Heart failure is a serious health condition that affects millions of people worldwide. Cardiovascular diseases are one of the main causes of mortality in Latvia. That's why it's important to understand what heart failure is, how it develops, and what we can do to prevent it from developing or manage its symptoms.

What is heart failure?

Heart failure is a chronic condition where the heart is unable to pump blood efficiently to meet the body's needs. This can happen if the heart muscles are weak or stiff, or if there are problems with the heart's valves or electrical system. Heart failure does not mean that the heart has stopped, but rather that it is not working as well as it should.

Heart failure can affect anyone at any age, but it is more common in older people. It is a chronic disease that can progress over time if not properly treated.

Types of heart failure

Heart failure can be classified in several ways based on the part of the heart affected and the nature of the heart failure.

Left ventricular heart failure

The left ventricle is the main chamber of the heart that pumps blood throughout the body. When it doesn't work properly, you may develop:

Systolic heart failure

• Definition: the left ventricle is unable to eject blood efficiently (reduced ejection fraction).
• Impact: reduced blood flow to the organs, which causes fatigue and weakness.

Diastolic heart failure

• Definition: the left ventricle cannot fill properly with blood because the heart muscles are stiff.
• Impact: increased pressure in the heart and blood vessels, which causes fluid to accumulate in the lungs and other tissues.

Right ventricular heart failure

The right ventricle pumps blood to the lungs where it is oxygenated. Right ventricular failure is often a consequence of left heart failure.

• Impact: accumulation of fluid in the veins, causing swelling in the legs, abdomen and liver.

Chronic and acute heart failure

• Chronic heart failure: develops gradually and can be stable for a long time with appropriate treatment.
• Acute heart failure: sudden worsening of symptoms or new heart failure that requires immediate medical intervention.

Classification of heart failure by severity

The World Health Organization and the New York Heart Association (NYHA) classify heart failure into four functional classes:

• Class I: no symptoms with normal physical activity.
• Class II: minor symptoms with normal physical activity.
• Class III: pronounced symptoms during normal activity.
• Class IV: symptoms at rest, inability to perform any physical activity.

How does it affect the body?

When the heart does not perform its functions to the full extent, the body tries to compensate for this deficiency. This can take the form of:

• Rapid heartbeat: the heart beats faster to pump more blood.
• Narrowing of blood vessels: blood vessels constrict to maintain blood pressure.
• Fluid retention: the kidneys retain sodium and water, causing edema.

These compensatory mechanisms may help in the short term, but in the long term they put extra strain on the heart.

Causes of heart failure

Heart failure is often the result of other cardiovascular diseases that impair the function of the heart muscle. The main causes include:

Coronary heart disease

• Atherosclerosis: fatty deposits (plaques) build up in the coronary arteries, reducing blood flow to the heart.
• Heart attack (myocardial infarction): interruption of blood flow causes damage to the heart muscle, reducing its pumping capacity.

Hypertension (high blood pressure)

• Sustained pressure: high blood pressure forces the heart to work harder, causing the muscle to thicken and stiffen, which reduces the efficiency of the heart.

Cardiomyopathy

• Diseases of the heart muscle: can be congenital or acquired, such as dilated, hypertrophic or restrictive cardiomyopathy.
• Causes: genetics, infections, alcohol abuse, toxins.

Diseases of heart valves

• Valvular stenosis: narrowing of the valves interferes with blood flow.
• Valvular insufficiency: failure of the valves to close tightly causes blood to back up (regurgitation).

Heart rhythm disorders (arrhythmias)

• Fast heartbeat (tachycardia): reduces the pumping efficiency of the heart.
• Slow heart rate (bradycardia): an insufficient heart rate to meet the body's needs.

Congenital heart defects

• Abnormalities in the structure of the heart: can cause heart failure in childhood or later in life.

Other diseases and factors

• Diabetes: increases the risk of heart disease.
• Thyroid diseases: hyperthyroidism or hypothyroidism can affect heart function.
• Anemia: a reduced number of red blood cells increases the workload of the heart.
• Lung diseases: chronic obstructive pulmonary disease (COPD) can cause right heart failure.

