Heart Failure – Classification, Cauese And Symptoms
Heart failure represents an evolutionary stage of heart disease, in which the heart loses its ability to provide a proper blood flow to the metabolic needs, in terms of rest and exercise. Accepted definition of heart failure is currently the European Society of Cardiology one, according to which heart failure is a syndrome in which patients have typical symptoms at rest and during exercise, show signs of fluid and salt retention (edema) and physical examinations and laboratory investigations reveal the existence of structural or functional cardiac abnormalities. It is estimated that the prevalence (total number of patients present in a population at a time.) is between 2 and 4%, the percentage being higher in the elderly and diabetics.
Classification of heart failure
- Depending on the evolution : Onset, Transient, Chronic . Onset heart failure – at the time of diagnosis, with symptoms that can be rapidly installed (acute pulmonary edema, cardiogenic shock) or insidious. Transient heart failure describes that transient symptomatic heart failure that is only present for a limited period fo time. Chronic heart failure (most cases) is described with permanent symptoms and repeated worsening episodes
- Depending on the dominant symptoms. Left heart failure (dyspnea), right heart failure (jugular turgor, hepatomegaly, edema) and global heart failure (right + left)
- Depending on left ventricular performance. Systolic and diastolic. Systolic heart failure is accompanied by a decrease in left ventricular ejection fraction below 40% (the limit set arbitrarily) and the radiological appearance showing cardiomegaly (heart enlargement). Diastolic heart failure – the ultrasound reveals left deficiencys in ventricular relaxation and normal ejection fraction. It occurs more frequently in elderly women and diabetics.
- Asymptomatic left ventricular dysfunction. It shows an ejection fraction below 40%, and is considered to be a pre-condition of heart failure associated with an increased risk of mortality. For these reasons it must be treated.
Heart Failure Causes
Heart failure is a late stage of evolution of various diseases of the heart and not a disease itself
- Ischemic heart disease – various forms of manifestation
- Cardiomiopathies – dilatative, hypertrophic, obstructive and peripartum
- Valvular diseases
- Arterial hypertension
- Congenital heart disease
- Lasting tachyarrhythmias
- Some drugs – beta blockers, calcium antagonists, antiarrhythmic drugs, chemotherapy
- Some toxic substances – alcohol, cocaine
- Diabetes mellitus
- Endocrine disorders – hypothyroidism, hyperthyroidism, Cushing syndrome, adrenal insufficiency, acromegaly, pheochromocytoma
- Nutrition disorders – thiamine and carnitine deficiency, obesity, cachexia
- Other diseases – sarcoidosis, amyloidosis, hemochromatosis, connective tissue diseases, HIV infection, hyperuricemia
Heart Failure Symptoms
- Symptoms are represented by dyspnea, cough, fatigue and muscle weakness, nocturia, cerebral symptoms, abdominal pain, digestive and other digestive manifestations. Dyspnea is the main symptom of heart failure. It is caused by pulmonary stasis (increased pulmonary capillary pressures) and can manifest as:
- Effort dyspnea
- Paroxysmal nocturnal dyspnea
- Decubitus dyspnea
- Rest dyspnea
- Acute pulmonary edema
Dyspnea in heart failure during exercises differs from that of healthy people, only in the fact that it appears at less intense effort.
Decubitus dyspnea appear shortly (1-2 minutes) after the patient lies. It is determined by increased blood flow to the heart due to change in position. The patient can only sleep with pillows under his head. In some severe cases he can only sleep in the sitting position. Symptoms may dissaepear when the patient stands. Paroxysmal nocturnal dyspnea occurs at night, after a few hours of sleep, with greater severity and longer duration (up to 30 minutes), bronchospasm due to bronchial wall edema (cardiac asthma), making it sometimes difficult to differentiate it from asthma attack. Rest dyspnea in the absence of physical activity, regardless of body position, means a severe form of heart failure.
Acute pulmonary edema manifestations are seen in acute heart failure, which can be superimposed on a chronic heart failure, in the presence of favoring factors. Dry cough, irritating (heart cough) is sometimes the main symptoms accused in patients with heart failure. It usually occurs at night, awakes the patient from sleep and demands him to stand. Fatigue and muscle weakness are caused by decreased blood flow to the muscles. Patients describe a feeling of “heaviness in limbs”. Nocturia (urinating profusely at night) appears relatively early in the disease and it is caused by increased renal perfusion, with consequent diuresis at rest. Cerebral symptoms include confusion, memory disturbances, anxiety, headache, insomnia, nightmares and even psychotic manifestations (disorientation, delusions or hallucinations) which can be found in the elderly with advanced heart failure. Abdominal pain is localized in the epigastrium and right upper quadrant, among other gastrointestinal events (abdominal distension, anorexia, nausea, constipation) and are caused by the intestinal venous stasis.