Heart failure

What is heart failure?

Heart failure is a clinical syndrome caused by damage to the heart’s pumping function. Its severity is described by the ejection fraction (EF), which shows how effectively the heart maintains circulation. Heart failure can develop suddenly (acute) or gradually over time (chronic). The most typical symptoms are breathlessness at rest or during physical activity, tiredness, swollen legs, a fast pulse, palpitations and coughing. Very many people in Hungary are affected, which is why choosing the right treatment is so important.

What are the symptoms?

Heart failure can develop suddenly as a result of damage to the heart muscle (heart attack, inflammation, metabolic causes, arrhythmia), or gradually (high blood pressure). The symptoms are similar in both cases and differ mainly in how quickly they develop, although acute heart failure usually causes more alarming and severe symptoms. Clinically, three forms are distinguished depending on the EF value. A normal EF is between 50% and 75%. When the EF is reduced, this is called heart failure with reduced ejection fraction; the EF can also be mildly reduced or within the normal range alongside the symptoms of heart failure. Heart failure used to be divided into diastolic and systolic types. In diastolic heart failure the heart does not fill properly with blood, so it has less blood to pump, while in systolic heart failure the pumping function itself is damaged.

The most typical symptoms are breathlessness at rest or during physical activity, tiredness, swollen legs, a fast pulse, palpitations and a cough that gets worse when lying down. Fluid often builds up in the lungs and lower legs and is passed mainly at night, so needing to urinate at night is common. Based on the patient’s physical activity and the severity of symptoms, the disease can be classified into stages (NYHA classes).

Class IV: any physical activity makes the patient feel unwell. Symptoms are present even at rest.

Class I: physical activity is not limited. Ordinary physical activity does not cause undue tiredness, breathlessness or chest pain (angina).

Class II: physical activity is slightly limited. Ordinary physical activity causes symptoms.

Class III: physical activity is markedly limited. The patient is comfortable at rest, but less than ordinary activity causes symptoms.

How is it diagnosed?

Diagnosis is based on the typical symptoms above, physical findings and objective test results showing reduced heart function. After a physical examination, an ECG is recommended. A heart ultrasound (echocardiogram) is then usually performed, which measures, among other things, the EF. Blood tests for heart failure markers (for example NT-proBNP) are essential. MRI, CT or SPECT scans can also help establish the cause.

What treatments are available?

The aim of treating heart failure is to relieve symptoms and improve quality of life. There are currently four treatment options.

1. I. Non-drug treatment
2. II. Medication
3. III. Device therapy
4. IV. Surgery

The first option is based on lifestyle change: stopping smoking, regular exercise and reducing alcohol. There are many medicines to choose from, although they have been proven to help mainly in patients with reduced ejection fraction. Implantable devices are used when heart failure is caused by heart rhythm problems or there is a high risk of them; these include implantable cardioverter defibrillators and pacemakers. Finally, in end-stage heart failure, a heart transplant may be the only option.