Symptoms that cannot be ignored

Symptoms of heart failure can be varied and often develop gradually. It is important to recognize them at an early stage.

Shortness of breath (dyspnoea)

• With exercise: initially with intense activity, later with less exercise.
• At rest: as the disease progresses.
• At night (paroxysmal nocturnal dyspnoea): sudden shortness of breath that wakes you from sleep.

Fatigue and weakness

• Reduced Stamina: difficulty performing daily activities.
• Constant fatigue: even after resting.

Edema (fluid retention)

• Lower limbs: swelling of the ankles, legs and feet.
• Stomach: ascites can cause discomfort and loss of appetite.
• Weight gain: due to fluid accumulation.

Palpitations

• Irregular heartbeat: a feeling that the heart is "skipping" beats or beating too fast.

Coughing and wheezing

• Accumulation of fluid in the lungs: causes coughing, wheezing, especially when lying down.
• Foamy, pink-colored sputum: in severe cases, indicates pulmonary edema.

Loss of appetite and nausea

• Indigestion: due to the accumulation of fluid in the abdominal cavity.

Disorders of mental function

• Difficulty concentrating, confusion: decreased blood flow to the brain.

Frequent urination at night (nocturia)

• Changes in kidney function: heart failure can affect blood flow to the kidneys.

Diagnostics

Diagnosis of heart failure includes several steps aimed at accurately determining the presence of the disease, its causes and severity. In the diagnostic process, the doctor performs a physical examination, analyzes the patient's symptoms and uses various diagnostic procedures.

History and evaluation of symptoms

The doctor first questions the patient about his medical history, symptoms and lifestyle. Symptoms of heart failure can include shortness of breath, fatigue, swelling in the legs and ankles, and an increased heart rate. A patient's past medical history – such as heart disease, high blood pressure or diabetes – may indicate an increased risk of heart failure.

Physical examination

A doctor performs a physical exam to check for fluid buildup in the body, which is a common symptom of heart failure. He investigates:

• Swelling of the ankles and feet,
• neck vein swelling,
• Heart and lung sounds to determine if there are signs of a heart murmur or pulmonary fluid build-up.

Electrocardiogram (ECG)

An EKG is an important test that helps detect abnormalities in the heart's electrical activity, changes in heart rate, or previous heart attacks. An EKG uses electrodes to pick up the heart's electrical impulses and can indicate damage to the heart muscle or an irregular rhythm.

Echocardiography

Echocardiography is an ultrasound test that allows detailed examination of the structure and function of the heart. This test helps:

• Measure the dimensions of the heart chambers and the thickness of the walls,
• Determine the cardiac ejection fraction (cardiac efficiency), which indicates how well the heart pumps blood,
• Check the function of the heart valves.

Echocardiography is essential in the diagnosis of heart failure because it provides a detailed picture of the heart's structure and function.

Radiography (chest X-ray)

A chest X-ray may show an enlarged heart and fluid accumulation in the lungs, which is often seen in heart failure. X-rays also help rule out other causes of a lung or chest problem.

Blood tests

Blood tests help detect heart failure biomarkers, such as B-natriuretic peptide (BNP) or NT-proBNP levels, which are elevated in heart failure. Blood tests also check electrolytes, kidney and liver function, which can be affected by heart failure.

Stress tests

Cardiac catheterization

This invasive procedure is performed to obtain detailed information about the heart's blood vessels and blood pressure in the heart. During a catheterization, a thin tube is inserted through an artery to the heart, allowing the doctor to measure pressure and oxygen levels in the heart's chambers, as well as to examine narrowed blood vessels.

Magnetic resonance imaging (MRI)

MRT is performed to obtain high-resolution images of the heart and blood vessels. It helps diagnose problems with the structure of the heart, such as muscle inflammation, scar tissue, or changes in the heart's ventricles. MRT is particularly useful in complex or ambiguous cases.

