Heart failure: symptoms and possible treatments
Heart failure is the leading cause of hospitalisation in patients over 65: it is characterised by a deterioration in the function of the heart that prevents the proper supply of blood to the body
This condition is caused by an inability of the heart to contract (systole) and/or release (diastole) properly.
As a result of heart failure (a condition in which the heart is unable to pump sufficient blood for the body’s needs), the organs and tissues receive insufficient oxygen and nutrients for their metabolic needs (downstream effect of the heart) and excess fluid accumulates in the lungs and tissues (upstream effect of the heart).
Heart failure is the leading cause of hospitalisation in the over-65s and is therefore considered a major public health problem. In Italy, about 1,500,000 people suffer from heart failure and it is estimated that its prevalence doubles with every decade of age (it reaches about 10% after the age of 65).
The causes of heart failure
It is a pathology linked to the lengthening of average life span and its prevalence is increasing every year due to the general ageing of the population.
It can occur following an episode of myocardial infarction or inadequate treatment of chronic diseases, including diabetes and hypertension.
Adopting lifestyles that prevent the onset of these conditions is therefore a key strategy to prevent heart failure.
Heart failure: the symptoms
- reduced tolerance to effort;
- oedema (i.e. swelling).
The condition can worsen to the point of acute pulmonary oedema and death.
Treating heart failure
The therapeutic approach to heart failure consists of pharmacological and non-pharmacological treatment.
Let’s see them in detail.
Pharmacological treatment is essential to counteract the gradual worsening of the clinical picture.
However, it is essential to guarantee these patients a continuity of care integrated between the hospital and the local area, in order to identify any worsening at an early stage and consequently modify the therapy in good time.
Non-pharmacological treatment of heart failure includes:
- implantation of defibrillators
- implantation of the VAD (Ventricular Assist Device);
- cardiac transplantation.
Let’s see how they work and when they are used.
Patients with an ejection fraction of less than 35% (ejection being the ability to pump the heart below a certain value) have a high probability of secondary cardiac arrest and malignant ventricular arrhythmias.
The implantation of an automatic defibrillator can minimise this eventuality.
In selected cases, implantation of a biventricular defibrillator may be considered, which, by correcting defects in the normal synchronisation of the heartbeat, can optimise cardiac contraction (resynchronising) by improving the ejection fraction.
The VAD (Ventricular Assist Device)
VAD is a mechanical pump that replaces the function of the left or right ventricle or both.
In most cases, a left ventricular assist device (LVAD) is used to support the left ventricle.
The device is implanted in the tip of the heart.
It draws oxygen-rich blood, which the heart can no longer pump through the body, from the left ventricle and then pumps it into the aorta through an artificial passage called a graft.
The control unit and battery are located outside the body and the heart pump is connected by a connecting cable.
It can be used
- in terminal heart failure
- in the transplant candidate;
- as definitive therapy.
Cardiac transplantation is indicated in patients with end-stage heart failure, refractory to medical and surgical therapy, as a last option for improving quality of life and increasing survival.
- must be less than 70 years old
- not have advanced failure of other organs, neoplasms, severe pulmonary hypertension.
Lifestyle adjustments after heart failure
After heart failure it is good to pay attention to your lifestyle, observing a series of good rules such as:
- reducing your daily sodium intake;
- reducing daily alcohol intake (max 1-2 glasses of wine/drink);
- reduction of body weight in obese patients;
- abolition of cigarette smoking;
- annual vaccination against influenza and pneumococcus;
- cardiac rehabilitation programmes.