Understand the symptoms, causes, and examination methods of heart failure.

Heart failure, commonly known as weak heart, is a chronic disease and a common fatal heart condition. Two to three out of every 100 people in Hong Kong suffer from heart failure, with 20,000 hospitalizations due to heart failure occurring annually.

Heart failure refers to an abnormality in the heart's pumping function. The heart's ability to contract and relax is weakened, making it unable to effectively pump enough blood to supply all parts of the body to meet its needs. As a result, organ function is affected due to insufficient blood and nutrients. Blood often flows back and accumulates in the lungs, abdomen, or lower limbs, causing discomfort. In recent years, heart failure has shown a trend towards affecting younger people, with the youngest case being only 28 years old. There are many symptoms of heart failure; if any are present, prompt examination for heart failure is essential to prolong survival.

Symptoms of heart failure

Heart failure can occur in the left or right heart, or both simultaneously. Symptoms can vary slightly depending on where the heart failure occurs.

Left ventricular failure, also known as systolic heart failure, occurs when the left ventricle, responsible for systemic circulation, pumps oxygenated and nutrient-rich blood to all parts of the body. When the left ventricle's contractile strength weakens or fails to contract, blood stagnates in the left atrium and pulmonary veins, increasing the workload on the left ventricle. Symptoms include shortness of breath, wheezing, pulmonary edema, fatigue, weakness, rapid heartbeat, arrhythmia, palpitations, and coughing. Even lying flat in bed, patients may experience shortness of breath, a suffocating feeling similar to drowning, and difficulty falling asleep.

Right heart failure, also known as diastolic heart failure, occurs when the right ventricle, primarily responsible for pulmonary circulation, pumps blood to the lungs for gas exchange. However, when the right heart muscle fails to relax properly, carbon dioxide-laden venous blood cannot fully return to the heart and be pumped into the ventricles, causing blood to stagnate in the veins or nearby tissues and organs. Patients may experience significant fatigue, abdominal or lower limb edema, even hepatomegaly, jugular venous distension, shortness of breath, chest tightness, chest pain, decreased appetite, nausea, and other discomfort.

Causes of heart failure

Any factor that increases the workload on the heart can potentially lead to heart failure, and can be broadly categorized into two types: heart-related and non-heart-related diseases.

• High blood pressure is a major cause of heart failure. If high blood pressure is not well controlled for a period of time, it can lead to myocardial hypertrophy, thickening of the myocardial wall, and increased cardiac load.
• Valvular heart disease : The heart has four valves: the aortic valve, pulmonary valve, tricuspid valve, and mitral valve, which are responsible for controlling the flow of blood. However, when valvular problems such as stenosis, valve prolapse, or valve regurgitation occur, the heart needs to work harder to maintain normal blood circulation, which increases the workload on the heart.
• Coronary artery disease : The coronary arteries are the blood vessels that supply oxygen and nutrients to the heart muscle. If any coronary artery becomes narrowed or blocked due to cholesterol accumulation, it will cause myocardial hypoxia, inhibit myocardial contraction function, and prevent the pumping of normal blood volume.
• Atrial fibrillation : refers to irregular or frequent rapid beating of the atria, where the atria and ventricles beat at different frequencies, causing blood to stagnate in the heart and increasing the risk of blood clot formation.
• Cardiomyopathy : This refers to problems with the heart muscle. Myocardial ischemia and hypoxia, dilated, hypertrophic, restrictive, or arrhythmogenic right ventricular cardiomyopathy can all weaken the heart and affect the normal functioning of the myocardium.
• Complications of heart valve surgery : After heart valve repair or replacement surgery, complications such as thrombosis and infection may occur, which may lead to heart failure.
• Other factors : obesity, diabetes, severe lung disease, severe anemia, hyperthyroidism, smoking, alcohol abuse, and drug abuse can all increase the burden on the heart.

Methods for detecting heart failure

Electrocardiogram:

An electrocardiogram (ECG) can be used to assess whether the heart has arrhythmias, myocardial ischemia, or myocardial hypertrophy.

Cardiac ultrasound:

It allows observation of the heart structure, systolic and diastolic function, valve opening and closing, and blood flow.

Chest X-ray:

In addition to revealing the size of the heart, a chest X-ray can also show signs of heart failure such as pulmonary edema, pleural effusion, and pulmonary congestion.

Blood test:

Blood tests can display indicators such as blood glucose, blood lipids, cardiac hormones (natriuretic peptides), creatinine hormone, cardiac troponin, blood electrolytes, and liver and kidney function to determine the degree of heart failure.

Cardiac computed tomography (CT) scan :

It provides high-resolution images of the heart, including the structures of the ventricles, atria, heart valves, coronary arteries, and peripheral vessels, and can also examine cardiac systolic and diastolic function.

Preventing heart failure

Besides congenital heart disease, following good and healthy eating and lifestyle habits can prevent and alleviate symptoms of heart failure and slow down the deterioration of the condition.

• Quit smoking
• Quit drinking
• Sufficient sleep
• Reduce stress
• Control blood pressure
• Maintain a healthy weight and avoid obesity.
• Eat foods that promote heart health, such as: fruits and vegetables, fish, olive oil, beans, nuts, and low-fat dairy products.
• Maintain a healthy diet and get balanced nutrition.
• Limit your intake of oil, salt, sugar, and saturated fat.
• Maintain a regular exercise habit