Facts about heart failure

I feel concerned this weekend to further enlighten us on the issue of heart failure. There have been unnecessary apprehensions when people have minor heart related symptoms  or worse  still, if they had heart test and there is any abnormality. The conclusion in their mind is that the heart has failed. This is not 100% the case! Agreed, heart failure is a chronic debilitating disease, affecting the quality of life and the financial status of affected persons but except in rare cases, heart will not abruptly fail, many times it fails gradually. Rate of decline in the functions of heart depends on the etiology, associated environmental factors, and the attitude of the person concerned. This then means if you have symptoms or have any abnormalities detected on the test, it only calls for caution, not death sentence. Many in the past have hastened their death due to unnecessary worry and agitations which in turn compound the heart issues.



What is heart failure?

Heart failure is a disease state where the heart can no longer pump out enough blood to meet the demand of the body. It is not synonymous with cardiac arrest which is sudden cessation of heart pump function and leads to death if not urgently resuscitated. In heart failure, pumping of blood is there but not sufficient. With heart failure you can still live a full life, only you have to be cautious and follow the advice of your doctors to modify the rate of decline in order to lengthen the survival years. Heart failure per se is not a disease but final end point for all cardiac diseases. It can affect the right or the left sides of the heart, one at a time or both sides at once leading to what is called congestive heart failure.

In normal circumstances, when heart pumps out blood (systole), the muscle relaxes for the chambers to dilate (diastole) and be filled with oxygen - rich blood from lungs. This relaxation function can be defective and lead to diastolic heart failure. It can occur in isolation or in association with pumping failure, systolic heart failure. Excessive demand far above the ability of heart, even in the absence of structural damage can cause heart failure – high output heart failure, especially in pregnancy and thyrotoxicosis. This does not mean all pregnant women develop heart failure.


Causes of heart failure

The commonest cause of heart failure in Nigeria is hypertension which is persistent raised blood pressure equal or above 140/90mmHg. The problem is that not many people know they have hypertension until when complication has occurred.  Uncontrolled high blood pressure results in damage to the heart (hypertensive heart disease) which occurs in stages, the first being thickening and enlargement of the heart, followed by inability of the heart to relax and be filled with oxygenated blood( diastolic dysfunction)  and eventual systolic failure. If at a stage a doctor says you have hypertensive heart disease, it doesn’t mean the heart has failed but if adequate treatment or precautions are not applied, the heart may then fail.

Even in hypertensive heart failure, there are stages of damage which when people concerned present in early stage; the heart can still be salvaged. Unfortunately, most people, out of ignorance, present to hospital at the last phase called end stage hypertensive heart disease. The mode of treatment at this stage is a new heart (heart transplantation). From the foregoing, heart itself does not want to fail; it gives enough room for intervention to save the failing heart. Check your blood pressure today.

Valvular heart diseases:  The commonest cause of damage to heart valves is largely preventable disease called rheumatic heart disease.  Adequate personal hygiene and prompt treatment of that sore throat can completely eradicate this disease.  Having this disease is not synonymous with heart failure, meaning with adequate treatment and prophylactics, the heart may not fail.  Simple logic here is prevention, so when next you have pain in your throat, consult your doctor for proper management. Rarely, with ageing process, the valves too can grow old and become defective- degenerative valvular diseases.

Coronary heart disease is a disease of the arteries that supply the heart with nutrients and oxygen. Being the strongest muscle in the body, heart muscle requires constant supply of blood. Acute presentation of coronary heart disease (heart attack) is the commonest cause of acute heart failure. The management at this stage will determine whether the heart reverts to its earlier functional status or progress to chronic heart failure.  Yes, this disease is now with us and the management is expensive, the best is to prevent the disease process by heart friendly lifestyles.

Cardiomyopathy: This implies problem with heart muscle which results in heart failure. Cardiomyopathy is termed to be a group of heart muscle disease with no known cause or causes. Recently with further studies, etiologies have been suggested for some of them. Genetic causes, for now, cannot be treated but other modifiable factors are controlled to prevent heart failure. Examples are dilated cardiomyopathy, hypertrophic cardiomyopathy and restrictive cardiomyopathy. Hypertrophic cardiomyopathy can cause sudden death during exercises while dilated and restrictive cardiomyopathy present in frank heart failure that can be treated to improve quality of life. If there is history of sudden death in your family, kindly visit your doctor for echocardiographic check.