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Heart Failure: Definition and Epidemiology
Heart Failure: Definition and Epidemiology
Heart Failure: Definition and Epidemiology
Heart Failure
Figure 1
Causes
Coronary heart disease (CHD) is the most common cause of heart failure with about
23,000 people aged less than 75 dying in the UK each year due to CHD.15 In coronary
heart disease the arteries that supply the cardiac muscle with oxygen becomes blocked
or severely narrowed by the process of atherosclerosis leading to myocardial
infarction. CHD weakens the heart overtime and leads to heart failure. Another
common cause of heart failure is hypertension.2 Since hypertension increases
afterload, there is a rise in preload as more blood stays in the heart after it pumps. The
heart will have to work harder to pump blood around the body. To cope with this, the
cardiac muscle becomes harder and stiffer which makes the heart inefficient at doing
its job. Usually there is an excessively high preload in heart failure.8, 9
Cardiomyopathy is the term used to define any disease of the cardiac muscle that
affects the hearts ability to pump blood with an adequate force.10 There are three
types of cardiomyopathies. In congested cardiomyopathy, the left ventricle becomes
dilated and weak. Initially, the chambers of the heart respond to this situation by
stretching to hold more blood for systemic perfusion. However, this only temporarily
strengthens the hearts contraction.11 Eventually, the cardiac muscle weakens and is
unable to pump blood with the force required. In hypertrophic cardiomyopathy the
walls of the ventricles become hypertrophied, the affected cardiac muscle may
become stiff. Consequently the ventricles may not fill as effortlessly as normal, so less
blood is pumped to the body. Restrictive cardiomyopathy inhibits the heart from
sufficiently filling with blood before contracting due to a loss of elasticity. This leads
to heart failure.
The types of arrhythmia that can lead to heart failure include bradycardia and
tachycardia. Bradycardia is when the heart beats at an abnormally slow rate resulting
in a low cardiac output that can consequently lead to heart failure.13 Tachycardia is
when the heart rhythm is too fast or irregular. The heart rate ranges from 100 beats per
minute to 400 beats per minute. The heart will not be able to pump oxygenated blood
sufficiently at such high rates.14
Ishwarya Sivakumar
St Angelas and St Bonaventures Sixth form
Heart failure
Other factors such as alcohol intake, smoking, valve regurgitation, valve stenosis and
genes can also increase the chances of heart failure.
Signs and symptoms
Many symptoms of heart failure are linked to the
congestion that develops due to the transudation of
plasma into alveolar spaces (pulmonary edema).
This occurs as a result of the redistribution of blood,
which causes an increase in venous blood pressure
in the lungs.2 The plasma reduces oxygen
movement through the lungs and leads to dyspnea.
Other symptoms occur due to insufficient systemic
perfusion so not enough oxygenated blood reaches
the metabolizing tissues.4 Some of the main
symptoms of heart failure can be seen in figure 2.
Figure 2
Ishwarya Sivakumar
St Angelas and St Bonaventures Sixth form
Heart failure
congestion in the lungs and heart and to see whether the heart is enlarged. An
electrocardiogram can be used to determine the hearts ejection fraction and also
check if there is any abnormality in the electrical activity of the heart. An
echocardiogram uses ultrasound waves to check blood flow across the valves by the
Doppler effect. A stress test is when the pumping of the heart is increased by physical
activities or medication to determine whether there are blocked arteries. Other tests
include cardiac catheterization and CT coronary angiogram to check if the person has
coronary heart disease, which can lead to heart failure.
Prognosis
The prognosis of heart failure is dependent on the health of the patient. However,
heart failure prognosis is generally poor with nearly 50% of patients dying within 5
years of being diagnosed.16 Smoking and alcohol intake tend to contribute to early
demise in people with heart failure. Some studies have revealed that there are heart
failure patients who dont even live up to their life expectancy28: Despite the
prediction that 50% of heart failure patients live for 5 years after diagnosis, studies in
Scotland showed that the five-year survival rate only applied to 25% of the
population. Furthermore, an American study showed that 54% of heart failure patients
died within three days even though they were expected to live for six more months.
Treatment
Figure 3
Ishwarya Sivakumar
St Angelas and St Bonaventures Sixth form
Heart failure
Beta-blockers cause the heart to beat with less force by slowing it down and reducing
afterload. This prevents arrhythmias from developing and therefore improves the
prognosis of heart failure.20 Digoxin is also a drug used to improve the symptoms of
heart failure. Digoxin blocks the sodium-potassium ATPase enzyme subsequently
rising the amount of calcium and potassium in heart cells.21 This makes the heart
muscle contract more forcefully.22 Consequently, systemic perfusion is more efficient.
