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EVERYTHING YOU NEED TO KNOW ABOUT HEART FAILURE



Ege University, Faculty of Pharmacy, Department of Pharmacology Selçuk Pharmaceutical Warehouse Responsible Manager

"Cannot sleep at night due to shortness of breath and cough? Have you ever thought about your heart?"

KALP YETMEZLİĞİ İLE İLGİLİ BİLMENİZ GEREKEN HER ŞEY
Title: | What is heart failure? | What is the frequency of heart failure? | What are the causes of heart failure? | Is there a gender difference in heart failure? | What are the symptoms of heart failure? | When should we suspect heart failure? | Is it possible to treat heart failure? | What is the drug treatment for heart failure? | Is there any benefit to pacemaker therapy in heart failure? | Can heart transplantation be used in the treatment of heart failure? | What are the treatments for heart failure other than medication and interventional treatments? | Is there a relationship between the COVID-19 epidemic and heart failure? | Is heart failure fatal? | Does having heart failure in the family increase the risk in children? | Can heart failure develop during pregnancy? | What is broken heart syndrome? | Can patients with heart failure work? | How should the sexual life of patients with heart failure be like? | How should exercise be in heart failure? | Should patients with heart failure get flu vaccination? | What are the conditions that worsen the picture of heart failure?

What is heart failure?

Heart failure is a health problem that refers to the heart's inability to pump enough blood to the body. Although it is generally considered to be a decrease in the contractility of the heart, sometimes heart relaxation defects can also lead to heart failure.

What is the frequency of heart failure?

Nearly three million people in Turkey have heart failure. It is thought that this figure will double within 10 years. The lifetime risk of developing heart failure after the age of 40 is 20%. Having risk factors such as hypertension increases this possibility.

What are the causes of heart failure?

Heart failure generally increases with age and is more common in the elderly population. Cardiovascular diseases are the most common cause. Untreated advanced heart valve disease can also lead to heart failure. Additionally, it may be more common in individuals with risk factors such as diabetes, high blood pressure, obesity, smoking, and family history of heart disease. Recently, viral infections have also attracted attention in the development of heart failure.

Is there a gender difference in heart failure?

In general, men seem to be more at risk. However, since women's life expectancy is longer, the likelihood of developing heart failure at older ages is higher. In total, half of the cases are women. Women are more likely to develop heart failure with relaxation failure.

What are the symptoms of heart failure?

a. Shortness of Breath (Dyspnea)
b. Fatigue and Weakness
c. Edema
d. Weight Gain or Loss
e. Muscle Weakness and Movement Restriction
f. Irregular Pulse
g. Cough
h. Stomach Complaints
i. Dizziness and Fainting

When should we suspect heart failure?

Although these symptoms are present in many diseases, cough, and shortness of breath, especially at night, should bring heart failure to mind. If cough and shortness of breath that start while lying on your back are relieved when you sit or require you to sleep with a high pillow, it may be a sign of heart failure. Edema that leaves a dough-like depression under the knee when pressed with a finger should also suggest heart failure. Sometimes it may even just be abdominal swelling.

Is it possible to treat heart failure?

Today, heart failure patients can be treated successfully. Treatment of heart failure usually includes a variety of strategies to control symptoms, halt disease progression, and improve quality of life. The main goal is to ensure that patients live both long and quality lives.

What is the drug treatment for heart failure?

a. Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors) and Angiotensin Receptor Blockers (ARBs): Dilates blood vessels, lowers blood pressure and reduces the workload of the heart.
b. Beta Blockers: Reduces the burden on the heart and regulates blood pressure by decreasing the heart rate.
c. Diuretics: Reduces edema and heart burden by removing excess fluid from the body.
d. Aldosterone Antagonists: Reduces heart load by reducing salt and water retention.
e. Digoxin Preparations (Cardiac Glycoside): It can increase the contraction power of the heart muscle.
f. In addition, SGLT2 inhibitors such as dapagliflozin and empagliflozin used in the treatment of diabetes, and a neprilysin inhibitor sacubitril, developed in recent years, have revolutionized the treatment of heart failure, and brought serious hope to drug therapy.

Is there any benefit to pacemaker therapy in heart failure?

The most common cause of death in patients with heart failure is cardiac arrest due to sudden rhythm disturbances. Pacemakers reduce this risk and extend the lifespan of patients. In addition, in selected suitable patients, 3-chamber pacemaker applications can reduce shortness of breath by increasing the contraction power of the patients.

Can heart transplantation be used in the treatment of heart failure?

Heart transplantation may be considered, especially in patients with advanced-stage and treatment-resistant heart failure. However, unfortunately, inadequacies in organ donation cause the number of patients who can undergo heart transplantation is very limited. Today, heart pumps, which are also known as artificial hearts, provide hope for patients who cannot undergo transplantation.

What are the treatments for heart failure other than medication and interventional treatments?

Lifestyle changes such as a healthy diet, weight control, regular exercise and avoiding stress can improve heart health. Limiting salt intake and fluid control are very important for the success of treatment. Risk factors such as hypertension and diabetes should be controlled. Smoking and alcohol consumption must be stopped.

Is there a relationship between the COVID-19 epidemic and heart failure?

