What is heart failure and how can it be recognised?
Heart failure occurs when the heart is no longer able to perform its contractile pumping function, thus failing to provide an adequate blood supply to the entire body
It is a chronic condition that requires the patient, following diagnosis, to begin a course of treatment that includes, first and foremost, a change in lifestyle and a very effective drug therapy, which has recently been enriched with new, even more effective drugs.
The treatment of heart failure may also require interventional treatments, such as the implantation of automatic defibrillators or pacemakers, surgical or percutaneous correction of valvular disease, surgical or percutaneous myocardial revascularisation, and even heart replacement with a transplant or artificial heart.
The frequency of heart failure in Italy is about 2%, but increases with age, becoming progressively more frequent in women and reaching 15% in both sexes in people aged 85 and over.
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Cardiac system: systolic and diastolic decompensation
Cardiac decompensation can be classified into systolic and diastolic decompensation; systolic decompensation is characterised by an ineffective pump function, while diastolic decompensation is characterised by ineffective ventricular filling.
In fact, the heart receives venous blood from the periphery through the atrium and the right ventricle and sends it into the pulmonary circulation for oxygenation, while the atrium and the left ventricle ‘launch’ it into the aorta and then into the arteries, transporting oxygen and nutrients to the tissues of all the organs.
The function of the left ventricle is expressed on the basis of the ejection fraction, a value (usually calculated using an echocardiogram) that expresses the percentage of blood that is ejected into the aorta with each contraction (systole) of the left ventricle.
A distinction is made between preserved ejection fraction decompensation, reduced ejection fraction decompensation and intermediate ejection fraction decompensation.
Heart failure: Who is most at risk?
Patients at increased risk of developing decompensation with reduced ejection fraction are those with a history of ischaemic heart disease, particularly previous myocardial infarction, or valvular heart disease, or hypertension, especially if it is not well controlled.
Risk factors for preserved ejection fraction decompensation are conditions such as diabetes, metabolic syndrome, obesity, hypertension, atrial fibrillation and female sex.
Dyspnoea, oedema and tiredness: the symptoms of heart failure
Heart failure, especially in its early stages, can be asymptomatic.
Dyspnoea on exertion, i.e. difficulty in breathing during physical activity, is usually the main symptom.
As the disease progresses, dyspnoea occurs with decreasing effort.
There is also decubitus dyspnoea, which occurs when the patient lies down during the night: the sensation of breathlessness interrupts sleep and forces the subject to sit up.
Other symptoms related to heart failure are oedema, i.e. swelling of the legs, feet, ankles and abdomen due to fluid accumulation, and fatigue.
Patients with heart failure do not necessarily present with these symptoms at the same time, but the appearance of dyspnoea and/or oedema in individuals considered to be at risk for heart failure should be considered an alarm bell and should be investigated by a specialist.
The natriuretic peptide assay by means of a blood sample is useful for diagnosis; these molecules are mainly produced by the left ventricle and normal values generally rule out the possibility of symptoms due to decompensation.
Recognition of decompensation is often difficult: patients, most of whom are elderly and suffer from a variety of diseases, underestimate the symptoms because they are non-specific and may be due to other causes.
Symptoms also fluctuate and can change in intensity as the days go by.
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The importance of lifestyle in prevention
Paying attention to one’s lifestyle and combating cardiovascular risk factors, such as smoking, high cholesterol, being overweight and being sedentary, is important to safeguard the health of the heart and prevent – as far as possible – the onset of a cardiovascular disease, including heart failure.
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Heart Failure: Symptoms And Possible Treatments