Heart Failure: Symptoms, Surgical Options, Diagnosis, Tests and Management of the Disease

What exactly?

Heart failure develops when the heart, through an abnormality of cardiac function (detectable or not), does not pump blood at a rate proportional to the requirements of the metabolic tissues or can only do so with a high diastolic filling pressure.

How often does heart failure occur?

Heart failure, for now, is one of the conditions that most affect men worldwide. This is what the different reports of the scientific research centers linked to the world’s most prestigious universities make clear.

Therefore, today in this note, it is essential that you know what it is, what its symptoms are, how it is treated, and the risk factors underlying this condition.

The name of this condition can be a bit confusing. It does not mean that the heart has stopped working correctly when you have heart failure. What happens is that your heart can not pump blood as well as it used to.

And it is that the chambers of your heart can respond by stretching to bring more blood to the pump through your body. It can become stiffer and thicker. This helps keep the blood moving, but the heart muscle walls weaken over time.

Your kidneys react by making your body cling to water and salt. The fluid may accumulate in the arms, legs, ankles, feet, lungs, or other organs.


The causes

Heart failure can be caused by many conditions that damage the heart, including:

  • Coronary artery disease is a disease of the arteries that supply blood and oxygen to your heart—decreasing blood flow to the heart muscle. If your arteries become narrowed or blocked, your heart will be hungry for both oxygen and nutrients, and then you will not be able to pump blood efficiently.
  • Heart attack. This can happen when a coronary artery is blocked by chance, stopping blood flow to your heart muscle.
  • Cardiomyopathy is damage to the heart muscle caused by blood or arterial flow problems, infections, and alcohol and drug abuse. Other diseases or genetic issues can also bring it. Make sure your doctor knows your family’s health history.
  • Conditions that over freeze the heart. These include high blood pressure, heart valve disease, thyroid disease, kidney disease, diabetes, or heart defects that you have had since you were born.

Signs and symptoms

The signs and symptoms of heart failure include the following:

  • Pulse weak, fast, and fast.
  • Wheezing
  • Alternating pulses.
  • Increase in the intensity of the heart sound.
  • Reflujo hepatoyugular.
  • Ascitis, hepatomegalia y / o anasarca.
  • Central or peripheral cyanosis, pallor.

Types of Heart Failure

  • Systolic heart failure. This happens when the heart muscle does not tighten with enough force. When that is the case, pump less oxygen-rich blood through your body.
  • Diastolic heart failure. Your heart is squeezed usually, but the ventricle – the main pumping chamber – does not relax properly. This reduces the amount of blood entering your heart and elevates blood pressure in your lungs. You get fluid in your lungs, legs, and belly.


The main criteria include the following:

  • Paroxysmal nocturnal dyspnea.
  • Central venous pressure greater than 16 cm of fluid.
  • Circulation time of 25 seconds.
  • Radiographic cardiomegaly.
  • Pulmonary edema, visceral congestion, or cardiomegaly at autopsy.

The minor criteria are the following:

  • Night cough
  • Dyspnea of ​​ordinary effort.
  • A decrease in vital capacity by one-third of the maximum value recorded.
  • Pleural effusion
  • Tachycardia (rate of 120 bpm).
  • Bilateral edema of the ankle.

The classification system of the New York Heart Association classifies heart failure on a scale from I to IV, as follows:

  1. Class I: Without limitation of physical activity.
  2. Class II: Mild restriction of physical activity.
  3. Class III: marked regulation of physical activity.
  4. Class IV: Symptoms occur even at rest; Upset with any physical activity.

The staging system of the American College of Cardiology / American Heart Association is defined by the following four stages:

Stage A: High risk of heart failure, but without structural heart disease or symptoms of heart failure.

Stage B: Structural heart disease but without symptoms of heart failure.

Stage C: Structural heart disease and symptoms of heart failure.

Stage D: refractory heart failure requiring specialized interventions.

Stages of heart failure

The American Heart Association and the American College of Cardiology have published a list of stages of heart failure that helps you understand how the condition changes over time and the types of treatments used in each phase.

Stage A: This is when you are at risk for heart failure. You can be in this stage if you have:

  • High blood pressure
  • Diabetes
  • Coronary artery disease
  • Metabolic syndrome
  • You may also be at risk if you have a history of:
  • Treatment with cardiotoxic drugs
  • Alcohol abuse
  • Rheumatic fever
  • Family members with cardiomyopathy

If you are in stage A, your doctor may suggest changes in your lifestyle and treatment, such as:

  • Regular exercise
  • If you smoke, stop smoking.
  • Treat high blood pressure or high cholesterol.
  • Stop drinking alcohol or using illegal drugs.
  • Take an angiotensin II receptor (ARB) inhibitor or blocker if you have had coronary artery disease or diabetes, high blood pressure, or other conditions of the heart and blood vessels.
  • Take beta-blockers if you have high blood pressure or have had a heart attack.