Treatment options for heart failure

Lifestyle change

For patients with heart failure, lifestyle changes are an essential element of treatment:

• Improving nutrition: Low sodium in the diet helps reduce fluid retention and swelling. The diet should include more fruits, vegetables, whole grains and healthy fats (such as omega-3 fatty acids).
• Fluid control: sometimes patients need to limit their fluid intake to avoid fluid accumulation in the body.
• Regular physical activities: Moderate activity, such as walking or light exercise, improves heart health. A physical activity plan should be created together with the doctor.
• Quitting smoking and limiting alcohol: smoking and excessive alcohol consumption are harmful to heart health, so you should try to avoid them or minimize them as much as possible.
• Weight management: Maintaining a healthy weight helps ease the heart and improves the effectiveness of treatment.

Medical devices and implantable devices

In case of heart failure, various devices can be used to help improve heart function and reduce the risk of complications:

• Cardiovascular defibrillator (ICD) implantation: ICDs are implanted to prevent sudden cardiac arrest in patients at high risk of arrhythmias. It registers and corrects dangerous heart rhythm disturbances.
• Cardiac Resynchronization Therapy (CRT): CRT, or biventricular pacing, is used to improve ventricular synchrony, thereby increasing cardiac efficiency in patients with heart failure and poor cardiac ejection fraction.
• Ventricular Assist Device (VAD): This is a mechanical device that helps the heart pump blood to the rest of the body. SAD is often used as a temporary solution for patients awaiting a heart transplant.

Surgical procedures

In severe cases, when other treatment methods are not effective, surgical intervention may be necessary:

• Coronary artery bypass surgery: Patients with coronary artery disease causing heart failure may have bypass surgery to improve blood flow and heart function.
• Heart valve surgery: If heart failure is due to a damaged heart valve, the valve may need to be replaced or repaired to improve blood flow and reduce stress on the heart.
• Heart transplantation: In severe cases, when other treatments are not effective, the patient may need a heart transplant. This is a complex operation that is only performed on patients with very severe heart failure.

Rehabilitation program and patient education

Cardiac rehabilitation and education is an essential part of treatment to help patients understand how to manage their disease:

• Cardiac rehabilitation program: A structured program that includes supervised physical activity, nutritional counseling, and lifestyle education.

How to prevent heart failure?

Prevention of heart failure is mainly based on maintaining a healthy lifestyle and risk factor control measures that help keep the heart healthy and reduce the risk of heart disease. Here are the main recommendations for preventing heart failure:

Healthy diet

• Balanced diet: the diet should include plenty of vegetables, fruits, whole grains, lean proteins and healthy fats (such as omega-3 fatty acids from fish and nuts).
• Reducing sodium intake: reduce salt intake, as too much salt can raise blood pressure and promote fluid retention, which puts extra strain on the heart.
• Limiting sugar and unhealthy fats: Limit sweets, processed foods, and saturated or trans fats, which can contribute to obesity and high cholesterol.

Physical activities

Regular physical activity improves cardiovascular health, helps control weight, blood pressure and blood sugar levels. Recommended:

• At least 150 minutes a week with moderate intensity activities (eg walking, cycling).
• Adapt the physical activity plan to your capabilities and consult your doctor to choose the most suitable regimen.

Smoking cessation

Smoking is a major risk factor for heart disease, which increases the chance of developing heart failure. When quitting smoking:

• Cardiovascular damage is reduced and vascular elasticity is improved.
• After just a few months, the risk of developing heart disease is significantly reduced.

Limitation of alcohol consumption

Excessive alcohol consumption can damage the heart muscle and cause heart failure. Recommendations:

• Moderate consumption: Do not exceed one serving of alcohol per day for women and two servings for men, unless your doctor has advised you to avoid alcohol completely.

