Heart Failure: Symptoms, Causes and Treatment

Heart failure is a condition in which the heart cannot pump enough blood to meet the body's needs. It affects millions of people worldwide and is one of the leading causes of hospitalization in adults over 65. Although the term may sound alarming, with early diagnosis and proper treatment, many patients are able to lead active and fulfilling lives.

What is heart failure

Contrary to what the name suggests, heart failure does not mean the heart has stopped working. It means the heart muscle has weakened or stiffened, reducing its ability to pump oxygenated blood to the rest of the body. As a result, organs and tissues do not receive the oxygen and nutrients they need, and fluids can accumulate in the lungs, legs, and abdomen.

Types of heart failure

There are two main types of heart failure, each with distinct mechanisms and therapeutic approaches:

• ●Systolic heart failure (reduced ejection fraction, HFrEF): The heart muscle weakens and does not contract with enough force. The ejection fraction is below 40%. This is the most common type and responds better to available medications.
• ●Diastolic heart failure (preserved ejection fraction, HFpEF): The heart muscle becomes stiff and does not relax properly to fill with blood. The ejection fraction is normal or near-normal (above 50%), but the heart does not fill correctly.

Symptoms of heart failure

Symptoms may develop gradually or appear suddenly. It is important to recognize them and seek timely medical attention:

• ●Shortness of breath (dyspnea), especially when lying down or during physical exertion
• ●Persistent fatigue and weakness that limit daily activities
• ●Swelling (edema) in the legs, ankles, feet, or abdomen
• ●Persistent cough or wheezing, particularly at night
• ●Rapid weight gain from fluid retention (more than 1 kg in a single day)
• ●Need to sleep with several pillows or sitting upright (orthopnea)
• ●Waking at night with shortness of breath (paroxysmal nocturnal dyspnea)
• ●Palpitations or irregular heartbeat
• ●Loss of appetite or nausea
• ●Difficulty concentrating or confusion

Stages of heart failure

The New York Heart Association (NYHA) functional classification divides heart failure into four stages based on physical activity limitation:

• ●Class I: No limitation. Ordinary physical activity does not cause symptoms.
• ●Class II: Mild limitation. Comfortable at rest, but ordinary activity causes fatigue, palpitations, or dyspnea.
• ●Class III: Marked limitation. Comfortable at rest, but less-than-ordinary activities cause symptoms.
• ●Class IV: Unable to perform any activity without discomfort. Symptoms at rest.

Main causes

Multiple conditions can damage or weaken the heart and lead to heart failure:

• ●Coronary artery disease and heart attack (most common cause)
• ●Uncontrolled high blood pressure over many years
• ●Valvular heart disease (mitral or aortic stenosis or regurgitation)
• ●Cardiomyopathy (dilated, hypertrophic, or restrictive)
• ●Chronic arrhythmias such as atrial fibrillation
• ●Diabetes mellitus
• ●Untreated thyroid disease
• ●Excessive alcohol consumption or drug use
• ●Viral heart infections (myocarditis)
• ●Congenital heart defects

Diagnosis: how it is detected

Diagnosing heart failure requires a comprehensive cardiac evaluation that includes:

• ●Detailed medical history and cardiovascular physical examination
• ●Echocardiogram: the fundamental study that shows heart structure, pumping function, valve status, and ejection fraction
• ●Electrocardiogram (ECG): detects arrhythmias, prior heart attacks, and cardiac hypertrophy
• ●Blood tests including brain natriuretic peptide (BNP or NT-proBNP): a specific marker for heart failure
• ●Chest X-ray: shows heart size and pulmonary congestion
• ●Additional studies as needed: cardiac MRI, catheterization, stress testing

Treatment of heart failure

Modern heart failure treatment has advanced significantly and can improve symptoms, quality of life, and survival. It includes several pillars:

Medications

• ●ACE inhibitors or angiotensin receptor blockers (ACEi/ARB): reduce the heart's workload
• ●Beta-blockers: lower heart rate and protect the heart muscle
• ●Aldosterone antagonists (spironolactone, eplerenone): reduce fluid retention and improve survival
• ●SGLT2 inhibitors (dapagliflozin, empagliflozin): proven cardiovascular benefit even without diabetes
• ●Diuretics: remove excess fluid and relieve congestion
• ●Sacubitril/valsartan (ARNI): advanced therapy that has shown superiority over ACE inhibitors in clinical trials

Lifestyle modifications

• ●Restrict sodium intake to less than 2 grams daily
• ●Strict body weight monitoring (weigh yourself daily)
• ●Limit fluid intake as directed by your physician
• ●Supervised and progressive physical activity (cardiac rehabilitation)
• ●Quit smoking completely
• ●Eliminate or minimize alcohol consumption
• ●Vaccinations against influenza and pneumococcus
• ●Stress management and psychological support

Prognosis and quality of life

The prognosis for heart failure has improved markedly in recent decades thanks to treatment advances. Many patients with optimized treatment are able to stabilize their condition, improve their symptoms, and maintain a good quality of life for years. Regular follow-up with a cardiologist is essential to adjust treatment and prevent decompensations.

When to seek emergency care

Go to the emergency room immediately or call 911 if you experience:

• ●Severe shortness of breath that does not improve with rest
• ●Intense or prolonged chest pain
• ●Fainting or loss of consciousness
• ●Sudden weight gain of more than 2 kg in 2-3 days
• ●Cough with pink or frothy sputum
• ●Rapid, irregular palpitations with dizziness

At ElderCardio, Dr. Elders Jimenez Iglesias performs comprehensive evaluations to diagnose and treat heart failure using the most up-to-date protocols. If you are experiencing symptoms such as shortness of breath, leg swelling, or persistent fatigue, do not wait for them to worsen. Schedule your appointment at Hospital Galenia, Office 403-A, Tower B, and receive a personalized treatment plan to protect your heart.

Dr. Elders Jimenez Iglesias

Cardiologist · Nuclear Cardiology

Professional License: 13819257 · Specialty: 12543211