Other conditions that may increase your risk for developing heart failure include:. Heart failure can occur in either the left or right side of your heart.
The left heart ventricle is located in the bottom left side of your heart. This area pumps oxygen-rich blood to the rest of your body. This prevents your body from getting enough oxygen-rich blood. The blood backs up into your lungs instead, which causes shortness of breath and a buildup of fluid. The right heart ventricle is responsible for pumping blood to your lungs to collect oxygen.
The accumulation of blood in the lungs caused by left-sided heart failure makes the right ventricle work harder. This can stress the right side of the heart and cause it to fail. Right-sided heart failure can also occur as a result of other conditions, such as lung disease. Right-sided heart failure is marked by swelling of the lower extremities. This swelling is caused by fluid backup in the legs, feet, and abdomen. Diastolic heart failure occurs when the heart muscle becomes stiffer than normal.
This is known as diastolic dysfunction. It leads to a lack of blood flow to the rest of the organs in your body. Systolic heart failure occurs when the heart muscle loses its ability to contract.
The contractions of the heart are necessary to pump oxygen-rich blood out to the body. This problem is known as systolic dysfunction, and it usually develops when your heart is weak and enlarged. Both diastolic and systolic heart failure can occur on the left or right sides of the heart.
You may have either condition on both sides of the heart. Heart failure can happen to anyone. However, certain factors may increase your risk of developing this condition. There is a higher incidence of heart failure in males compared with females, though the prevalence is about the same for all sexes. People with diseases that damage the heart are also at an increased risk. These diseases include:.
Your doctor may perform a physical exam to check for signs of heart failure. For instance, leg swelling, irregular heart rate, and bulging neck veins may lead your doctor to diagnose heart failure. An echocardiogram is the most effective way to diagnose heart failure. It uses sound waves to create detailed pictures of your heart, which help your doctor evaluate the damage to your heart and determine the underlying causes of your condition.
Physical examination during systolic congestive HF will reveal a S3 heart sound if significant left ventricular dilation is present. A S4 heart sound can be present in diastolic HF. The point of maximal impulse, or PMI, will be laterally displaced and, at times, the S3 can even be palpable. Cardiac murmurs will be present if valvular heart disease is present, contributing to the HF such as aortic stenosis or mitral regurgitation. Physical examination in states of right heart failure may reveal elevated jugular venous pressure including hepatojugular reflux, lower extremity pitting edema and ascites.
Pleural effusions may be present and more prominent on the right compared to the left. Echocardiography is indicated in all patients with a new diagnosis of congestive HF to help determine the etiology. The LV systolic function can be measured, including ejection fraction.
Diastolic function assessment can help determine the left heart pressures. The cardiac valves can be interrogated for significant regurgitant or stenotic lesions. Cardiac catheterization including coronary angiography is indicated whenever angina symptoms accompany a new onset of congestive heart failure Class I. If no angina is present, stress testing to evaluate for ischemia as a contributor is recommended. Alternatively, coronary CT angiography can be done when no angina is present to exclude occlusive coronary artery disease.
Lifestyle modifications to help decrease the risk for volume overload leading to hospitalization is important. Fluid restriction to about 2 L of all liquids daily should be maintained as well as sodium restriction of 2 g daily.
Monitoring daily weights at home in order to dose diuretics on an as-needed or individualized basis is recommended. Educating patients on the importance of medication compliance is crucial to prevent decompensated episodes of HF. There is an abundance of clinical evidence to show many available pharmacotherapies support mortality reduction and symptom improvement in patients with congestive HF. It is important to understand which therapies are the most important and reduce mortality vs.
Angiotensin converting enzyme inhibitors are a class of oral medications that act primarily through blockade of the angiotensin converting enzyme, known as ACE. This enzyme converts angiotensin I to angiotensin II.
Angiotensin II causes vasoconstriction, increasing afterload, and thus increasing systemic blood pressure. Angiotensin contributes to the production of aldosterone, which normally acts to retain sodium and water.
Reducing the activity of the RAAS is crucial in heart failure, during which it is overactive and contributes to negative remodeling. ACE inhibitors can reduce the symptoms of HF and have been shown in multiple clinical trials to have a mortality benefit in patients with systolic HF. Doses usually start low, with up-titratration to a predetermined goal dose if the patient is able to tolerate it.
Commonly-used ACE inhibitors include lisinopril, captopril, ramipril and enalapril. Angiotensin receptor blockers are a class of oral medications that act primarily through blockade of the angiotensin receptor. These drugs have been shown in multiple clinical trials to offer significant mortality benefit.
Beta-blockers antagonize beta-1 and beta-2 receptors — the usual targets of the SNS — including epinephrine and norepinephrine. The overactive SNS has deleterious effects on long-term cardiac function, as described earlier.
Three beta-blockers are approved by the FDA in the United States for the treatment of systolic congestive heart failure: metoprolol succinate, carvedilol and bisoprolol.
Beta-blockers are contraindicated specifically in systolic HF when pulmonary edema is present and when there are signs of cardiogenic shock, severe bradycardia, hypotension or wheezing related to asthma. Beta-blockers should be initiated in patients hospitalized for acute systolic congestive HF prior to hospital discharge. It is reasonable to withhold beta-blockers in patients previously taking them in the outpatient setting for chronic systolic HF when they are admitted with a HF exacerbation.
These drugs have also been shown in multiple clinical trials to offer significant mortality benefit. Normally, when sodium reabsorbs, it is exchanged with potassium, which is then excreted. This can make you feel nauseous or full, even if you haven't eaten. Mental Confusion or Impaired Thinking Abnormal levels of certain substances, such as sodium, in the blood and reduced blood flow to the brain can cause memory loss or disorientation, which you may or may not be aware of.
Fluid Buildup and Swelling Because blood flow to the kidneys is restricted, the kidneys produce hormones that lead to salt and water retention. This causes swelling, also called edema, that occurs most often in the feet, ankles and legs. Rapid Weight Gain The fluid build-up throughout the body, may cause you to gain weight quickly. For example: Heart Grows Larger The muscle mass of the heart grows in an attempt to increase its pumping power, which works for a while.
The heart chambers also enlarge and stretch so they can hold a larger volume of blood. As the heart expands, the cells controlling its contractions also grow. Heart Pumps Faster In an attempt to circulate more blood throughout the body, the heart speeds up.
Blood Vessels Narrow As less blood flows through the arteries and veins, blood pressure can drop to dangerously low levels. To compensate, the blood vessels become narrower, which keeps blood pressure higher, even as the heart loses power. Blood Flow Is Diverted When the blood supply is no longer able to meet all of the body's needs, it is diverted away from less-crucial areas, such as the arms and legs, and given to the organs that are most important for survival, including the heart and brain.
In turn, physical activity becomes more difficult as heart failure progresses. For example: An enlarged heart eventually doesn't function as well as a normal heart, and the extra muscle mass adds stress to the entire cardiovascular system. The organ systems from which blood has been diverted may eventually deteriorate because of an inadequate supply of oxygen. Narrowing of the blood vessels limits the blood supply and can contribute to conditions such as stroke, heart disease and clogged or blocked blood vessels in the legs and other parts of the body.
Pumping blood too fast for too long can damage the heart muscle and interfere with its normal electrical signals, which can result in a dangerous heart rhythm disorder. Living With. Related Issues. Cardiac Asthma: What Causes It? Statistics and Research. Clinical Trials. Article: Response to cardiac resynchronisation therapy in men and women: a secondary Article: Effect of dynamic stratified potassium supplementation in elderly patients with chronic Article: Impaired knowledge in individuals with heart failure: a middle range nursing
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