleeping flat.
  • You often need to get up and pee at night.

These are some symptoms of severe heart failure, which can be life-threatening:

  • You are very tired.
  • You will get severe shortness of breath and perhaps rattling breathing.
  • You get a feeling of tightness or chest pain.
  • You become cold-sweaty and have a palpitations.

When and where should I seek care?

If you think you have heart failure or if your heart failure worsens despite treatment, contact a  health center   or emergency room . You can contact many receptions by  logging in . If closed, you can wait until the on-call reception or medical center opens.

Immediately contact a health center or a j ouröppen reception if you have symptoms of severe heart failure. If it is closed at the health center or on-call reception, seek care at an emergency room.

What can I do for myself?

Since diseases such as diabetes, angina, heart attacks and high blood pressure are common causes of heart failure, it is primarily to follow the treatment recommendations you have already received if you have these diseases.

If you already have heart failure, you can do the following to feel better despite the disease:

  • Take your medication regularly and at the right dose.
  • Go on a regular visit to a doctor and maybe also a heart failure nurse.
  • Touch yourself regularly and participate in special training or gymnastics in groups that are available in many places for people with heart problems.
  • Stop smoking.
  • Eat vegetables and fruits daily and reduce the amount of salt in the food.
  • Avoid drinking too much, both alcohol and other liquids.

Vaccination against influenza and pneumonia

If you have heart failure you can become much worse and even die from the stresses that a flu or pneumonia causes to the heart. You therefore belong to a risk group that is recommended to vaccinate annually with influenza vaccine and once basic vaccination against pneumonia.

Investigations and investigations

The ECG is usually taken on anyone who is short of breath and tired. An ECG examination that records electrical impulses from the heart muscle is of some help, since an ECG is very rarely normal in heart failure. If you have a normal ECG, it is unusual for heart failure, but cannot be ruled out solely with the ECG. Although the ECG study shows changes, they may be due to many other heart diseases than just heart failure and which should be investigated in some other way.

Blood sample of GDP – natriuretic peptide

In order for the doctor to rule out heart failure, a blood test is taken to measure the so-called natriuretic peptide, also known as GDP or NTproBNP. In the event of heart failure, the value is increased.

If you are short of breath and tired but have a value that is right, it is probably not heart failure. However, if GDP or NTproBNP is elevated, you may also undergo ultrasound examination of the heart so that the doctor can see if it is due to heart failure.

Ultrasound shows the movements of the heart

The diagnosis of heart failure cannot be made unless you have undergone an ultrasound examination of the heart, called echocardiography.

On a monitor, the investigator sees how the walls of the heart move, how the flaps look and how they work. With the help of so-called Doppler technology it is possible to simultaneously measure the rate of blood flow in and out of the different heart cavities and also to assess whether there is high pressure in the heart cavity. The study is performed by cardiac specialists or clinical physiologists at most hospitals and some specialist clinics.

An X-ray examination of the heart and lungs is not necessary to diagnose heart failure, but may be good if the doctor suspects lung disease or other causes of your breathlessness.

Work tests with ECG and blood pressure monitoring can show if you have coronary artery disease, rhythm disorders and give notice of work ability.

Occasionally, x-rays are also done

If it is found that you have heart failure, and examination results or symptoms suggest that you may have a coronary artery disease, a contrast  x-ray of the coronary artery called coronary angiography or CT angiography is sometimes made. If it is found that there are constrictions in the coronary vessels that can contribute to heart failure, a coronary artery surgery or balloon enlargement can often improve heart failure.

Treatment

Treatment of underlying disease is important. In some cases, for example, a flap operation can improve the pump’s heart function. A bypass operation or balloon enlargement that improves blood circulation in the coronary heart can improve symptoms and pump function if the heart failure is due to coronary heart disease. Heart rhythm disorders can often be alleviated and sometimes ceased completely. If the thyroid gland does not work well, you may receive treatment with medicines that improve symptoms.

Here are the goals for medication and treatment of heart failure:

  • The symptoms decrease.
  • You feel better.
  • Work ability is getting better.
  • Your need for hospital care is decreasing.

