Heart Failure - Causes and Symptoms

The heart is an organ composed primarily of muscle and is responsible for pumping blood to all tissues. You say it is the engine of our body.

The heart has four chambers: two ventricles, right and left atrium. The ventricles are larger and more muscular cavities; their most important task is blood pumping.

To understand what heart failure is, we must first know how the heart works. Consider a simple and quick summary. Follow the text and the picture below.

Heart
Heart


How heart works

Blood circulation
Blood circulation
The tissues receive blood from which they remove oxygen. The oxygen-poor blood goes back to the heart through the veins, reaches the right side of the heart, enters the right atrium, right ventricle and then is eventually pumped to the lungs. From the lungs the blood returns to be rich in oxygen. This blood is re-oxygenated to the left side of the heart in the atrium, falls first into the left ventricle and then it is pumped back into the tissues, restarting the cycle.

Therefore, the right part of the heart is responsible for returning blood to the lungs and the left part of it for pumping blood to the tissues.

Heart failure occurs when the heart can no longer play one or both functions efficiently. The heart failure can then affect the left or the right heart, or both. Symptoms vary according to the affected chamber of the heart. That will be explained later on.


But how does heart failure arise?


Normal heart
As has been said, the heart is mainly composed of muscles. The main cause of heart failure is cardiac ischemia or myocardial infarction. It means myocardial tissue death, in which case the heart refers to the heart muscle. Therefore, for the more extensive infarction, more muscle die, therefore, the heart gets weaker. If there is a large area of myocardial necrosis, the patient dies of cardiac pump failure.

Another common cause of heart failure is untreated hypertension. When the patient has high blood pressure, the heart needs to do more strength to overcome this resistance and distribute blood throughout the body. Like any muscle when exposed to stress, the wall of the ventricles begins to grow and get stronger. It is the case of cardiac hypertrophy. What seems a good thing actually is the early stage of heart failure. The hypertrophy of the heart that occurs in hypertension is different from what occurs in athletes who have stronger hearts.


Heart failure
Notice in the figure below that the hypertrophied by hypertension heart has thicker walls and therefore less space for the ventricle to fill with blood. Despite being more muscular, the heart is filled less and so pumps less blood with each beat (systole). This is the phase of diastolic heart failure, i.e., the heart cannot be filled during diastole period of heart relaxation that occurs between the systole (cardiac contractions).

If hypertension is left untreated, the heart continues to suffer to the point where it can no longer be hypertrophied. Imagine a rubber band that you pull all the time. One time it ends up losing its elasticity and becomes lax. It is more or less what happens to the heart. After long suffering stress the heart muscle begins to stretch and the heart is dilated.

At this time we have a muscle that has little ability to contract and a heart that can no longer pump blood properly. The body becomes too large.

It is the left ventricle that most suffers from high blood pressure. When we perform an echocardiogram the first sign of suffering heart by hypertension is left ventricular hypertrophy or diastolic heart failure. This is the stage of heart failure still curable if treated.

On radiographs below, we see a normal heart on the left and a failing heart and dilated on the right.

Another common cause of heart failure is diseases of the heart valves. When a heart valve shows any alteration, either congenital or acquired during life (endocarditis, rheumatic fever, calcification of the valves, etc.), the heart begins to have difficulty pumping blood, beginning the process of expansion similar to that of hypertension.

There are several other diseases that cause heart failure, almost all fall into one of the above examples of ischemia / injury / muscle cardiac stress. They are:

What are the symptoms of heart failure?

Symptoms of cardiac insufficiency of the camera depend most on affectedness and severity of the disease. The dysfunction of the heart is most often progressive and slow.

Left ventricular failure manifests with symptoms of low blood flow to the body. The patient feels weak and fatigue after exercising or exertion. In advanced stages of heart failure, the patient may get bored with simple tasks such as bathing and combing hair.

Pulmonary edema
Pulmonary edema
 
Another typical symptom is shortness of breath when lying down. The inability to pump blood to the tissues causes an accumulation in the lungs. It's like a traffic jam. Blood leaving the lungs cannot effectively reach the heart because it is unable to pump blood that is already inside. This slow flow leakage causes lungs disease called pulmonary congestion. In severe cases it can develop into pulmonary edema. The edema of the lungs is a medical emergency where the patient literally drowns in the water and can die if not treated in time.

When we lie, the blood in the legs is no longer suffers from the strength of gravity and comes more easily to the heart and lungs. If we have an insufficient left heart and increase the amount of blood that reaches the lungs, pulmonary congestion favors. Therefore, many patients with heart failure do not tolerate long stay in bed. Some need more sleep with a pillow to keep the trunk always higher than the rest of the body. We call this phase congestive heart failure.

When the left heart cannot efficiently pump blood to the organs, the kidneys interpret this as a drop in blood volume and body begins to retain water and salt to try to fill the arteries. The result is an excess of water in the body which leads to the onset of edema (swelling), especially in the legs.

The low output of blood to the organs can cause renal and hepatic (liver).

If there is an associated right heart failure, these edemas are even greater, because along with excess water, the right ventricle cannot bring the blood from the legs to the lungs. Then there is a large impoundment of blood in the lower limbs and large bumps. Depending on the degree of cardiac dysfunction, there may be swelling up to the belly, called ascites.

Swelling in the legs
Swelling in the legs
 
The typical picture of severe heart failure is the patient with swelling in the legs, tired even at rest, with cough and white sputum (pulmonary congestion) and impaired the decubitus position (not lying).

Dilated hearts also exhibit disturbances in electrical conduction and are more susceptible to arrhythmias. One consequence may be the sudden death from ventricular fibrillation (malignant arrhythmia).

The treatment is done with water and salt restriction, diuretics, antihypertensives and drugs that increase the strength of heart as digoxin. Obese people should lose weight, smokers quit smoking, alcohol should be avoided and supervised exercise for cardiac rehabilitation are indicated. Blood pressure should be closely controlled.

In terminal cases the only solution is heart transplantation. Therefore, the best treatment is prevention.

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User discussion

Suzette
30 March 2012
. Hello I received the results of echocardiograms. In conclusion, among other things, it is written: Regurgitation in MK (+) TC (+). What are the pros in the brackets? I won’t be able to get an appointment to the doctor soon, so I decided to appeal to the forum. Are there any doctors who can explain to me what it means?
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Frida
01 April 2012
Please answer this question. I saw the therapist a week ago about high blood pressure. After inspection, he prescribed Equator. But when I took a pill, there was redness of the skin, tachycardia, cough, insomnia occured. Tell me.. is it possible to smoothly move on to another medicine, because this is clearly not appropriate. Thanks in advance.
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Bill
08 May 2012
I am 73. The blood pressure can jump from high (up to 200 - the top) to low (up to 70 - top)during the day. What may be the cause of these jumps? Are there any medications that do not increase or decrease the pressure, but simply keep it average. Because it causes discomfort.
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