Heart failure

Congestive heart failure

It is the inability of the heart to adequately pump the blood it needs to the body organs and tissues and to provide oxygen. It is a clinical picture in which there are many underlying diseases, progressing with many signs and symptoms rather than a disease.

It is a life-threatening disease. In recent years, its incidence has increased due to factors such as changing living habits and environmental pollution. It is still one of the most common causes of death worldwide. It greatly reduces the patient’s quality of life and requires serious health care.



There are many preventable causes of heart failure that are not congenital or familial. Taking precautions to prevent heart failure is always quite easy and cheap when compared to the pain, suffering, deaths, health costs, etc. it brings after the disease occurs. Societies should focus on prevention policies as much as the treatment of heart failure.

In heart failure, the heart is working. But it is weakened, the muscles are weak, or the vessels are clogged. Therefore, heart performance is low.

It is a chronic and incurable disease that can be seen at almost all ages. However, the incidence increases with advancing age, especially over the age of 65.

What is the anatomy of the heart, how does it work? 

The heart consists of four chambers, two on the right and two on the left. The two chambers on either side at the top are called the atria, and the two chambers on either side below are called the ventricles. There are valves between the atria and ventricles to prevent backflow of blood. There are large arteries and veins that bring blood to the chambers and carry it to the lungs and the whole body. Smaller vessels also feed the heart muscle.

The chambers are surrounded by three layers of muscle. The outermost layer is the epicardium, the middle is the myocardium, and the innermost is the endocardium. The muscles around the chambers are striated muscles and work against our will. The outermost layer is the pericardium, which completely surrounds the heart. A gap remains between the epicardium and the pericardium.

The oxygen-poor blood (polluted blood) collected from the whole body is brought to the right atrium through the vena cava vein. The blood collected here is transmitted to the right ventricle by opening the valve in between. The structure of the cover is such that it prevents the backflow of blood during its conduction. Blood is carried to the lungs through the right ventricle. Here, oxygen-laden blood (clean blood) is brought to the left ventricle. The blood, which passes through the valves and passes into the right atrium with the contractions of the left ventricle, is carried to the whole body by the largest artery called the aorta. Therefore, the blood circulation of the body is evaluated in two groups as pulmonary circulation and systemic circulation.

The heart also has a powerful conduction system that coordinates the contraction of the chambers and the spread of blood between the chambers, to the lungs and throughout the body.

What are the risk factors for heart failure? 

Heart failure is a complex clinical picture that can develop due to many reasons. Therefore, many risk factors may be responsible. The majority of these are preventable risk factors.



Risk factors that can often be blamed are:

• Obesity: Obesity poses a serious risk for reasons such as an increase in blood fat levels, narrowing of the vessels, and an increase in the load on the heart.
• Tobacco and tobacco products: All tobacco and tobacco products are harmful, regardless of more or less use, due to the harmful substances they contain. It prepares the ground for heart diseases.
• Alcohol: It weakens the heart muscle, reduces the performance of the heart.
• Hypertension: The load on the heart increases, the heart that has to work harder weakens.
• Diabetes mellitus: The increase in blood glucose level causes damage to small vessels. The nutrition of the heart is also impaired. Some drugs used in the treatment of diabetes mellitus may also be a factor in heart failure.
• Sleep apnea: Not getting enough oxygen at night causes the dirty blood not to be cleaned enough and therefore the heart to work harder.
• Nutritional habits: Fat-rich diet habits can lead to clogged arteries and heart failure in the future.
• Viruses: Coxsackie viruses that damage the heart muscles, measles, rubella viruses, viral agents such as EBV, HIV/AIDS may also predispose to heart failure.
• Congenital heart diseases: Many problems such as weakening of the heart muscles, problems in the valves, gaps between the chambers can be the cause of heart failure.
• Heart attack: Heart failure may develop as a result of blockages in the vessels feeding the heart, weakening of the muscles and weakening of the heart’s work.
• Coronary artery disease: The narrowing of the vessels feeding the heart causes weakening in the functioning of the muscles that cannot be fed adequately.
• Heart valve diseases: Since the backflow of blood circulating between the chambers cannot be prevented, the performance of the heart that tries to clean the blood accumulated behind weakens.
• Arrhythmia: Disruption of the normal working rhythm of the heart can cause insufficient and untimely pumping of the blood, work harder to correct it and weaken it.
• Cardiomyopathy: The heart’s pumping ability is impaired by enlargement of the heart muscle and narrowing of the chambers.
• Lung diseases: Diseases that prevent adequate oxygenation of the blood coming to the lungs can also cause heart failure.
• Medications: Some diabetes medications, painkillers, heart disease medications, etc. can also be a factor in heart failure.
• Pregnancy: Increased heart load due to fetal needs, pressure on the heart can weaken the heart.
• Anemia: The heart will have to pump more blood that cannot carry enough oxygen.

What are the types of heart failure? 