Improvement with special type of pacemaker

This treatment is called failure pacemaker, CRT or resynchronization with biventricular pacing. It is a special form of pacemaker treatment with pulse sensors in both the right and left ventricles and prevents the left and right ventricles from moving in unison. Pumping capacity is improved by coordinating the contractions in the heart’s chamber in a way that is good for circulation. 

Protection against life-threatening rhythm disturbance

If you have had, or are at high risk of, life-threatening heart rhythm disorders, you may have an inoperable defibrillator, a so-called ICD. It’s a kind of pacemaker. If the ICD detects that the heart crashes into a severe life-threatening rhythm disorder, it triggers a shock through the heart muscle so that the rhythm disorder is interrupted and the heart beats again as usual. Ask your treating physician if ICD is appropriate for you.

Individuals may need both a CRT and an ICD. Then there are devices with both functions in the same box, called CRT-D.

Heart transplant and other surgical procedures

Heart transplantation is life-saving and in many countries gives an average survival of about 15 years. The treatment is suitable if you do not have other debilitating illnesses and despite optimal medical treatment have very severe heart failure which makes daily life difficult. There is no actual age limit for heart transplant, but it is more common to have other aggravating circumstances or illnesses at a higher age.

Heart pump operated in

Mechanical circulation support, also known as MCS, is an inoperable heart pump that can be operated at home and provides the opportunity for a good daily life. About half of all patients waiting for a heart transplant are treated with mechanical circulation support to cope with the wait for a new heart. 

What is the cause of heart failure?

Heart failure is the result of having another heart disease. In the event of a heart failure, the heart is unable to pump out enough blood to the body, which causes the cells to get too little nutrition and oxygen. The body then activates a hormone system that further counteracts the work of the heart. Heart failure symptoms are due to a combination of the heart’s impaired pumping ability and an activated hormone system.

Heart failure can also be called cardiac compensation or heart failure. Depending on which half of the heart has impaired function, heart failure is usually referred to as right or left failure. If both halves have impaired function, it is called biventricular failure.

If the right side of the heart is unable to pump the blood, there is high pressure in the heart cavity and blood is collected in the stomach and legs. Swollen internal organs often cause stomach upset of varying degrees. When the left side of the heart fails, there is high pressure in the heart cavity and blood then collects in the lungs and causes breathing difficulties. In both conditions you get tired.

Different mechanisms behind heart failure

The impaired muscle function of the heart can be of two kinds and it is not uncommon for both to occur simultaneously.

The first and most common form is called systolic dysfunction, HFREF, because it is primarily the contracting, so-called systolic, pumping ability that is impaired.

The second form is called heart failure with preserved systolic function, so called diastolic dysfunction or HFPEF, occurs when the heart muscle has become less elastic and more rigid. Then the ventricle cannot expand sufficiently during the relaxation phase, called diastole. The heart causes problems with filling and it often leads to higher pressure in the heart cavity. This condition is most common if you have diabetes, hypertension or are women.

High blood pressure and heart attack are common causes

The causes of heart failure are many and sometimes more than one occur simultaneously.

Heart failure may be due to the following:

  • Myocardial infarction or angina.
  • Hypertension.
  • Cardiomyopathy, a disease that weakens the heart muscle.
  • Flap or congenital heart failure.
  • arrhythmia; too fast or too slow rhythm.
  • Abuse of alcohol or drugs.
  • Consequences of any other illness such as anemia, lung disease or diabetes.
  • Side effects of certain drugs such as cytostatic drugs and psychoactive drugs.
  • Heart muscle inflammation, myocarditis.
  • Storage disorders such as amyloidosis and sarcoidosis.
  • Pregnancy and childbirth.
  • Thyroid disease.

For a few days after an acute myocardial infarction, some patients have transient heart failure. The risk of long-term chronic heart failure increases if the heart attack was large or if you have had multiple infarctions in the past. High blood pressure rises in the length of the heart muscle which becomes thicker and stiffer.

Other causes are leakage or constriction of the heart valves. Heart failure can also be caused by rapid and irregular heartbeat, such as atrial fibrillation.

Diabetes increases the risk

If you have diabetes, the risk is higher for heart failure. Women with diabetes also have an increased risk compared to men with the same disease. The increased risk is partly due to the fact that coronary heart disease in the heart is more common in people with diabetes, but also because diabetes deteriorates the heart muscle itself.

