Heart failure ( HF ), often referred to as congestive heart failure ( CHF ), is when the heart can not pump enough to maintain the flow of blood to meet the needs of the body. Signs and symptoms usually include shortness of breath, excessive fatigue, and swollen feet. Breathlessness is usually worse with exercise, while lying down, and can wake people up at night. Limited ability to exercise is also a common feature. Chest pain, including angina, usually does not occur due to heart failure.
Common causes of heart failure include coronary artery disease including previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, heart valve disease, excessive alcohol use, infection, and cardiomyopathy due to unknown causes. It causes heart failure by altering the structure or function of the heart. There are two main types of heart failure: heart failure due to left ventricular dysfunction and heart failure with normal ejection fraction depending on whether the ability of the left ventricle to contract is affected, or the ability of the heart to relax. The severity of the disease is usually assessed by the extent of the problem with exercise. Heart failure is not the same as myocardial infarction (where part of the heart muscle dies) or cardiac arrest (where blood flow stops completely). Other diseases that may have symptoms similar to heart failure include obesity, kidney failure, liver problems, anemia, and thyroid disease.
This condition is diagnosed based on history of symptoms and physical examination with confirmation with echocardiography. Blood tests, electrocardiography, and chest radiography may be useful for determining underlying causes. Treatment depends on the severity and cause of the disease. In people with mild chronic stable heart failure, treatment usually consists of lifestyle modifications such as smoking cessation, physical exercise, and dietary changes, and medications. In those with heart failure due to left ventricular dysfunction, angiotensin converting enzyme inhibitors or angiotensin receptor blockers along with beta blockers are recommended. For those with severe disease, an aldosterone antagonist, or hydralazine with nitrates may be used. Diuretics are useful for preventing fluid retention. Sometimes, depending on the cause, an implanted device such as a pacemaker or implanted heart defibrillator may be recommended. In some moderate or severe cases, cardiac resynchronization (CRT) therapy or modulation of cardiac contractility may be beneficial. Ventricular aids or sometimes heart transplantation may be recommended in those with persistent severe illness despite all other measures.
Heart failure is a common, costly, and potentially fatal condition. By 2015 it affects about 40 million people worldwide. Overall about 2% of adults have heart failure and in those over 65, this increases to 6-10%. Rates are predicted to increase. In the year after diagnosis the risk of death is about 35% after which it drops to below 10% every year. This is similar to the risk with some types of cancer. In the UK the disease is the reason for 5% of emergency hospital admissions. Heart failure has been known since ancient times with Ebers papyrus that commented about 1550 BC.
Video Heart failure
Terminology
Heart failure is a physiological state in which cardiac output is insufficient to meet the needs of the body and lungs. The term "congestive heart failure" is often used, as one of the common symptoms is congestion, or fluid accumulation in a person's tissues and veins in the lungs or other parts of the body. In particular, congestion takes the form of water retention and swelling (edema), both as peripheral edema (causing swollen feet and feet) and as pulmonary edema (causing breathing difficulties), ascites (swollen abdomen). This is a common problem in old age due to cardiovascular disease, but it can occur at any age, even in the fetus.
The term "acute" is used to mean rapid onset, and "chronic" refers to long durations. Chronic heart failure is a long-term condition, usually kept stable by symptomatic treatment. Acute decompensated heart failure is a worsening of symptoms of chronic heart failure that can cause acute respiratory distress. High-output heart failure can occur when there is an increase in cardiac output. Excess circulation caused, can lead to increased left ventricular diastolic pressure which can develop into pulmonary congestion (pulmonary edema).
Heart failure is divided into two types based on ejection fraction, which is the proportion of blood pumped out of the heart during a single contraction. Ejection fraction is given as a percentage with a normal range between 50 and 75%. The two types are:
1) Heart failure due to ejection fraction reduction (HFrEF). This type is also known as heart failure due to left ventricular systolic dysfunction or systolic heart failure. This type of heart failure occurs when the ejection fraction is less than 40%.
