Heart Failure

Heart Failure is a complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood, which in turn leads to the cardinal clinical symptoms of dyspnea, fatigue, and signs of HF, namely edema and rales.

Last Updated: February 21, 2024

In a study on the epidemiology of Heart Failure in the Philippines, every 16 for every 1000 admitted Filipino patients in 2014 had heart failure. Compared to western and Asia-Pacific countries, the local mortality/death rate in the Philippines is relatively higher. 

Heart failure is a progressive disorder that is initiated after a cardiac event either damages the heart muscles or disrupts the ability of the heart to contract normally. These cardiac events can be abrupt as is the case in Myocardial infarction (Heart Attack), or gradual as is the case of hemodynamic pressure or volume overloading. Heart Failure may also be hereditary as in the case of many genetic cardiac abnormalities. Regardless of the nature of the inciting event, the feature that is common to each of these index events is that they all in some manner produce a decline in the pumping capacity of the heart.

In most instances, patients remain asymptomatic or minimally symptomatic after the initial decline in pumping capacity of the heart. Typically, patients develop symptoms only after the dysfunction has been present for some time. Common signs and symptoms of heart failure include:

  • Shortness of breath/Dyspnea
  • Paroxysmal Nocturnal Dyspnea (Sensation of shortness of breath that awakens the patient from sleep that is usually relieved when the patient is positioned sitting up)
  • Neck vein distension
  • Abnormal heart sounds heard on stethoscope
  • Edema of arms and legs
  • Tachycardia (Heart rate > 120 beats per minute)

A clinical diagnosis may be made by your attending physician using the Framingham Diagnostic Criteria for Heart Failure using information from History and Physical Examination. Afterwards, they may order 2D Echocardiography with Doppler which uses ultrasound to assess the function of the heart and its valves. They may also order ECG to assess cardiac function and laboratory tests such as BNP, NT-pro BNP, CBC, Electrolytes, etc.

Therapeutic targets in Heart Failure include control of congestion, stabilization of heart rate and blood pressure, and efforts at improving exercise tolerance. Pharmacologic management can be given to reduce symptoms as well. Some of these medications include:

  • Furosemide (for control of volume overload)
  • Nitroglycerine (for control of hypertension and relief of dyspnea)
  • Captopril
  • Carvedilol
  • Spironolactone, Digoxin, Ivabradine, Sacubitril/Valsartan

Overall, management of heart failure hinges on management of contributing and associated conditions. However, patients may induce lifestyle changes to help manage Heart Failure

  • Exercise (as tolerated)
  • Cessation of smoking
  • Restriction or abstinence from alcohol consumption
  • Avoidance of illicit drug use
  • Sodium restriction to 3g/day
  • Avoidance of obesity
  • Vaccination (Pneumococcal vaccine, Annual influenza)

Reference:

Gupta, A., Gopal Ghimire, M. D., & Hage, F. G. (2014). Guidelines in review: 2013 ACCF/AHA Guideline for the Management of Heart Failure. Journal of Nuclear Cardiology, 21(2), 397.

Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J., & Loscalzo, J. (2018). Harrison's principles of internal medicine, 12e (Vol. 1, No. 2). New York, NY, USA:: Mcgraw-hill.

Last Updated: February 21, 2024