The human heart pumps approximately 23,000 litres of blood throughout the body daily. Heart failure occurs when the heart fails to pump sufficient blood to meet the body’s needs.
This article will explore the causes, prevention, and management of heart failure.
What is heart failure?
Heart failure is a complex clinical syndrome characterized by your heart’s inability to pump blood sufficiently to meet your body’s needs.
Initially, your body compensates for the inadequate blood supply through different mechanisms, such as:
- Enlargement of the heart: your heart stretches to generate a greater force to pump blood.
- Increased heart muscle mass: your heart muscles expand to generate a stronger force of contraction.
- Narrowing of the arteries: your arteries, the blood vessels that carry blood from your heart, may narrow to increase the contracting pressure to help your failing heart maintain arterial pressure.
- Blood shunting: If heart failure is severe, the body may redirect blood from peripheral areas like the skin to vital organs like the heart, kidneys, and brain.
Because of these compensatory mechanisms, you may not have symptoms initially. However, the compensation is temporary and may not solve the underlying problem.
If the heart failure is not properly managed, the compensatory mechanisms may fail, and you may start to have symptoms like breathlessness, fatigue, persistent dry cough, and other signs of heart failure.
Signs and symptoms of heart failure
Patients with heart failure may have signs and symptoms such as:
- Shortness of breath
- Dry cough
- Cold extremities with bluish lips
- Pallor
- Tiredness
- Fatigue from minimum exertion
- Swelling of the legs and/or abdomen from fluid retention
- Poor appetite
- Nausea
Types of heart failure
Heart failure can be classified based on the location of the failure and the type of heart function that fails.
Heart failure types based on location
You could have either a right-side heart failure or a left-side heart failure.
- Right-sided heart failure affects the right side of the heart, where the right ventricle pumps blood to the lungs. When the right side fails, blood backs up into the veins, causing your legs, ankles, and abdomen to swell.
- Left-sided heart failure occurs when the left ventricle can’t efficiently pump blood to the rest of the body. Fluid builds up in the lungs, causing shortness of breath.
If the heart failure is from both the right and the left ventricles, it is called congestive heart failure.
Heart failure types based on function
Depending on which aspect of heart function that fails, you could experience either systolic heart failure or diastolic heart failure.
- Systolic heart failure happens when the heart can’t pump blood because it’s weak or enlarged.
- Diastolic heart failure happens when the heart muscle doesn’t relax because it’s stiff, which leads to inadequate filling of the heart.
Causes of Heart Failure in Africa
The causes of heart failure in Africa vary across the continent, but the common causes among the general population include:
- Hypertension
- Coronary artery disease (CAD)
- Cardiomyopathy
- Rheumatic heart disease
- Chronic lung disease
- Pericardial diseases like constrictive pericarditis, pericardial effusion
- HIV
Hypertension is the leading cause of heart failure in Nigeria.
Unlike hypertension, coronary artery disease (CAD) and its complications are less common in Africa but are gradually becoming more prevalent due to:
- Lifestyle modifications,
- Smoking
- Drinking of alcohol
- Urbanization
Other causes of heart failure include:
- Excessive salt intake
- Smoking or sniffing tobacco of any kind
- Excessive alcohol intake
- Infection
- Use of certain medications like anticancer drugs, stimulants, etc.
- Autoimmune diseases like lupus erythematosus
Risk factors
Risk factors for heart failure in sub-Saharan Africa include:
- Hypertension
- Diabetes
- Dyslipidaemia
- Kidney disease
- Smoking
- High alcohol intake
- Myocarditis
- HIV
- Pregnancy
Other risk factors include:
- Rheumatic Heart Disease
- Obesity
- Dilated cardiomyopathy
- Anaemia
Diagnosis
Your doctor will take your medical history, examine you, and ask you to do:
- A chest x-ray,
- An ECG (electrocardiogram)
- Blood test
- Echocardiogram
A heart MRI or CT scan, PET scan, or angiogram may sometimes be requested.
Treatment and Prevention of Heart Failure
The treatment of heart failure depends on the cause of your heart failure and the type and severity of your heart failure.
If the cause is hypertension, you may need to take anti-heart failure drugs plus anti-hypertensives and adjust your diet and lifestyle.
If it’s an infection, you may need antibiotics.
If the problem is with your heart valves, you may need surgery.
If these treatments don’t work, a heart transplant may be recommended for you.
Whatever the cause, heart failure management is both pharmacological and non-pharmacological.
Pharmacological management
This type of management includes drugs such as:
- Angiotensin receptor blockers (ARB)
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin receptor-neprilysin inhibitors (ARNIs)
- Diuretics
- Vasodilators
- Digitalis
- Beta-blockers
- Aldosterone blockers
- Statins
The drugs help to
- Reduce your blood pressure
- Relax your blood vessels
- Reduce the amount of fluid and sodium in your body
- Strengthen the contraction of your heart muscles
- Reduce your heart rate
- Reduce the level amount of unhealthy cholesterol in your blood
Non-pharmacological management
This type of management does not include drugs. It only requires you to:
- Reduce your salt intake
- Reduce your alcohol intake
- Quit smoking
- Exercise regularly as much as you can tolerate
- Control your blood sugar if you’re diabetic
- Reduce your body weight if you’re overweight or obese
Heart failure caused by physical damage to the heart may require surgery, such as:
- Valvular repair or replacement
- Device implantation
- Heart transplantation
Complications of Heart Failure
If your heart failure is not treated at all or is treated poorly, it may lead to life-threatening complications like congestive heart failure, which is a failure of both the right and left sides of your heart. This causes worse and more dangerous symptoms.
Other complications of heart failure include:
- Pulmonary hypertension
- Kidney or liver damage
- Cardiac arrest
- Pulmonary oedema
- Irregular heartbeat
- Stroke
What is the prognosis of heart failure?
The outlook (prognosis) for heart failure is poor. People with the disease have a life expectancy of about five years from diagnosis, so it’s necessary to seek expert care as soon as you realise that your heart may be failing.
Conclusion
Heart failure is better prevented than treated. Once it has begun, there is no permanent cure, and no treatment can reverse the damage.
If you’re at risk, like if you are hypertensive, have diabetes or any other chronic disease, adjust your diet and lifestyle as recommended, and be regular with your drugs and clinical checkups.
Having heart failure doesn’t mean the end of the world. You can still enjoy life if you follow the steps outlined in this article and your doctor’s advice.