Symptoms of heart failure are traditionally and somewhat arbitrarily divided into "left" and "right" sides, acknowledging that the left and right ventricles of the heart supply different parts of the circulation. However, heart failure is not exclusively
There are several other exceptions for the symptom of simple left-to-right heart failure. In addition, the most common cause of right-sided heart failure is left-sided heart failure. The result is that patients usually present with sets of signs and symptoms.
Left side failure
The left side of the heart is responsible for receiving oxygen-rich blood from the lungs and pumping it into the systemic circulation (the rest of the body except for pulmonary circulation). The failure of the left side of the heart causes the blood to spare (into solids) into the lungs, causing respiratory symptoms and fatigue due to inadequate oxygen blood supply. Common respiratory signs are increased respiratory rates and increased respiratory work (respiratory signs). Rales or crackles, initially heard in the lung base, and when severe, the entire lung field exhibits the development of pulmonary edema (fluid in the alveoli). Cyanosis, which shows severe low blood oxygen, is a very severe sign of late pulmonary edema.
Additional signs that indicate left ventricular failure include a shifted lateral apical pulse (which occurs when the heart is enlarged) and gallop rhythm (additional heart sound) can be heard as a marker of increased blood flow or increased intra-heart pressure. Heart murmurs may indicate the presence of valvular heart disease, either as a cause (eg aortic stenosis) or as a result (eg mitral regurgitation) of heart failure.
Backward Left ventricular failure causes clogging of the lung's blood vessels, and its symptoms are largely respiratory in nature. Backward failure can be divided into left atrial failure, left ventricle or both within the left circuit. Patients will experience dyspnea (shortness of breath) while on the move and in severe cases, dyspnea at rest. Improving shortness of breath on a flat lying, called orthopnea, occurs. It is often measured in the number of cushions needed to lie down comfortably, and in orthopnea, the patient can use sleep while sitting. Another symptom of heart failure is paroxysmal nocturnal dyspnea: a sudden onset of night from a severe shortness of breath, usually several hours after sleep. Easy fatigue and exercise intolerance are also common complaints associated with respiratory problems.
"Asthma cardiac" or wheezing can occur.
Physical examination may reveal pitting of peripheral edema, ascites, and liver enlargement. Jugular venous pressure is often assessed as a marker of fluid status, which can be emphasized by generating hepatojugular reflux. If the right ventricle pressure is increased, the parasternal heave may be present, indicating an increase in compensation in the strength of contraction.
Backward Right ventricular failure leads to systemic capillary congestion. This results in excessive accumulation of fluid in the body. This causes swelling under the skin (called peripheral edema or anasarca) and usually affects the first dependent parts of the body (causing the legs and ankles to swell in the standing person, and sacral edema in the dominant person lying down). Nocturia (frequent urination at night) can occur when fluids from the feet are returned to the bloodstream while lying down at night. In severe cases, ascites (accumulation of fluid in the abdominal cavity causes swelling) and enlargement of the liver may occur. Significant liver congestion may lead to liver dysfunction (congestive hepatopathy), and jaundice and even coagulopathy (problems of decreased or elevated blood clotting) may occur.
Biventricular failure
The sharpness of the lung fields for finger percussion and decreased breath sounds in the lung base may indicate the development of pleural effusion (fluid collection between the lungs and chest wall). Although it may occur in isolated left or right heart failure, it is more common in biventricular failure because the pleural veins flow into the systemic and pulmonary venous system. When unilateral, effusions are often true.
If a person with a single ventricular failure is living long enough, he or she will tend to experience both ventricular failure. For example, left ventricular failure allows pulmonary edema and pulmonary hypertension to occur, which increases stress in the right ventricle. Right ventricular failure does not damage the other side, but is also harmless.
Maps Heart failure
Cause
Congestive congestive heart failure
Heart failure can also occur in "high output" situations (called "high-output heart failure"), in which the amount of blood pumped is more than typical and the heart is unable to follow. This can occur in excessive situations (serum blood or infusion), kidney disease, severe chronic anemia, beri-beri (vitamin B deficiency 1 /thiamine), hyperthyroidism, cirrhosis, Paget's disease, multiple myeloma , arteriovenous fistula, or arteriovenous malformations.
