Description
Heart failure does not imply that the heart is no longer beating. Instead, it indicates that the heart performs less effectively than usual. Blood pressure in the heart rises and blood flow through the heart and body is slowed down due to a number of potential causes. As a result, the heart is unable to pump the body's requirements for oxygen and nourishment.
Résumé
- Heart failure patients can present with left-sided symptoms (restlessness, dyspnea, orthopnea) or right-sided symptoms (edema, jugular distension, abdominal distension). Specific terms like orthopnea, paroxysmal nocturnal dyspnea, and bendopnea help differentiate cardiac breathlessness from pulmonary causes. Orthopnea is caused by increased venous return when lying down, while paroxysmal nocturnal dyspnea involves fluid accumulation during sleep.
- Initial investigations for suspected heart failure include blood tests, ECG, and chest X-ray. Anti-proBNP levels are crucial for differentiating heart failure from asthma and for assessing prognosis and treatment effectiveness. ECG findings can vary, offering clues about the underlying cause of heart failure. Chest X-rays can reveal cardiomegaly, pulmonary edema, and vascular changes associated with heart failure.
- Echocardiography is a vital tool for evaluating heart function, chamber size, valve movement, and hemodynamic parameters. It distinguishes between systolic and diastolic heart failure and can identify dilated, restrictive, or constrictive cardiomyopathies. CT and MRI can provide detailed information on pericardial thickness, chamber volumes, and myocardial fibrosis. Coronary angiography can rule out ischemic heart disease as a cause of heart failure.
- Iron deficiency is common in heart failure patients due to poor nutrition, impaired absorption, and blood loss. Iron replacement therapy is an important adjunct to standard heart failure medications. Treatment for heart failure has evolved, with newer therapies like ARNI (angiotensin receptor-neprilysin inhibitor) and vericiguat improving outcomes and reducing hospital readmissions.
- Despite advances, barriers to effective heart failure management in India include limited specialized services, inadequate knowledge of guideline-directed medical therapy, insufficient patient education at discharge, and poor medication adherence. High rates of hospital readmission and mortality underscore the need to improve management strategies. Preventative measures like vaccination are vital.
- ARNI, a combination of sacubitril and valsartan, is now a class one recommendation in heart failure guidelines. It reduces sodium and water retention, decreases vasoconstriction, and inhibits fibrosis. Vericiguat, a soluble guanylate cyclase stimulator, reduces inflammation and fibrosis in both the heart and kidneys and is used to prevent recurrent heart failure.
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