The relationship between heart failure and COVID-19 is complex and based on several factors. Here are some key points about possible relationships between COVID-19 and heart failure:
1. Direct Effect on the Heart Muscle: COVID-19 can affect the heart muscle in some cases and cause the development of myocarditis (inflammation of the heart muscle).
2. Inflammation and Organ Failures: COVID-19 can initiate a widespread inflammatory response in the body. This inflammation can affect organ systems and disrupt the normal function of the heart.
3. Oxygen Deficiency: In severe cases of COVID-19, lung damage and lack of oxygen may occur. Insufficient oxygen can prevent the heart muscle from functioning normally and increase the risk of heart failure in the long term.
4. Vascular System Effects: COVID-19 can affect the vascular system and increase the risk of thrombosis (clot formation). This condition can affect the heart vessels, increasing the risk of heart failure.
Underlying Health Problems: COVID-19 is generally more severe in older individuals and those with underlying health problems. Chronic diseases, such as heart disease, may increase the risk of heart failure in these people.

Is heart failure fatal?

Heart failure is a chronic disease that continues throughout life. Rarely or if it develops due to a correctable cause, it may return to normal. Life expectancy is worse than many types of cancer such as prostate cancer, colon cancer, skin cancer, breast cancer, uterine cancer. The 5-year survival chance is 50%.

Does having heart failure in the family increase the risk in children?

Yes. Having heart failure in the family can increase the risk in children by up to 70%. This risk is especially higher in types of heart failure such as hypertrophic cardiomyopathy, which has a high probability of genetic transmission.

Can heart failure develop during pregnancy?

Yes, it can develop. Peripartum cardiomyopathy is the name given to cardiomyopathy that develops in the last stages of pregnancy or in the first months after birth in patients without previous heart disease or heart failure. Although the exact underlying cause is not clear, it is thought to be related to many reasons including infections, myocarditis, immunological factors, and oxidative stress caused by prolactin. Early recognition is vital for pregnant or postpartum patients. Therefore, it should be taken into consideration, especially in the last stages of pregnancy and after birth, if there are signs of heart failure.

What is broken heart syndrome?

Takotsubo cardiomyopathy is a rare type of heart failure that develops with weakening of the left ventricle. This disease, which can develop in response to excessive emotional load or stress as the major factor, is also known as "broken heart syndrome" or "stress cardiomyopathy". It was discovered in Japan in 1990. It is a benign disease and has a 95% full recovery rate. Sudden chest pain, ECG changes, and slight changes in cardiac enzymes almost mimic a heart attack, but they are completely different from each other. The exact reason is not clear.

Can patients with heart failure work?

A diagnosis of heart failure does not mean that your working life is over. In fact, working keeps people active and protects them from depression. What is important is the degree of physical activity required by the job. It can be easy to return to work in desk jobs. However, in a job that requires physical strength, it would be appropriate to switch to a job that requires less physical strength.

How should the sexual life of patients with heart failure be like?

Patients with heart failure are worried about their sexual lives. If the patient has symptoms such as shortness of breath or chest pain, he should avoid sexual intercourse. Apart from this, sex in stable situations is not harmful to heart health. However, sexual reluctance and impotence may occur due to heart failure, medications or accompanying diseases. If the patient discusses this openly with his physician, the problem can be solved with the help of healthcare professionals.

How should exercise be in heart failure?

It is not desirable for patients with heart failure to significantly restrict their daily activities and lead a sedentary lifestyle at home. Researches show that regular exercise activities performed at a mild level and as recommended by the doctor in patients with heart failure improve the quality of life and preserve the performance of the person. Daily walks at a certain pace and for a certain period of time are useful. Some practical recommendations regarding exercise in heart failure can be listed as follow:
a. Wait 1-2 hours for exercise after light meals.
b. Do not exercise outdoors in very cold or hot weather.
c. Make sure to have warm-up periods before exercise and cool-down periods afterward.
d. Never hold your breath, no matter what type of exercise you do.
e. Do exercise when you feel most energetic.

Should patients with heart failure get flu vaccination?

One of the conditions for keeping heart failure under control is to be protected from infections that may worsen heart failure. To reduce the risk of respiratory system infections, vaccines that provide immunity against pneumonia and flu can be given, especially before the winter season.

What are the conditions that worsen the picture of heart failure?

In cases where heart failure is controlled with diet and medication, various intervening conditions may cause a worsening of the patient's condition. Among the conditions that cause worsening of the patient's clinical course in cases of heart failure can be listed as follows:
-Development of new cardiovascular occlusion,
-Development of new hypertension or uncontrolled high blood pressure in hypertensive people,
-infections,
-new or progressive failure in kidney functions,
-development of anemia,
-the emergence of heart rhythm disorders,
-under or overactivity of the thyroid gland (e.g. goiter),
- discontinuation or improper use of continuously used heart failure medications,
-increasing the amount of salt taken in the diet,
-clots in the pulmonary vessels,
- progression in heart valve diseases,
-excessive alcohol intake,
-Starting to use medications that negatively affect heart performance,
- the use of medications that cause water and salt retention in the body.
If these conditions are treated or eliminated, the worsening of heart failure usually regress.

•Bahira Shahim, Chris J Kapelios, Gianluigi Savarese, Lars H Lund, Global Public Health Burden of Heart Failure: An Updated Review, Cardiac Failure Review 2023;9:e11.

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•https://www.turkiyeklinikleri.com/article/tr-takotsubo-kardiyomiyopati-90227.html

•Koçak, Ümran, T. O. K. Derya, and İ. P. E. K. Göktürk. "Peripartum Kardiyomiyopati." Abant Tıp Dergisi 2.2 (2013): 161-167.

•Roger, Véronique L. "Epidemiology of heart failure: a contemporary perspective." Circulation research 128.10 (2021): 1421-1434.

•Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023 Jan 18;118(17):3272-3287. doi: 10.1093/cvr/cvac013. Erratum in: Cardiovasc Res. 2023 Jun 13;119(6):1453. PMID: 35150240.

•www.tkd.org.tr

 

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