Viral infections of the heart can cause inflammation of the heart muscle layer and then contribute to the development of heart failure. Heart damage can affect a person to develop heart failure later in life and has many causes including systemic viral infections (eg, HIV), chemotherapy agents such as daunorubicin, cyclophosphamide, and trastuzumab, and substance abuse such as alcohol, cocaine, and methamphetamine. Uncommon causes are exposure to certain toxins such as lead and cobalt. In addition, infiltrative disorders such as amyloidosis and connective tissue diseases such as systemic lupus erythematosus have similar consequences. Obstructive sleep apnea (a condition of sleep where respiratory disorders overlap with obesity, hypertension, and/or diabetes) is considered an independent cause of heart failure.
Acute decompensation
Stable chronic heart failure can easily decompensate. This is most often the result of concomitant disease (such as myocardial infarction (heart attack), pneumonia), abnormal heart rhythm, uncontrolled hypertension, or patient failure to maintain fluid, diet, or medication restrictions. Other factors that are also known to aggravate CHF include: anemia and hyperthyroidism that put extra strain on the heart muscle, fluid intake or excessive salt, and drugs that cause fluid retention such as NSAIDs and thiazolidinedions. NSAIDs generally increase the risk of doubling.
Drugs
The heart of a person with heart failure may have reduced contraction force due to ventricular overloading. In a healthy liver, increased ventricular filling results in increased contraction strength (by Frank-Starling's law of the heart) and thus an increase in cardiac output. In heart failure, this mechanism fails, because the ventricle is full of blood to the point where the heart muscle contraction becomes less efficient. This is due to the reduced ability to cross-link actin and myosin filaments in the overly stretched heart muscle.
Diagnosis
There is no agreed diagnostic criteria system as the gold standard for heart failure. The National Institute for Health and Nursing Excellence recommends measuring the natriuretic peptide of the brain (BNP) followed by cardiac ultrasound if positive. This is recommended for those who have shortness of breath. In those with heart failure that exacerbate both BNP and troponin is recommended to help determine the possible outcome.
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Echocardiography is usually used to support a clinical diagnosis of heart failure. This modality uses ultrasound to determine the volume of stroke (SV, the amount of blood in the heart that exits the ventricle with each beat), the final diastolic volume (EDV, total blood count at the end of diastole), and SV is proportional to EDV, the value known as ejection fraction (EF). In pediatrics, the shortening fraction is the preferred measure of systolic function. Typically, EF should be between 50% and 70%; in systolic heart failure, fell below 40%. Echocardiography can also identify valvular heart disease and assess the state of the pericardium (the connective tissue sac surrounding the heart). Echocardiography can also help in deciding what treatments will help the patient, such as medication, insertion of implanted cardioverter-defibrillator or cardiovascular rescreation therapy. Echocardiography may also help determine whether acute myocardial ischaemia is the cause of its initiator, and may manifest as a regional wall motion abnormality in echoes.
Chest X-rays
Chest x-ray is often used to help diagnose CHF. In a compensated person, this may indicate cardiomegaly (enlarged sight of the heart), calculated as the cardiothoracic ratio (the proportion of the size of the heart to the chest). In left ventricular failure, there may be evidence of vascular redistribution ("upper lobe blood flow" or "cephalization"), Kerley lines, cuffing areas around the bronchi, and interstitial edema. Lung ultrasound can also detect Kerley lines.
Electrophysiology
The electrocardiogram (EKG/EKG) can be used to identify arrhythmias, ischemic heart disease, right ventricular hypertrophy and left, and delayed conduction or abnormality (eg left bundle branch block). Although these findings are not specific for the diagnosis of heart failure, normal ECGs almost exclude left ventricular systolic dysfunction.