Heart failure can be classified in different ways. These:

• Classification of heart failure (HF) according to onset time (Acute HF, Chronic HF)
• Heart failure according to the involved heart side (Right HF, Left HF)
• Heart failure according to cardiac output (High output HF, Low output HF)
• Heart failure according to ventricular functions (Systolic HF, Diastolic HF)

What are the stages of heart failure? 

Heart failure can be divided into stages according to its clinical findings. Staging is important in determining the type of treatment to be applied.

Accordingly, the stages of heart failure according to physical activity are as follows:

• Class 1 : Heart failure risk factors (hypertension, obesity, coronary heart disease, etc.) are present but no symptoms. Symptoms can occur with high levels of physical activity. Elimination of risk factors is recommended.
• Class 2: No signs of heart failure at rest, but may develop with moderate physical activity.
• Class 3: Symptoms occur with mild physical activity.
• Class 4: Clinical symptoms are also observed at rest.

Another classification is as follows:

• Stage 1: Heart failure risk factors (hypertension, obesity, coronary heart disease, etc.) are present but no symptoms.
• Stage 2: There is damage to the structure of the heart, there is no sign of heart failure yet. Treatment is applied for signs of heart disease.
• Stage 3: There is damage to the heart structure and signs of heart failure have appeared.
• Stage 4: End-stage heart failure

What are the symptoms of heart failure? 

Since heart failure will affect many functions, its symptoms are also numerous. Symptoms may develop suddenly, or they may develop over a long period of time.

Common signs and symptoms include:

• Shortness of breath (during activity, while sleeping, later at rest),
• Wheezing,
• Cough,
• Weakness, fatigue,
• Dizziness,
• Fainting,
• Chest pain,
• Edema (swelling in ankles, legs),
• Fatigue quickly in exercises,
• Swelling in the abdomen (ascites),
• Liver, spleen enlargement,
• Nausea, vomiting,
• Weight gain due to weight loss or edema,
• Increased heart rate (tachycardia),
• Sleeping disorders,
• Memory disorders,
• Difficulty concentrating

Diagnosis of heart failure

In the anamnesis, family history, smoking, alcohol use, time of onset and occurrence of complaints, past diseases, eating habits, infections, etc. is questioned.

Physical examination may reveal moist, dirty and pale skin, coldness in the hands and feet, enlarged liver, spleen, swelling in the ankles or legs, and an increase in heart rate.

Laboratory tests that can be used in the diagnosis of heart failure:

• ECG: Heart attack, left ventricular enlargement, rhythm disorders etc. are investigated by following the rhythms of the heart.
• Chest X-ray: Ventilation of the lungs, position and size of the heart,
• Complete blood count: Anemia vs.
• Blood glucose level: In terms of diabetes mellitus,
• Liver and kidney function tests,
• Echocardiography: Heart functions, valve status are monitored
• Coronary angiography: Obstructions in the heart vessels are monitored, intervened if necessary,
• Heart biopsy . heart muscle diseases,
• Holter: 24-hour monitoring of the heart

Treatment of heart failure

The treatment of heart failure is applied by determining the appropriate treatment methods after the expert evaluation. The first stage of heart failure treatment is to improve lifestyle habits and reduce risk factors. On the other hand, there are different treatment methods such as appropriate drug therapy, treatment of the underlying disease and, if necessary, heart transplantation.

However, none of them are specific treatments for heart failure. It is necessary to reduce the signs and symptoms, to continue with the daily activities of the person, and to stop the progression of the picture.

Correction of living habits: 

• Body weight control: Losing excess weight with appropriate programs under the support of a dietitian, taking into account the body mass index,
• Salt restriction: Salt causes water retention in the body and increases heart failure. Remove the salt shaker from the table, do not add salt to the food, follow the salt content of the foods you buy, etc.,
• Fluid control : Excess fluid intake increases the pressure on the heart. 1.5-2 liters of fluid intake per day may be sufficient.
• stay away from alcohol,
• Stay away from tobacco and tobacco products,
• Fat restriction : Fatty foods cause blockage in the veins,
• Blood glucose control : The lack of control of blood glucose level in diabetic patients exacerbates the symptoms of heart failure,
• Regular exercise: Exercise at a level that will not increase your heart failure complaints,
• Nutrition: Follow a fruit and vegetable-based diet.

Medication: 

Medications that can be used in heart failure include:

• Angiotensin converting enzyme inhibitors
• Beta blockers
• Digoxin,
• Diuretics (diuretic),
• Aldosterone antagonists,

It is recommended to apply flu vaccine and pneumonia vaccine in order to prevent additional diseases in heart failure.

In addition, a pacemaker to regulate the heart rhythm, surgical intervention in valve diseases or heart transplantation may be considered in some heart muscle diseases.

Heart failure is a chronic condition and worsens over time. Most of the drugs given relieve the symptoms but do not relieve the picture. However, if the underlying and treatable disease is corrected, the picture of heart failure may improve.