Heart failure

The heart is a muscle that sends blood full of oxygen and essential nutrients to the body's various organs. In the event of heart failure, the heart can no longer pump enough blood, especially during exercise. As a result, during physical activity, the heart has to beat faster (increased heart rate) to compensate for its weakness. It works harder and, over time, becomes tired.

Over time, heart failure can worsen. This is known as chronic heart failure. There are different stages, from mild to severe. Heart failure can also be acute, i.e. appear suddenly.

The first symptom of heart failure is often dyspnea (shortness of breath during light exertion, which can even occur at rest when the disease is at an advanced stage).

Other main symptoms include fatigue (due to poor muscle oxygenation), water retention (leading to weight gain and edema), weakness, palpitations, tachycardia*Tachycardia: a heart rhythm disorder characterized by a rapid heartbeat loss of appetite, and coughing (again due to fluid accumulation, but this time in the lungs).

Elderly people may experience different symptoms, such as confusion, disorientation, memory problems or falls.

The onset of acute heart failure is usually due to cardiovascular disease. For example, myocardial infarction*myocardial infarction: myocardial infarction is characterized by partial or complete obstruction of a coronary artery. The part of the heart irrigated by this artery no longer receives oxygen, and can become necrotic and die. This is also known as a heart attack or ischemic heart disease*Ischemic heart disease: poor oxygenation of the cells (ischemia) of the heart, usually due to narrowing of an artery, resulting in poorer blood flow, both of which result from poor oxygenation of the heart due to narrowing of the arteries, can be the cause. As can pulmonary embolism*pulmonary embolism: obstruction of blood circulation by a clot in a lung artery (pulmonary artery., a heart valve problem, or cardiac arrhythmia*cardiac arrhythmia: a medical condition characterized by hardening, thickening and lack of elasticity of the artery walls. such as fibrillation or atrial flutter.

Chronic heart failure (which occurs slowly and develops over time) can be linked to high blood pressure (which, over many years, forces the heart to work harder), diabetes or prolonged alcohol consumption. Atherosclerosis, arrhythmia or an old myocardial infarction may also be responsible.

The main risk factors for heart failure are tobacco, cholesterol, high blood pressure, overweight, diabetes, high alcohol and salt consumption, sedentary lifestyle and age. These are general and modifiable factors which, more globally, increase the risk of cardiovascular disease.

Sleep apnea may also be a risk factor for heart failure.

To properly treat heart failure, it's essential to determine the causes of the onset of the disease.

Diagnosis may involve a variety of tests: electrocardiogram, cardiac echocardiography and MRI, chest X-ray, stress test or coronary angiography. Blood markers of heart failure (NT-proBNP and BNP) are also tested. The higher their concentration, the more severe the heart failure.

In terms of treatment, drugs such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs or sartans), often combined with Sacubitril (a neprilysin inhibitor), beta-blockers and specific treatments (glifozines or anti-SGLT-2) can relieve the heart and improve its pump function. Diuretics can help eliminate accumulated water. Antihypertensives, antidiabetics and statins (for cholesterol) may also be prescribed.

When symptoms are not sufficiently reduced by medication and lifestyle modifications, and if the cause of heart failure is coronary artery disease, coronary dilatation, with or without stenting, or surgery (coronary artery bypass grafting) may be necessary to restore circulation in the coronary arteries. If the cause of heart failure is valve disease, an operation (surgical or percutaneous) may be required to repair the heart valve. Finally, if the problem is due to a heart rhythm disorder, arrhythmia ablation (fibrillation or atrial flutter) or a pacemaker can be fitted, depending on the disorder.

• If the heart is dilated, the 2 ventricles may be out of sync, and a resynchronization pacemaker may be implanted to improve cardiac function.  
• In the event of severe heart muscle fatigue, the risk of sudden cardiac arrest increases, and a defibrillator can be implanted, with or without a resynchronization pacemaker. 
• Finally, in the case of very advanced heart failure, and when the therapies described above have failed to improve the situation, a heart transplant may sometimes be considered. While waiting for the transplant, a ventricular assist device (LVAD) can be introduced to support the heart and enable the patient to leave hospital in the meantime.

Whatever the treatment chosen, chronic heart failure cannot be cured. The aim of treatment is to stabilize the disease (to avoid emergency situations) while reducing symptoms, in order to improve quality of life.

Heart failure gradually reduces physical capacity.
If left untreated, chronic heart failure can lead to decompensation, with serious consequences for the heart and lungs, and thus become a medical emergency. Cardiac decompensation*|Cardiac decompensation: a consequence of heart failure. Also known as acute decompensated heart failure, cardiac decompensation occurs when the body is no longer able to compensate for the heart's failure to function properly.

However, a favorable outcome is possible. Targeted treatment and a healthy lifestyle are essential if there is to be any hope of significantly improving quality of life and survival.

To prevent the development of heart failure, it is possible to combat its various risk factors. To achieve the best possible lifestyle, it is recommended to:

It's essential to consult a doctor if signs such as unusual shortness of breath occur. The doctor will be able to diagnose the problem and, if necessary, start treatment to help improve breathing.

In the event of swollen legs or dizziness, don't hesitate to seek medical advice. The same applies to any increase in heart rate. Rapid and significant weight gain is a sign not to be overlooked, as it may indicate worsening heart failure.

Vigilance is also required in the event of weakness or tightness in the chest, as these symptoms may be signs of heart failure or other heart disease.

The diagnosis of heart failure can be made through various tests, such as an electrocardiogram, echocardiography or MRI.

An exercise test may also be recommended, the most common being the exercise electrocardiogram, which is performed on a treadmill or stationary bicycle. A blood test may be requested to detect the possible presence of biomarkers of heart failure.

The consulting physician will perform an auscultation, paying particular attention to the heart and lungs. He will check pulse, blood pressure and weight, and look for edema.

If the diagnosis of heart failure is confirmed, treatment will certainly be initiated, and a reminder of the good habits to adopt will be given.

Hôpital de La Tour offers a comprehensive cardiac rehabilitation program tailored to each patient. Called Cardio-Tour and covered by the healthcare insurance, it lasts nine weeks and helps you to take good care of yourself and your heart.