Blood tests
Regular blood tests include electrolytes (sodium, potassium), measures of renal function, liver function tests, thyroid function tests, complete blood counts, and often C-reactive protein if infection is suspected. Increased type B natriuretic peptide (BNP) is a specific test that indicates heart failure. In addition, BNP can be used to differentiate between the causes of dyspnea due to heart failure from other causes of dyspnea. If myocardial infarction is suspected, various cardiac markers may be used.
According to a meta-analysis comparing BNP and N-terminal pro-BNP (NTproBNP) in the diagnosis of heart failure, BNP is a better indicator for heart failure and left ventricular systolic dysfunction. In the symptomatic patient group, the diagnostic odds ratio 27 for BNP compared with 85% sensitivity and 84% specificity â € <â € Hyponatremia (low sodium levels) is common in heart failure. Vasopressin levels are usually elevated, along with renin, angiotensin II, and catecholamines to compensate for reduced circulating volume due to inadequate cardiac output. This causes increased fluid and sodium retention in the body; the level of fluid retention is higher than the rate of sodium retention in the body, this phenomenon causes "hypervolemic hyponatremia" (low sodium concentration due to high body fluid retention). This phenomenon is more common in older women with lower body mass. Severe hyponatremia can lead to fluid accumulation in the brain, causing cerebral edema and intracranial hemorrhage. Angiography
Angiography is a vascular X-ray imaging done by injecting contrast substances into the bloodstream through a thin plastic tube (catheter) placed directly in the blood vessels. An X-ray image is called an angiogram. Heart failure may be a result of coronary artery disease, and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle). Consequently, coronary catheterization may be used to identify the possibility for revascularization by percutaneous coronary intervention or bypass surgery.
Monitoring
Steps are often used to assess the progress of patients treated for heart failure. These include fluid balance (calculation of fluid intake and excretion), weight monitoring (which in short term reflects fluid shifts). Remote monitoring can be effective to reduce complications for people with heart failure.
Classification
There are many different ways to categorize heart failure, including:
- the side of the heart involved (left heart failure versus right heart failure). Right heart failure interferes with pulmonary flow to the lungs. Left heart failure disrupts the flow of the aorta to the body and brain. Mixed presentations are common; Left heart failure often causes right heart failure in the long run.
- whether this disorder is caused by insufficient contraction (systolic dysfunction), or due to insufficient cardiac relaxation (diastolic dysfunction), or both.
- whether the problem is mainly the increase in vein pressure (preload), or failure to provide adequate arterial perfusion (afterload).
- whether this disorder is caused by low cardiac output with high systemic vascular resistance or high cardiac output with low vascular resistance (low-output heart failure vs high-output heart failure).
- the degree of functional impairment given by the disorder (as reflected in the New York Heart's Physical Classification of Functions)
- the rate of concomitant disease: cardiac failure/systemic hypertension, heart failure/pulmonary hypertension, heart failure/diabetes, heart failure/kidney failure, etc.
Functional classification generally depends on the functional classification of the New York Heart Association. The classes (I-IV) are:
- Class I: no restrictions are experienced in any activity; no symptoms of ordinary activities.
- Class II: slight, light activity restrictions; patients feel comfortable at rest or with mild activity.
- Class III: a real limitation of any activity; the patient is only comfortable at rest.
- Class IV: Any physical activity causes discomfort and symptoms occur at rest.
This score documents the severity of the symptoms and can be used to assess the response to treatment. Although its use is widespread, the NYHA score can not be reproduced and can not reliably predict the walking distance or exercise tolerance on formal testing.
In the 2001 guidelines, the American College of Cardiology/American Heart Association working group introduced four stages of heart failure:
- Stage A: Patients at high risk of developing HF in the future but no functional or structural heart problems.
- Stage B: structural heart disorders but no symptoms at any stage.
- Stage C: previous or current heart failure symptoms in the context of underlying structural heart problems, but managed with medical care.
- Stage D: advanced disease requiring hospital-based support, heart transplant or palliative care.
The ACC staging system is useful in Phase A which includes "pre-heart failure" - the stage at which treatment intervention may be able to prevent the development of obvious symptoms. ACC Stage A does not have the corresponding NYHA class. The ACC B phase will correspond to NYHA Class I. ACC Stage C is in accordance with NYHA Class II and III, while ACC Stage D overlaps with NYHA Class IV.