What happens in the body?

The heart itself is a little bigger than a fist. It consists of four different cavities, where two of the cavities are called atrium and two are called chambers. The walls of the cavities consist almost exclusively of muscle tissue. There are also four flaps in the heart. They have the task of pushing the blood forward in the right direction and not letting it leak back when the heart relaxes between the beats.

The way of the blood through the heart

The blood is pumped around the body, out of the heart and back into the heart through the small circulation, the so-called pulmonary circulation, and the large circulation, the so-called systemic circulation.

When the blood returns from the large circulation to the right half of the heart, it has released oxygen and nourishment to all the cells, tissues and organs of the body.

Along the way, it has also left some slag products in the kidneys and absorbed intestinal nutrition or stored energy from the liver and fatty tissue. The bloodstream is also a kind of communication system where organs release hormones and other substances into the blood that affect the body’s functions.

When oxygen-poor blood comes from the body into the heart, it first enters the right atrium. From the atrium it flows through the tricuspid valve into the right chamber. From here, the blood is pumped out through the pulmonary valve and into the pulmonary artery to the lungs to take up oxygen.

After the blood has been oxygenated into the lungs, where it has also released carbon dioxide from the metabolism, it returns to the stronger left part of the heart, the so-called left atrium. From the atrium, blood flows through the mitral valve into the left ventricle that has strong muscle walls. The left ventricle needs to be strong as it will pump the oxygenated blood through the aortic valve into the large body pulse vein, the so-called aorta, and further out to the entire body.

In a healthy heart, both atoms work synchronously to move the blood into the chambers. A fraction of a second later, the blood is pumped on through the contraction of the chambers, partly to the lungs of the right ventricle and partly to the rest of the body from the left.

The heart muscle gets its blood supply through the coronary artery which starts from the aorta a few centimeters from the aortic valve. The blood flows through the heart muscle tissue above all while the heart relaxes between contractions.

Blood flow is regulated by the heartbeat

At rest, the heart usually beats 60 to 70 beats per minute. At maximum effort, the heart rate increases to approximately 220 beats per minute minus the person’s age. This means that in young people, the rate can increase to just over 200 beats per minute, while in a 60-year-old it can increase to around 160 per minute. With each stroke, the heart pumps out about 70 milliliters of blood, ie about five liters per minute at rest. As you exert yourself, your body needs a greater blood flow, and it is increased above all by the heart beating more beats per minute.

Living with heart failure

Over the years, medical knowledge of heart failure has increased and treatment has improved. It has reduced mortality and improved the quality of life for those with heart failure. But it is still one of the most serious heart diseases, and survival depends on the severity of the disease and that you receive the treatment you need.

Heart failure is usually divided into the following four degrees of difficulty, which are usually called NYHA classes:

  • Grade 1: Heart failure where you do not feel any symptoms yourself, but which can be detected during a heart examination.
  • Grade 2: Mild heart failure that makes you feel short of breath and tired when you make a big effort.
  • Grade 3: Moderate heart failure that makes you feel short of breath and tired, even if you only exert yourself effortlessly or moderately.
  • Grade 4: If you have severe heart failure, you become short of breath and tired already at rest or after minimal effort. Many are bedridden.

An elderly person with moderate heart failure and the right treatment can live about the same as a peer without heart failure. When the disease worsens, the symptoms can become stronger and it can be difficult to cope with even moderate physical activity.

The impaired pumping capacity can affect the possibilities of carrying out ordinary daily activities, but then you can get help with it from the municipality’s home service. If you have other diseases that strain the heart, such as influenza or pneumonia, you may need hospital care for a week to treat the infection or adjust the medication.

Influence and participate in your care

You can  seek care  at any healthcare center you want throughout the country. You also have the opportunity to have a regular doctor’s contact at the health center. 

In order for you to be able to participate in your care and make decisions, it is important that you understand the  information you receive  from the healthcare staff. Ask questions if you don’t understand.

National guidelines for care

The National Board of Health and Welfare has developed national guidelines for how heart failure and a number of other chronic diseases should be investigated and treated. The guidelines contain recommendations to health care about certain examinations and treatments that may be relevant to treating those with heart failure.

In the area there are also examinations and treatments that are done more

routinely. They are not included in the guidelines.

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