Heart Failure: Symptoms, Causes & Treatment

Heart failure is a chronic disease in which the heart muscle cannot pump enough blood to meet the body's oxygen and nutrient needs. This leads to fluid accumulation in the lungs, extremities, and liver, causing shortness of breath, fatigue, and leg swelling. The condition can affect the left ventricle (systolic), right ventricle (diastolic), or both.

Heart failure is one of the most prevalent cardiac conditions worldwide, affecting millions of people. In the Middle East and Jordan specifically, prevalence rates are rising due to increased rates of hypertension, diabetes, and obesity. The disease can be acute (sudden onset) or chronic (gradual progression), with severity ranging from mild to life-threatening.

Despite being chronic, early diagnosis and proper treatment can significantly improve quality of life and reduce complications. Treatment depends on the underlying cause and severity, and may include medications, advanced medical devices, or in severe cases, heart transplantation.

Heart failure symptoms vary based on disease severity and which part of the heart is affected. Symptoms may develop gradually over weeks or months, or appear suddenly in acute cases. Often, symptoms worsen with physical exertion or stress and improve with rest. Early symptom detection is crucial to prevent serious complications.

• Shortness of Breath (Dyspnea): May occur during exertion or at rest, and worsens when lying down.
• Fatigue and Severe Weakness: Persistent tiredness even without effort.
• Swelling of Limbs and Ankles (Edema): Fluid accumulation causes leg and foot swelling, especially at day's end.
• Persistent Cough: Especially at night or when lying down.
• Rapid or Irregular Heartbeat: May feel palpitations or fast pulse.
• Chest Pain: Especially if caused by heart attack or coronary artery disease.
• Dizziness and Vertigo: Due to reduced blood and oxygen flow to the brain.
• Loss of Appetite and Nausea: May be accompanied by abdominal bloating.
• Inability to Perform Usual Physical Activity: Reduced exercise tolerance.
• Fainting (in severe cases): Due to sharp drop in blood flow.
• Irritability and Anxiety: May accompany depression from lifestyle impact.
• Weak or Rapid Pulse: Doctor may detect on examination or patient may notice.

• Hypertension (High Blood Pressure): Prolonged high pressure forces the heart to work harder, leading to enlarged and weakened heart muscle over time.
• Coronary Artery Disease: Narrowed coronary arteries reduce blood and oxygen flow to the heart muscle, causing weakness or death (heart attack).
• Previous Heart Attack (Myocardial Infarction): Heart attack destroys part of the heart muscle, reducing its pumping capacity.
• Congenital Heart Defects: Structural abnormalities present from birth may weaken the heart.
• Atrial Fibrillation: Irregular, rapid heartbeat prevents efficient pumping of blood.
• Cardiomyopathy (Heart Muscle Disease): Direct weakening of the heart muscle, which may be inherited or acquired.
• Heart Valve Disease: Improper opening or closing of valves impairs blood-pumping efficiency.
• Viral or Bacterial Infections: Some infections can directly weaken the heart muscle.

• Advanced Age: Risk increases significantly after age 65.
• Male Gender: Men have higher risk than women before menopause.
• Diabetes: People with Type 1 or Type 2 diabetes face significantly higher risk.
• Obesity: Excess weight raises blood pressure and stress on the heart.
• Smoking: Damages blood vessels and the heart, raising blood pressure.
• Excessive Alcohol Consumption: Directly weakens the heart muscle.
• Certain Medications: Such as chemotherapy drugs or illegal drugs.
• Chronic Kidney Disease: Associated with heart weakness and fluid accumulation.
• Severe or Chronic Anemia: Forces the heart to work harder to pump oxygen.
• Family History: Genetic predisposition to heart failure increases risk.

Diagnosing heart failure requires a combination of clinical examination, blood tests, and imaging. No single test is sufficient; diagnosis relies on multiple indicators. Early diagnosis is critical to begin timely treatment and prevent disease progression.

• Physical Examination: Doctor asks about symptoms and medical history, listens to heart and lungs with stethoscope, and checks for limb swelling.
• Electrocardiogram (ECG/EKG): Simple device recording heart's electrical activity, detecting irregularities and previous heart attacks. Results read within minutes.
• Echocardiogram (Heart Ultrasound): Primary test showing heart shape, size, and function. Measures ejection fraction (EF); normal is ≥50%, low values indicate failure.
• Stress Test: Used when needed to assess heart response to physical exertion.
• Cardiac Catheterization: Invasive procedure where doctor inserts thin tube through arteries to measure heart pressure and assess coronary arteries.
• CT or MRI Scans: Advanced imaging for detailed heart structure and tissue information when needed.
• Blood Tests: Measure hemoglobin (normal: 12-17 g/dL in men, 12-15 g/dL in women), creatinine (0.7-1.3 mg/dL), potassium (3.5-5 mmol/L), and BNP (elevated in heart failure; normal <100 pg/mL).
• Blood Urea Nitrogen (BUN) and Sodium Tests: Assess kidney function and electrolyte balance.