Algorithm
There are various algorithms for the diagnosis of heart failure. For example, the algorithm used by the Heart Study Framingham adds criteria together primarily from physical examination. In contrast, the broader algorithm by the European Society of Cardiology (ESC) measures the difference between supporting parameters and the opposite of medical history, physical examination, further medical tests and response to therapy.
Framingham criteria
With the Framingham criteria, the diagnosis of congestive heart failure (heart failure with impaired pumping ability) requires a simultaneous presence of at least 2 of the following major criteria or 1 major criterion in relation to the following two minor criteria. The main criteria include an enlarged heart on chest x-ray, S3 gallop (third heart sound), acute pulmonary edema, wake-up episodes of breathing, falling out of auscultation of the lung, central venous pressure of more than 16 cm H 2 O in the right atrium, jugular venous distention, positive abdominojugular tests, and weight loss of more than 4.5 kg in 5 days in response to treatment (sometimes classified as minor criteria). Minor criteria include an abnormally fast heartbeat of more than 120 beats per minute, night cough, breathing difficulties with physical activity, pleural effusion, decreased vital capacity by one-third of the maximum recorded, enlarged liver, and bilateral ankle swelling.
Minor criteria are acceptable only if they can not be attributed to other medical conditions such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or nephrotic syndrome. The Framingham Heart Research criteria are 100% sensitive and 78% specific to identify people with definite congestive heart failure.
ESC algorithm
The ESC algorithm weighs the following parameters in establishing a diagnosis of heart failure:
Differential diagnosis
There are several terms that are closely related to heart failure and may be the cause of heart failure, but should not be confused with it. Cardiac arrest and asystole refer to a situation where there is no cardiac output at all. Without urgent care, this causes sudden death. Myocardial infarction ("Heart attack") refers to cardiac muscle damage due to insufficient blood supply, usually as a result of blocked coronary arteries. Cardiomyopathy refers specifically to problems in the heart muscle, and these problems can lead to heart failure. Ischemic cardiomyopathy implies that the cause of muscle damage is coronary artery disease. Dilated cardiomyopathy implies that muscle damage has resulted in cardiac enlargement. Hypertrophic cardiomyopathy involves enlarging and thickening heart muscle.
Prevention
The risk of developing a heart failure is inversely proportional to their level of physical activity. Those who achieve at least 500 MET-minutes/week (the minimum recommended by US guidelines) have a lower risk of heart failure than individuals who do not report exercising during their free time; lower risk of heart failure is even greater in those involved in higher levels of physical activity than recommended. Heart failure can also be prevented by lowering high blood pressure, high blood cholesterol, and controlling diabetes. Also, staying on the right weight and reducing obesity can help. Lowering salt, alcoholic beverages, stopping smoking, and lowering sugar intake all help.
Management
Treatment focuses on improving symptoms and preventing disease progression. The cause of reversible heart failure also needs to be addressed (eg infection, alcohol consumption, anemia, thyrotoxicosis, arrhythmia, hypertension). Treatments include lifestyle and pharmacological modalities, and sometimes various forms of device therapy and infrequent heart transplants.
Acute decompensation
In acute decompensated heart failure (ADHF), the immediate goal is to rebuild perfusion and adequate oxygen delivery to terminate the organs. This requires ensuring that the respiratory, respiratory, and circulatory channels are sufficient. Instant care usually involves several combinations of vasodilators such as nitroglycerin, diuretics such as furosemide, and possible noninvasive positive pressure ventilation (NIPPV).
Chronic management
The goal of treatment for people with chronic heart failure is the extension of life, the prevention of acute decompensation and the reduction of symptoms, allowing for greater activity.
