Heart Failure

Every day, 45 Spaniards die as a result of heart failure, a figure that shows that this pathology is one of the leading causes of cardiovascular mortality. In addition, the incidence of this disease has increased in recent years due to the ageing of the population and the greater prevalence of cardiovascular risk factors.

Hand in hand with the Spanish Heart Foundation, we tell you what heart failure is, its causes, symptoms, complications and possible treatment.

What is heart failure?

Heart failure occurs when there is an imbalance between the heart’s ability to pump blood and the body’s needs. It is currently the leading cause of hospitalization in people over 65 in Spain, and affects around 6.8% of the population over 45. However, we can avoid its appearance if we take measures and follow a cardio-healthy lifestyle, controlling risk factors.

What classes are there?

There are several types of heart failure:

  • Systolic: when the heart contracts inappropriately to pump the amount of blood the body needs, both at rest and during exercise.
  • Diastolic: when the heart relaxes with difficulty and the blood-filling function is poor.
  • Mixed: systolic/diastolic.

What are its causes?

There are different factors that can lead to heart failure, but the most common are:

  • Hypertension.
  • Coronary heart disease (heart attacks, angina).
  • Valvulopathies.
  • Diseases of the myocardium.
  • Infectious causes.

What symptoms do you have?

Heart failure can be a disease that has no symptoms for a long time throughout life (called the asymptomatic phase). Once they appear, the predominant symptoms are:

  • Dyspnea (respiratory fatigue during exertion or at rest).
  • Orthopnea (difficulty breathing when lying down).
  • Adinamia or generalized lack of strength.
  • Paleness of skin and mucous membranes (due to poor circulation and anaemia).
  • Edema (swelling of the feet and ankles that leave an imprint when pressed with the finger).
  • Digestive disorders (flatulence, slow digestions, congestive liver, ascites…).
  • Weight gain (from fluid retention).
  • Decrease in urine volume.
  • More visible veins, especially in the neck.

What are the most common complications?

Heart failure usually presents with decompensations that include periods of aggravation by fatigue or fluid retention, which in many cases requires a hospital stay.

In other patients, complications take the form of sudden events such as severe arrhythmias, angina or infarction, which can even lead to sudden death, i.e. the sudden and unexpected onset of cardiac arrest.

What is your diagnosis and treatment?

In order to diagnose if the patient suffers from heart failure, the specialist will carry out a detailed

medical history:

  • Cardiovascular risk factors in the patient.
  • History of ischemic heart disease.
  • Hypertension or diabetes.
  • Family history of cardiomyopathies or valvular diseases.
  • Recent infections.
  • Symptoms related to stress tolerance.
  • Swelling.
  • Heart rhythm alterations.
  • Physical examination to check blood pressure and heart rate.
  • Cardiac and pulmonary auscultation.
  • Abdominal examination.

In some cases, additional tests such as an electrocardiogram or echocardiogram, chest x-rays or a stress test may be necessary.

Once the diagnosis has been made, there are effective treatments to delay the progression of this disease and improve the patient’s quality of life. To do this, the specialist will treat the cause, monitor weight and fluid intake, recommend a low-salt diet and determine the type of medication most indicated in each case.

Some of these drugs are:

  • Diuretics: improve congestive symptoms and reduce swelling or lung congestion.
  • Vasodilators: reduce the burden with which the heart must work, increase its performance and lower blood pressure.
  • Beta-blockers: reduce pulsations and improve vital prognosis, and are essential if the function of the heart is impaired.
  • Aldosterone inhibitors: increase the volume of urine reducing dyspnea and edema and are necessary as they improve survival in patients with decreased heart function and symptoms.

In cases in which, despite treatment, the patient continues with symptoms, has certain alterations in the echocardiogram and has a decreased heart function (less than 35%), it will be necessary to implant a device (implantable automatic defibrillator, pacemaker or biventricular resynchronizer). This device, in patients with an adequate life expectancy, may improve symptoms or decrease the likelihood of sudden death.

In addition, as a last resort, if the patient does not improve with any of the above treatments, heart transplantation may be considered (depending on age and the presence of other diseases or complications).