Causes of Heart Failure

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Causes of Heart Failure

Introduction of disease

Heart failure is the incapability of the heart to pump enough blood to ensure adequate blood flow throughout the body. In chronic and progressive heart failure, the blood circulates less well and tends to stagnate. Heart failure can only affect one part of the heart, namely: it is called left or right heart failure or global heart failure. Depending on the affected part, the symptoms change slightly, but the evolution of a deficiency goes in the direction of a global attack.

This pathology occurs in seniors with heart disease, for example after myocardial infarction, a pathology of the heart valve, cardiac arrhythmias, and hypertension. Some persistent respiratory diseases such as chronic obstructive pulmonary disease, chronic respiratory insufficiency, or fibrous lung diseases also cause left or right heart failure.

Etiology

The usual distinction between left and right ventricular deficiencies is misleading because the heart is an integrated pump and changes in the cavity affect the whole heart. However, these terms indicate that the primary pathological site is leading to heart failure and may be useful for initial evaluation and treatment. Other frequently used descriptive terms include acute or chronic terms; high or low flow; dilated or unexpanded; and ischemic, hypertensive, or idiopathic cardiomyopathy dilated. Treatment differs depending on whether the presentation is acute or chronic heart failure.

Pathophysiological Processes

In heart failure, the heart may not supply enough blood to the tissues for metabolic needs. Systemic pulmonary or venous pulmonary pressure following cardiac dysfunction may induce organ congestion. This disorder may be the result of abnormal systolic or diastolic function or often both. Although the primary abnormality is a change in cardiomyocyte function, changes in collagen turnover of the extracellular matrix may also be involved. Structural cardiac abnormalities such as congenital malformations, rhythm disturbances (including chronically elevated heart rates), and high metabolic stress (due to thyrotoxicosis) may also cause either right or left-side heart failure.

Left heart failure

Left heart failure is the inability of the left ventricle to provide enough blood flow to meet the body’s needs, in case of stress and rest. It is characterized by breathing difficulties accompanied by an accumulation of liquids in the lungs. Several factors may be the cause, including high blood pressure, coronary disorders (infarction, angina pectoris), and narrowing of the aortic valve.

Right heart failure

Right heart failure is defined as a weakness of the right ventricle that is struggling to pump blood and leads to fluid accumulation in the legs and ankles, swelling of the belly, heaviness, and digestive and liver problems. There are many causes: chronic lung disease, sequelae of tuberculosis, and high blood pressure.

Clinical manifestation

Shortness of breath is the first sign of heart failure: first, a difficulty breathing, linked to blood clogging in the lungs, felt like a simple respiratory discomfort, then a real breathlessness with the effort, which can get worse by showing up even at rest. Fatigue is the second sign of heart failure. She is felt even for a little effort. The swelling of certain parts of the body (liver, veins of the neck, legs) is the third alarming sign, such as a significant and rapid weight gain of the order of one kilogram per day. Other signs can alert you, such as palpitations, a drop in blood pressure, as well as digestive disorders.

Heart failure is not an old people’s disease. It can also be a disease of the child and the pregnant woman. Some specific person is more at risk than others who have coronary heart disease or cardiac arrhythmia, those born with a congenital heart defect, or who have chronic lung disease. Some other risk factors for heart failure are well identified. It is the case of high blood pressure, hyperthyroidism, smoking, but also excessive consumption of fat or salt, sedentary lifestyle, or alcohol abuse.

Complications

Complications vary according to the state of health, age, the cause of heart failure, and the severity of the disease. If left untreated, heart failure can quickly lead to complications. Fluids accumulate in the lungs and cause breathing difficulties. The risks of arrhythmia and cardiac arrest increase. Also, if a blood clot forms in the veins, it can block the pulmonary artery (pulmonary embolism), a problem that can lead to death. Finally, in the absence of treatment, heart failure can damage the liver and kidneys, vital organs.

Diagnosis

The diagnosis of heart failure is based, on the one hand, on the interrogation and collection of the various pathologies encountered by the patient during his lifetime, and on the other hand on the clinical examination to find these different symptoms. The diagnosis is confirmed by numerous examinations that are also involved in the search for the cause of the disease: the electrocardiogram, the chest X-ray, the biological examinations, but especially the Doppler ultrasound of the heart are practiced according to the cause.

Other investigations may be used to identify the cause of heart failure, including isotope imaging, magnetic resonance imaging, computed tomography, and cardiac catheterization with angiography. In rare cases, a cardiac muscle biopsy is needed, usually when doctors suspect heart infiltration or myocarditis due to bacterial, viral, or other infections.

Blood tests are sometimes necessary. Doctors can measure natriuretic peptides (PNs). PN is a substance that accumulates in the blood in case of heart failure but not when other dyspnea-causing disorders are present. Other substances in the blood can also be measured to detect conditions that may cause heart failure.

Conclusion

Heart failure is the result of cardiac lesions among which we distinguish cardiomyopathies, lung diseases, which can hinder the circulation of blood which affects the efficiency of the right heart, and finally the diseases of the valves. Ensuring the sealing and passage of blood between the atria and ventricles and between the latter and the arteries (aorta and pulmonary artery). These valves may have a narrowing restraining the passage of blood or, on the contrary, not be sufficiently tight to the right moment, causing reflux of blood in the opposite direction, forcing the heart muscle to increase the volumes it must eject to ensure its mission.

The consultation with the doctor is a valuable and indispensable source for the diagnosis, from the description of the signs felt by the patient to the palpation of the liver through the observation of the legs and veins of the neck, the listening of the heart and the taking blood pressure. Thus, all these procedures will allow the doctor to evaluate the cardiac function and thus to better appreciate the filling, the ejection, the work of the valves, and the state of the cavities.

References

• Heart failure. (2017, December 23). Retrieved February 15, 2019, from https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
• Inamdar, A. A., & Inamdar, A. C. (2016). Heart Failure: Diagnosis, Management and Utilization. Journal of clinical medicine, 5(7), 62. doi:10.3390/jcm5070062
• Cardiovascular Pharmacology: Open Access Open Access. (n.d.). Retrieved February 15, 2019, from https://www.omicsonline.org/scholarly/congestive-heart-failure-journals-articles-ppts-list.php
• Angiotensin–Neprilysin Inhibition in Acute Decompensated Heart Failure | NEJM. (2009, February 7). Retrieved February 15, 2019, from https://www.nejm.org/doi/full/10.1056/NEJMoa1812851
• N Engl J Med 2019; 380:539-548 DOI: 10.1056/NEJMoa1812851

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