Heart failure can result from a variety of conditions. In considering therapeutic options, it is important to first exclude reversible causes, including thyroid disease, anemia, chronic tachycardia, alcohol abuse, hypertension and dysfunction of one or more heart valves. The underlying cause treatment is usually the first approach to treating heart failure. However, in most cases, no major cause or treatment of primary causes did not restore normal cardiac function. In these cases, existing behavioral, medical and peripheral care strategies can provide significant improvements in outcomes, including relief of symptoms, exercise tolerance, and decreased likelihood of hospitalization or death. Shortness of breath rehabilitation for chronic obstructive pulmonary disease (COPD) and heart failure have been proposed with exercise training as a core component. Rehabilitation should also include other interventions to address shortness of breath including psychological needs and patient education and caregiver needs.
Lifestyle
Behavior modification is a major consideration in chronic heart failure management programs, with dietary guidelines on fluid and salt intake being extremely important. Fluid restriction is important to reduce fluid retention in the body and to improve the hyponatremic status of the body.
Exercises should be encouraged and adapted to suit individual abilities. The inclusion of regular physical conditioning as part of a cardiac rehabilitation program can significantly improve quality of life and reduce the risk of hospital admission because of worsening symptoms; However, there is no evidence to decrease the mortality rate due to exercise. Furthermore, it is unclear whether this evidence can be extended to people with heart failure with a preserved ejection fraction (HFpEF) or to those whose exercise regimen occurs entirely at home.
Home visits and routine monitoring at a heart failure clinic reduce the need for hospitalization and increase life expectancy.
Medication
First-line therapy for people with heart failure due to reduced systolic function should include angiotensin-converting enzyme (ACE) inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) if people develop long-term cough as a side effect of ACE-I. The use of drugs from this class is associated with increased survival and quality of life in people with heart failure.
The beta-adrenergic blocking agent (beta blocker) is also part of the first-line treatment, adding to the improvement in symptoms and deaths provided by ACE-I/ARB. The mortality benefit of beta blockers in people with systolic dysfunction who also have atrial fibrillation (AF) is more limited than in those without AF. If the ejection fraction is not reduced (HFpEF), beta blocker benefits are simpler; a decrease in mortality has been observed but a decrease in hospital admissions due to uncontrolled symptoms has not been observed.
In people who are intolerant of ACE-I and ARB or who have significant kidney dysfunction, the combined use of hydralazine and long-acting nitrate, such as isosorbide dinitrate, is an effective alternative strategy. This regimen has been shown to reduce mortality in people with moderate heart failure. This is very useful in African-American (AA). In symptomatic AAs, hydralazine and isosorbid dinitrate (HI) may be added to ACE-I or ARB.
In people with extremely reduced ejection fraction, the use of aldosterone antagonists, in addition to beta-blockers and ACE-I, can improve symptoms and reduce mortality.
Second-line drugs for CHF do not benefit death. Digoxin is one such drug. Narrow therapeutic windows, high levels of toxicity, and failure of several trials to demonstrate the benefits of death have reduced their role in clinical practice. It is now used only in a small number of people with refractory symptoms, who are in atrial fibrillation and/or who have chronic low blood pressure.
Diuretics have been the mainstay of treatment for the treatment of fluid accumulation, and include diuretic classes such as loop diuretics, diuretics such as thiazide, and potassium-sparing diuretics. Although widely used, evidence of its efficacy and safety is limited, with the exception of mineralocorticoid antagonists such as spironolactone. Mineralocorticoid antagonists in those younger than 75 years seem to reduce the risk of death. A Cochrane review recently found that in small studies, the use of diuretics appears to have increased mortality in individuals with heart failure. However, the extent to which these results can be extrapolated to the general population is unclear because of the small number of participants in the study cited.
Anemia is an independent factor in death in people with chronic heart failure. Treatment of anemia significantly improves the quality of life for those with heart failure, often with a decrease in the severity of the NYHA classification, as well as increasing mortality. The latest European guidelines (2012) recommend screening for iron deficiency anemia and treating with parenteral iron if anemia is found.
Decisions for anticoagulant people with HF, usually with left ventricular ejection fraction & lt; 35% is debatable, but generally, people with joint atrial fibrillation, previous embolism events, or conditions that increase the risk of embolism occurrence such as amyloidosis, left ventricular noncompaction, familial dilated cardiomyopathy, or thromboembolic events in first-degree relatives.