Blood pressure and cholesterol control

Diabetes control

Diabetes increases the risk of heart disease because high sugar levels damage blood vessels and raise blood pressure. Prevention includes:

• Healthy diet and activitiesto maintain normal blood sugar levels.
• Regular check-ups and, if necessary, treatment prescribed by the doctor to control the sugar level.

Weight management

Overweight and obesity make it harder for the heart to work and increase blood pressure. Maintaining a normal weight helps reduce the risk of heart disease and promotes good heart health. This includes:

• Regular physical activities,
• healthy diet,
• Checking and maintaining weight according to the recommendations of health professionals.

Stress management

Chronic stress can affect heart health and increase blood pressure. Stress management includes:

• Relaxation techniques: meditation, breathing exercises and yoga.
• Spending time on hobbies and activities that help you relax.

Regular health checks

Regular examinations allow early detection of heart failure risk factors and control of their progression:

• Blood pressure, cholesterol and sugar level check.
• Regular contact with your doctor if you develop symptoms of heart failure, such as shortness of breath, tiredness or swelling in your legs.

Life with heart failure

Life with heart failure requires daily adaptation by following various health improvement measures and carefully controlling the symptoms of the disease. Although heart failure is a chronic disease, with appropriate treatment and lifestyle adjustments, the quality of life can be significantly improved and the risk of complications can be reduced.

Lifestyle adjustments

Making life easier with heart failure often requires significant lifestyle changes:

• Dietary control: A low-salt diet is essential because salt promotes fluid retention, which can make it harder for the heart to work. It is recommended to choose a nutritious diet with vegetables, fruits, whole grains and lean proteins.
• Fluid consumption control: Depending on the severity of your symptoms, your doctor may recommend limiting your fluid intake to avoid fluid retention.
• Regular weighing is important: weight gain may indicate fluid retention, so it is recommended to monitor your body weight regularly and report unusual weight gain to your doctor.

Physical activities

Appropriate physical activity is important for improving cardiovascular health, but finding a moderate level of activity is essential. A safe exercise plan can be developed with the help of a doctor:

• Moderate intensity: Exercise such as walking, swimming or light exercise can improve stamina and well-being.
• Moments of rest: short rest periods between activities are important to keep the heart from straining.

Stress management

Chronic stress can worsen heart failure symptoms, so stress management techniques are essential:

• Relaxation techniques: Meditation, yoga, breathing exercises and relaxation music can help you relax and reduce stress levels.
• Support groups: Talking to other people living with heart failure can help you share experiences, get emotional support and feel understood.

Healthy sleep habits

Quality sleep is very important for heart health and general well-being:

• Create a regular sleep routine: go to bed and wake up at the same time so that the body gets used to the rhythm.
• Avoid caffeine and heavy food late at night, which can interfere with sleep quality.

Self-monitoring of symptoms

In order to detect a possible worsening of symptoms in time, it is important for patients with heart failure to be attentive to body signals:

• Shortness of breath and fatigue: If symptoms worsen or there is difficulty with daily activities, treatment may need to be adjusted.
• Weight changes: rapid weight gain (usually more than 2-3 kg in a week) may indicate fluid retention and should be reported to the doctor.
• Swelling of the feet or ankles: Swelling in the legs, feet or ankles can be a sign of worsening heart failure and should be monitored regularly.

Social and emotional support

Heart failure can affect emotional well-being, so it's important to get emotional support and help:

• Support group and family involvement: Sharing experiences with other patients and receiving support from family can be essential for improving emotional health.
• Consultations of a psychologist: A psychologist or psychotherapist can help you deal with the emotional difficulties and depression that can come with living with a chronic illness.

Conclusion

Heart failure is a serious and chronic disease that can significantly affect a person's quality of life. However, with early diagnosis, proper treatment, and active involvement in managing your health, it is possible to control symptoms, slow disease progression, and live a fulfilling life. It is important to work with medical professionals, follow instructions and make necessary lifestyle changes.

Additional resources

• Latvian Society of Cardiology: www.kardiologs.lv
• Latvian Heart Failure Society: Information and support for patients.