Stage B: You are in this phase if you have never had symptoms of heart failure but are diagnosed with left ventricular systolic dysfunction, which means that the left chamber of your heart does not pump well. You can be in this group if you had or have:

  • Heart attack
  • The disease of the valve
  • Cardiomyopathy

Treatments for Stage B. Depending on your situation, your doctor may suggest treatments such as:

  • The ACE inhibitor or angiotensin II receptor blocker (ARB)
  • Beta-blockers after a heart attack
  • An aldosterone inhibitor if symptoms continue while you are taking beta-blockers and ACE / ARB medications
  • Surgery for coronary artery repair and repair or replacement of the valve
  • Implantable cardiac defibrillator (ICD)

Stage C: You are in this phase if you have systolic heart failure along with symptoms such as:

  • Difficulty breathing
  • Fatigue
  • Less ability to exercise

Treatments for Stage C., Your doctor may suggest treatments like these, depending on your specific condition:

  • Inhibitors and beta-blockers
  • Hydralazine/nitrate combination for some people if symptoms persist
  • Diuretics (water pills) and Digoxin if you continue to have symptoms
  • Aldosterone inhibitor when your symptoms remain severe with other treatments
  • The blocker of angiotensin receptors and inhibitors of neprilysin
  • Biventricular pacemaker
  • Implantable cardiac defibrillator (ICD)

Your doctor can also tell you these steps:

  • Eat less salt.
  • Lose weight if you are overweight.
  • Drink fewer fluids if necessary.
  • Stop drugs that worsen your condition.

Stage D: You are in this phase if you have systolic heart failure and advanced symptoms after receiving medical attention.

Treatments for Stage D., Your doctor may suggest some of the treatments for stages A, B, and C. You can also talk to your doctor about other types of treatments, such as:

  • Heart transplant
  • Ventricular assist devices
  • Surgery options
  • The continuous infusion of intravenous inotropic drugs.

Remember that you should always consult a health professional qualified in this specialty of medicine and pass medical examinations relevant to your topic so that the condition evolves correctly.


The following tests may be useful in the initial assessment of suspected heart failure:

  • Complete blood count.
  • Urine analysis.
  • Electrolyte levels.
  • Studies of renal and hepatic function.
  • Fasting blood glucose levels.
  • Lipidic profile.
  • The levels of the thyroid-stimulating hormone.
  • Levels of type B natriuretic peptides
  • N-terminal pro-B type natriuretic peptide.
  • Electrocardiograph.
  • Chest x-ray.
  • Two-dimensional echocardiography.
  • Nuclear images
  • Maximum stress test.
  • Pulse oximetry or arterial blood gas.

Management of Heart Failure

The treatment includes the following:

Non-pharmacological therapy: Oxygen and non-invasive positive pressure ventilation, sodium in the diet and fluid restriction, physical activity, as appropriate, and attention to weight gain.

Pharmacotherapy: diuretics, vasodilators, inotropic agents, anticoagulants, beta-blockers, and Digoxin.

Surgical options

Surgical treatment options include the following:

  • Electrophysiological intervention.
  • Revascularization procedures.
  • Replacement/repair of valves.
  • Ventricular restoration.
  • Oxygenation of the extracorporeal membrane.
  • Ventricular assist devices.
  • Heart transplant.
  • Total artificial heart.

The disease in depth

Heart failure is the pathophysiological state in which the heart, through an abnormality of cardiac function (detectable or not), fails to pump blood at a rate proportional to the requirements of the metabolic tissues or can do so only with a filling diastolic elevated pressure.

Heart failure can be caused by myocardial failure, but it can also occur in the presence of an almost normal cardiac function in conditions of high demand.

Heart failure always causes circulatory failure, but the opposite is not necessarily the case.

Since several non-cardiac conditions (e.g., hypovolemic shock, septic shock) may produce circulatory failure in the presence of normal, modestly impaired, or even supranormal cardiac function.

To maintain the heart’s pumping function, compensatory mechanisms increase blood volume, cardiac filling pressure, heart rate, and cardiac muscle mass.

However, despite these mechanisms, there is a progressive decrease in the heart’s ability to contract and relax, worsening heart failure.

Heart failure signs and symptoms include tachycardia and manifestations of venous congestion (e.g., edema) and low cardiac output (e.g., fatigue).

Shortness of breath is a cardinal symptom of left ventricular failure that can manifest itself with a progressively increasing severity. Laboratory studies for heart failure should include a complete blood count, electrolytes, and kidney function studies.

Imaging studies such as chest x-ray and two-dimensional echocardiography are recommended in the initial evaluation of patients with known or suspected heart failure.

B-type natriuretic peptides and pro-B type N-terminal natriuretic peptides (NT-proBNP) may help differentiate cardiac and non-cardiac causes of dyspnea.

In acute heart failure, patient care involves stabilizing the clinical condition, Establishing the diagnosis, etiology, and precipitating factors, and initiating therapies to provide rapid relief of symptoms and survival benefits.

Surgical options for heart failure include revascularization procedures, electrophysiological intervention, cardiac resynchronization therapy, implantable defibrillators, and replacement or repair of valves.

But also ventricular restoration, heart transplant, and ventricular assist devices.

The objectives of pharmacotherapy are to increase survival and prevent complications. Along with oxygen, medications that help relieve symptoms include diuretics, Digoxin, inotropes, and morphine.

Drugs that can exacerbate heart failure should be avoided (non-steroidal anti-inflammatory drugs, calcium channel blockers, and most antiarrhythmic drugs).

When risk factors for heart failure are present, there is usually inflammatory stress, which further damages the heart muscle by depleting energy cells and antioxidants.

Heart failure can be frightening, but in reality, it only means that the heart is not pumping as well as it could.

When the heart muscle is weak, blood can not be pumped with sufficient efficiency to get oxygen to all cells.

Sometimes the heart dilates and weakens. Other times it may be stiff and thickened. Over time, the heart can not keep up with its workload.

Not enough oxygenated blood reaches the brain and muscles when this happens, and the fluid begins to strengthen the lungs and other tissues.