Vasopressin receptor antagonists can also be used to treat heart failure. Conivaptan is the first drug approved by the US Food and Drug Administration for the treatment of euvolemic hyponatremia in those with heart failure. In rare cases, 3% hypertonic saline along with diuretics may be used to correct hyponatremia.
Minimally invasive therapy
In people with severe cardiomyopathy (left ventricular ejection fraction below 35%), or in patients with recurrent VT or malignant arrhythmias, treatment with an automatic implantable cardioverter defibrillator (AICD) is indicated to reduce the risk of serious life-threatening arrhythmias. AICD does not improve symptoms or reduce the incidence of malignant arrhythmias but reduces mortality from the arrhythmia, often simultaneously with antiarrhythmic drugs. In people with left ventricular ejection (LVEF) below 35%, the incidence of ventricular tachycardia (VT) or sudden cardiac death is high enough to ensure AICD placement. Therefore, its use is recommended in the AHA/ACC guidelines.
The heart of contractile modulation (CCM) is a treatment for people with severe left ventricular systolic heart failure (NYHA class II-IV) which improves both the strength of ventricular contraction and the heart's pumping capacity. The CCM mechanism is based on cardiac muscle stimulation by non-excited electrical signals (NES), which are delivered by devices such as pacemakers. CCM is particularly suitable for the treatment of heart failure with a normal duration of complex QRS (120 ms or less) and has been shown to improve symptoms, quality of life and exercise tolerance. CCM is approved for use in Europe, but not currently in North America.
About one-third of people with LVEF below 35% had significantly changed conduction to the ventricle, resulting in synchronized depolarization in the right and left ventricle. This is particularly problematic in people with left bundle branch block (blockage of one of the two main fiber bonds originating from the base of the heart and carrying depolarizing impulses into the left ventricle). Using a special pacing algorithm, biventricular heart resynchronization (CRT) therapy can initiate a normal sequence of ventricular depolarization. In people with LVEF below 35% and long duration of QRS on ECG (LBBB or QRS 150 ms or more) there is improvement in symptoms and death when CRT is added to standard medical therapy. However, in two-thirds of people without the duration of the old QRS, CRTs can actually be harmful.
Surgical therapy
People with the most severe heart failure are probably candidates for ventricular aids (VAD). VAD is commonly used as a bridge for heart transplantation, but has been used more recently as a treatment goal for advanced heart failure.
In some cases, a heart transplant may be considered. While this may solve problems associated with heart failure, the person should remain on an immunosuppressive regimen to prevent rejection, which has its own disadvantages. The main limitation of this treatment option is the scarcity of liver available for transplantation.
Palliative care
People with CHF often have significant symptoms, such as shortness of breath and chest pain. Palliative care should begin at the beginning of the HF path, and should not be the last resort. Palliative care not only can provide symptom management, but also helps with advanced treatment planning, treatment goals in cases of significant reduction, and ensures the patient has a lawyer's medical strength and discusses his wish with this individual. A review of 2016 and 2017 found that palliative care was associated with better outcomes, such as quality of life, the burden of symptoms, and careful satisfaction.
Without transplantation, heart failure may not reverse and heart function usually worsens over time. More patients with Stage IV heart failure (symptoms of unbearable fatigue, shortness of breath or chest pain at rest despite optimal medical therapy) should be considered for palliative care or home care, according to the American College of Cardiology/American Heart Association guidelines.
Prognosis
The prognosis in heart failure can be assessed in various ways including clinical prediction rules and cardiopulmonary exercise tests. Clinical prediction rules use a combination of clinical factors such as laboratory tests and blood pressure to estimate prognosis. Among several clinical prediction rules for prognosticating acute heart failure, the 'EFFECT rule' slightly outperforms other rules in patient stratification and identifies those at low risk of death during hospitalization or within 30 days. An easy method for identifying low-risk patients is:
- SECURITY The rule of the tree shows that patients with blood urea nitrogen & lt; 43 mg/dl and systolic blood pressure of at least 115 mm Hg has less than 10% chance of death or complication of inpatients.