If medication isnt working, surgery may be considered. Coronary angioplasty or
coronary artery bypass may be used if the persons heart failure is caused by coronary
heart disease.24 Valve replacements may be considered if valve regurgitation or
stenosis is the root cause of heart failure. A cardiac defibrillator can be surgically
implanted in the chest to treat arrhythmia and lessen some of the symptoms of heart
failure. Despite the advancement in medical and surgical treatments for heart failure,
patients continue to move to end-stage failure.23 During this stage, when all other
treatments have failed, heart transplantation is used as a last resort given that there is
chance of long-term transplantation success.
Possible future direction
Figure 4
Ishwarya Sivakumar
St Angelas and St Bonaventures Sixth form
Heart failure
4. http://www.upmc.com/patients-visitors/education/cardiology/Pages/heartfailure-what-happens-body.aspx Accessed on 01/08/14
5. http://www.bhf.org.uk/heart-matters-online/september-october2013/medical/ace-inhibitors.aspx Accessed on 01/08/14
6. http://www.medicinenet.com/ace_inhibitors/article.htm#what_are_some_exam
ples_of_ace_inhibitors Accessed on 01/08/14
7. http://cvpharmacology.com/vasodilator/ACE.htm Accessed on 01/08/14
8. http://www.bloodpressureuk.org/BloodPressureandyou/Yourbody/Heartfailure
Accessed on 01/08/14
9. http://www.livestrong.com/article/253300-factors-that-influence-cardiacpreload/ Accessed on 01/08/14
10. http://www.hopkinsmedicine.org/heart_vascular_institute/conditions_treatmen
ts/conditions/cardiomyopathy.html Accessed on 01/08/14
11. http://my.clevelandclinic.org/heart/disorders/heartfailure/dilated_cardiomyopat
hy.aspx Accessed on 01/08/14
12. http://www.patient.co.uk/health/mitral-regurgitation-leaflet Accessed on
01/08/14 - Figure 1
13. http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/
Bradycardia_UCM_302016_Article.jsp Accessed on 01/08/14
14. http://www.medtronic.co.uk/your-health/tachycardia/index.htm Accessed on
01/08/14
15. http://www.bhf.org.uk/heart-health/heart-statistics.aspx Accessed on 01/08/14
16. http://www.buzzle.com/articles/congestive-heart-failure-prognosis.html
Accessed on 01/08/14
17. Chong JH, Yang X, Don CW, et al. Human embryonic-stem-cell-derived
cardiomyoctes regenerate non-human primate hearts. Nature.
2014;510(1):273-277. doi:10.1038/nature13233
18. http://cvpharmacology.com/diuretic/diuretics.htm Accessed on 01/08/14
19. How do diuretics work? The British Journal of Primary Care Nursing.
2006;3(6):274-275
20. http://www.bupa.co.uk/individuals/health-information/directory/b/betablockers Accessed on 02/08/14
21. http://congestive-heart-failure.emedtv.com/digoxin/digoxin-p2.html Accessed
on 02/08/14
22. http://www.webmd.boots.com/heart-disease/heart-failure-digoxin Accessed on
02/08/14
23. http://my.clevelandclinic.org/services/Heart_surgery/hic_Surgical_Treatments
_for_Heart_Failure.aspx Accessed on 02/08/14
24. http://www.webmd.boots.com/heart-disease/heart-failure-surgery?page=2
Accessed on 02/08/14
25. http://stemcells.nih.gov/info/scireport/pages/chapter9.aspx Accessed on
02/08/14
26. http://www.emedicinehealth.com/congestive_heart_failure/page2_em.htm
Accessed on 02/08/14
27. http://www.rightdiagnosis.com/l/left_heart_failure/intro.htm Accessed on
03/08/14
28. http://www.patient.co.uk/doctor/palliative-care-of-heart-failure Accessed on
03/08/14
29. http://body-disease.com/congestive-heart-failure/ Accessed on 03/08/14 Figure 2
5
Ishwarya Sivakumar
St Angelas and St Bonaventures Sixth form
Heart failure
30. http://www.euroclinix.net/ace-inhibitors.html Accessed on 03/08/14 - Figure 3
31. http://trussty-jasmine.blogspot.fr/2012/03/stem-cells-forcardiac.html#axzz39eCC0Vba Accessed on 03/08/14 Figure 4
32. http://www.webmd.com/heart-disease/heart-failure/heart-failure-diagnosis
Accessed on 03/08/14
33. http://www.cardioconsult.com/DiagnosticTechniques/Echocardiogram.php
Accessed o 03/08/14
34. http://www.rightdiagnosis.com/l/left_heart_failure/intro.htm Accessed on
03/08/14
35. http://www.abouthf.org/questions_stages.htm Accessed on 03/08/14