what is heart failure? complex, chronic and misunderstood
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heart failure is one of the top reasons for hospitalization in canada and as many as one in five heart failure patients will be readmitted to hospital within a month of being discharged, according to research by the heart and stroke foundation.
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nearly half of people with heart failure in canada will die within five years of being diagnosed.
and yet, polls show four in every 10 canadians don’t know what heart failure actually is. is it heart attack? is it cardiac arrest?
none of the above.
what is heart failure?
heart failure is a chronic, progressive syndrome where the heart weakens over time and needs long-term management. certain heart conditions, like narrowed arteries in the heart or high blood pressure, gradually leave the heart too weak or stiff to fill and pump blood properly.
“basically, the heart muscle doesn’t pump enough blood to supply the demands of the body,” says cardiologist dr. diego delgado of toronto’s university health network, who is also a professor of medicine at the university of toronto. he has treated heart patients for 25 years. “so the blood builds up in different organs, like the lungs, for example, and that’s when people have shortness of breath,” he says of one of the most common symptoms of heart failure.
when he explains the diagnosis to patients, he often calls the condition “heart dysfunction” so people understand that their heart isn’t working properly but can be treated with medication and improved lifestyle habits.
knowing the differences between heart failure, heart attack and cardiac arrest is a lot more important than an exercise in medical terminology. it is critical for people to know what to do when they have symptoms.
what is a heart attack?
a heart attack happens when circulation issues prevent blood from reaching the heart. it’s usually the result of a blood clot or because of plaque buildup in the arteries, so tissues in the heart area aren’t getting the oxygen they need to survive. if a heart attack isn’t treated promptly, the heart tissue will start to die. while people recognize the “hollywood heart attack” chest-clutching pain, not all heart attacks are sudden events, and symptoms can start days or weeks before with chest pain, shortness of breath or tiredness.
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furthermore, if someone’s pain is less severe, or if they have non-pain signs like nausea, sudden fatigue or shortness of breath — signs more often reported by women — they are more likely to delay getting to the er, notes the heart and stroke foundation. and they are also less likely to get the fast, aggressive treatment required like oxygen therapy and clot-busting medicines to help maintain blood flow. a heart attack can lead to heart failure by weakening your heart’s pumping ability.
what is cardiac arrest?
then there’s cardiac arrest, a sudden failure of the heart’s electrical system that causes it to stop beating. when the heart isn’t pumping blood to the rest of the body, like the brain and other vital organs, death can happen in minutes without treatment. cardiac arrest can strike anyone at any age for a number of reasons, including a past heart attack. cardiac arrest can also result from heart failure where the heart is already weakened. cardiac arrest is a medical emergency that requires immediate action: call 9-1-1, perform cpr and use an aed, or automated external defibrillator, if possible, until emergency help arrives.
delgado points out that these three heart conditions can be prevented, for the most part, by addressing underlying behavioural risk factors like tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol. while you can’t change your family history, sex at birth or age, proven prevention strategies are within your control.
heart failure symptoms and prevention
a comprehensive review of the impact of lifestyle interventions on heart failure in the journal of the american college of cardiology in 2018 found that achieving and maintaining high levels of fitness and maintaining normal body weight have the most compelling benefits for prevention, while exercise therapy has the strongest evidence for patients with heart failure. researchers also noted that stress reduction through mind and body activities like yoga and tai chi has many health benefits, although the long-term efficacy on heart failure is not yet clearly defined. they recommend healthcare providers encourage heart failure patients to enroll in cardiac rehabilitation programs and engage in home exercise options.
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equally important is knowing what’s going on with your body. delgado explains that shortness of breath with activity or when you’re lying down is one of the most common symptoms of heart failure, along with noticeable fatigue and swelling in the ankles and feet. symptoms can develop slowly over time or come on suddenly, but elderly people especially can dismiss them as something that just happens with aging and they don’t tell their doctor. but if it’s left untreated, symptoms can get a lot worse and could lead to hospitalization.
“people will have trouble breathing. they will have significant fluid retention in the legs and in the abdomen. they will be unable to lay down flat in bed or be up in the middle of the night, gasping for air,” delgado says of symptoms in patients with more advanced heart failure.
“blood can accumulate in different organs like the bowel, the guts, so some people can feel swelling in the belly area. they might have nausea or vomiting or they’re unable to tolerate foods.”
lack of oxygen-rich blood circulating properly also can affect your brain, or cerebral blood floor, so symptoms are also linked to memory and attention loss.
“i can tell you after seeing patients in my clinic complaining of these very advanced symptoms, it is very frustrating for them. there’s a lot of anxiety and depression.”
severe heart failure can land you in hospital on a ventilator to keep you breathing, or in surgery for blocked arteries or heart valve repair, depending on your situation. heart failure is one of the top reasons for hospitalization in canada and as many as one in five heart failure patients will be readmitted to hospital within a month of being discharged, according to research by the heart and stroke foundation.
while people assume heart failure only happens to the elderly, delgado and others are seeing more people in their 50s, 40s and younger, including kids, being diagnosed because of better tools for detection as well as an increase in some risk factors. rising obesity, diabetes and hypertension, or high blood pressure, put you at higher risk for heart failure.
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the best thing to do is see a doctor regularly for a blood pressure check and to talk about your risks. and if you are particularly concerned, you can ask for a physical exam. the doctor may order tests like an electrocardiogram to monitor heartbeat, a chest x-ray or an echocardiogram, which is an ultrasound of the heart. there is also a blood test to look for biomarkers of heart failure.
early diagnosis means earlier treatment on medications that can help to release water retention, stabilize the heart and prevent further damage, delgado says.
“i think we are seeing that people are more aware of preventative medicine in terms of eating healthier, and being proactive about doing blood work, checking cholesterol regularly and monitoring blood pressure at home. it’s positive to see people taking the initiative.”
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