- The BWH rule shows that patients with systolic blood pressure greater than 90 mmHg, respiratory rate of 30 or fewer breaths per minute, serum sodium greater than 135 mmol/L, no changes in new ST-T waves having less than 10 % of hospitalized patients of death or complications.
A very important method for assessing prognosis in patients with advanced heart failure is a cardiopulmonary exercise test (CPX test). CPX testing is usually required before heart transplantation as an indicator of prognosis. Cardiopulmonary exercise tests involve measurements of exhaled oxygen and carbon dioxide during exercise. Peak oxygen consumption (VO2 max) is used as an indicator of prognosis. As a general rule, max VO2 less than 12-14 cc/kg/min indicates poor survival and suggests that the patient may be a candidate for heart transplantation. Patients with VO2 max & lt; 10 cc/kg/min had a significantly worse prognosis. The latest International Society for Heart and Lung Transplantation (ISHLT) guidelines also suggest two other parameters that can be used to evaluate the prognosis of advanced heart failure, survival rate of heart failure and the use of slope criteria VE/VCO2 & gt; 35 from the CPX test. The survival score of heart failure was a computed score using a combination of clinical predictors and maximal VO2 of cardiopulmonary exercise tests.
Heart failure is associated with significantly reduced physical and mental health, resulting in a marked decline in the quality of life. With the exception of heart failure caused by reversible conditions, the condition usually worsens over time. Although some people survive for years, progressive disease is associated with an annual mortality rate of 10%.
About 18 out of every 1,000 people will have an ischemic stroke during the first year after HF diagnosis. As the duration of follow-up increases, the rate of stroke increases to nearly 50 times per 1000 HF cases over 5 years.
Epidemiology
By 2015 heart failure affects around 40 million people globally. Overall about 2% of adults have heart failure and in those over 65, this increases to 6-10%. Above 75 years, the rate is more than 10%.
Rates are predicted to increase. The increase in rates is largely due to increased life span, but also due to increased risk factors (hypertension, diabetes, dyslipidemia, and obesity) and improved survival rates of other types of cardiovascular disease (myocardial infarction, valvular disease, and arrhythmia). Heart failure is a major cause of hospitalization in people older than 65 years.
United States
In the UK having a moderate improvement in prevention, the rate of heart failure has increased due to population growth and aging. The overall rate of heart failure is similar to the four most common causes of cancer (breast, lung, prostate, and colon) combined. People from a deprived background are more likely to be diagnosed with heart failure and at a younger age.
Developing the world
In tropical countries, the most common cause of heart failure is heart valve disease or some type of cardiomyopathy. Because underdeveloped countries have become more prosperous, there is also an increased incidence of diabetes, hypertension and obesity, which in turn increases the incidence of heart failure.
Sex
Males have a higher incidence of heart failure, but overall prevalence rates are similar in both sexes as women survive longer after the onset of heart failure. Women tend to be older when diagnosed with heart failure (after menopause), they are more likely than men to have diastolic dysfunction, and seem to experience a lower overall quality of life than men after diagnosis.
Ethnicity
Heart failure occurs at the same rate in Asians as other ethnic groups.
Economy
In 2011, non-hypertensive congestive heart failure was one of the ten most expensive conditions seen during hospitalization in the US, with aggregate hospital admissions costing more than $ 10.5 billion.
Heart failure is associated with high health expenditures, in large part due to hospitalization costs; costs have been estimated at 2% of the total National Health Service budget in the UK, and more than $ 35 billion in the United States.
Direction of research
A Cochrane review of 2016 found tentative evidence of longer life expectancy and an increase in left ventricular ejection fraction in people treated with stem cells derived from bone marrow.
References
External links
- Heart failure, American Heart Association - information and resources to treat and live with heart failure
- Heart Failure Failure - patient information website of the Heart Failure Association of the European Cardiology Society
- Heart failure in children by Great Ormond Street Hospital, London, United Kingdom
Source of the article : Wikipedia
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