Medications

• ACE Inhibitors: Such as lisinopril and enalapril lower blood pressure and reduce heart stress. Used in most cases.
• Angiotensin Receptor Blockers (ARBs): Such as losartan work similarly and used when patient doesn't tolerate ACE inhibitors.
• Beta Blockers: Such as metoprolol and carvedilol reduce heart rate and pressure, decreasing heart workload.
• Diuretics: Such as furosemide and bumetanide remove excess fluid via urine, relieving swelling and shortness of breath.
• SGLT2 Inhibitors: Such as empagliflozin are newer and improve symptoms and reduce mortality in all heart failure types.
• Calcium Channel Blockers: Such as verapamil used in specific cases, especially with atrial fibrillation.
• Isosorbide and Nitroglycerin: Dilate blood vessels and reduce heart pressure.
• Digoxin: Older but effective tablet that strengthens heart contractions and slows pulse.

Procedures and Surgery

• Pacemakers: Small devices implanted under skin that monitor and regulate irregular heartbeats.
• Implantable Cardioverter-Defibrillator (ICD): Advanced device detecting dangerous arrhythmias and shocking the heart to restore normal rhythm in severe cases.
• Ventricular Assist Device (VAD): Mechanical pump helping weak heart pump blood, used as temporary or permanent (bridge to transplant) therapy.
• Interventional Catheterization: Opens blocked arteries via balloon or stent to restore blood flow.
• Coronary Artery Bypass Surgery: Major surgery routing new arteries around blockages when needed.
• Valve Repair or Replacement: Repairs damaged valves or replaces them with patch or artificial valve.
• Heart Transplantation: Final and most effective option for severe cases, replacing diseased heart with healthy donor heart.

Lifestyle Changes

• Reduce Salt Intake: Salt promotes fluid accumulation; limit sodium to less than 2000-3000 mg daily.
• Reduce Fluid Intake: Especially in severe cases, may be limited to 1.5-2 liters daily.
• Quit Smoking Immediately: Smoking increases heart stress and reduces oxygen levels.
• Avoid or Greatly Reduce Alcohol: Directly weakens the heart muscle.
• Exercise Regularly and Moderately: Such as brisk walking 30 minutes daily most days under doctor supervision.
• Maintain Healthy Weight: Weight loss significantly reduces heart workload.
• Manage Stress and Get Adequate Sleep: Stress worsens symptoms; 7-8 hours daily sleep is essential.
• Strict Medication Adherence: Take medications exactly as prescribed at specified times.
• Regular Monitoring of Weight and Symptoms: Sudden weight gain may indicate fluid accumulation and worsening.
• Avoid Sudden Strenuous Exercise: Increase activity gradually under doctor supervision.

• Atrial Fibrillation: Irregular heartbeat significantly increases risk of blood clots and stroke.
• Acute or Chronic Kidney Failure: Reduced blood flow to kidneys weakens them, potentially requiring dialysis.
• Thromboembolism (Blood Clots): Blood clots in the heart or vessels may cause stroke or pulmonary embolism.
• Stroke: Clots traveling to the brain cause paralysis or death.
• Pulmonary Edema (Chronic Lung Disease): Fluid accumulation in lungs causes severe shortness of breath potentially life-threatening.
• Pulmonary Hypertension (High Lung Blood Pressure): Elevated pressure in lung vessels worsens heart condition.
• Liver Cirrhosis (Chronic Liver Disease): Fluid accumulation in liver weakens it and reduces function.
• Sudden Cardiac Death: In severe cases especially with dangerous arrhythmias.

• Control Blood Pressure: Check regularly and keep below 130/80 mmHg.
• Manage Diabetes: Keep blood sugar in normal range (fasting 70-100 mg/dL).
• Avoid Smoking and Secondhand Smoke: Quit smoking completely and avoid secondhand smoke.
• Limit Alcohol Consumption: No more than one drink daily for women, two for men.
• Regular Physical Activity: 150 minutes moderate activity weekly (such as brisk walking).
• Maintain Healthy Weight: BMI between 18.5-24.9.
• Eat a Healthy Diet: Rich in fruits, vegetables, whole grains; low in salt and fat.
• Control Cholesterol: Keep total cholesterol below 200 mg/dL.
• Manage Stress and Anxiety: Practice relaxation techniques and meditation.
• Regular Check-ups: Routine heart exams especially with risk factors or family history.