Mt Elizabeth Hospital, 3 Mount Elizabeth #14-13, Mt Elizabeth Medical Centre, S228510
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Heart Failure

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What is heart failure?

Heart failure describes a condition whereby the heart is weakened and does not pump blood as efficiently as it should. It is also known as congestive heart failure and is often the result of other conditions like coronary artery disease or high blood pressure. 

What causes heart failure?

Heart failure is usually caused by underlying conditions that have caused damage to the heart. Some common examples of this include:

●     Coronary artery disease (CAD)

This refers to the buildup of plaque in the coronary arteries, causing them to become clogged or narrowed. CAD is known to lead to heart attacks, which may result in damage to the heart muscles. Coronary artery disease is the most common cause of heart failure.

●     Hypertension

In hypertension, more commonly known as high blood pressure, the heart has to work harder to pump blood throughout the body. This increased stress on the heart can cause it to grow weaker or become stiff.

●     Cardiomyopathy

Cardiomyopathy is any disease of the heart muscles and can sometimes be congenital. Such conditions make it harder for the heart to pump blood to the rest of the body, resulting in a weakened heart.

●     Arrhythmia

Arrhythmias are conditions where the heart beats abnormally, usually either too fast or too slow. Long-standing abnormally fast heart beats over time, can lead to weakened heart muscles and heart failure.

●     Heart valve disease

Heart valve disease is a condition where one or more of the valves of the heart — which ensure that blood flows in the correct direction — do not function properly. This results in increased stress on the heart, which will cause it to weaken over time.

●     Metabolic conditions

Some endocrine disorders are known to contribute to the development of heart failure. Examples include diabetes and hyperthyroidism.

What are the symptoms of heart failure?

Heart failure may be either chronic or acute. Some common signs and symptoms to look out for are:

  • Chest pain
  • Fatigue or weakness
  • Difficulty breathing, especially after physical exertion or when lying down
  • Shortness of breath
  • Swelling in the abdomen or lower limbs
  • Arrhythmia
  • Persistent cough with white or pink blood-tinged phlegm
  • Increased urination at night
  • Nausea
  • Decreased appetite
  • Difficulty concentrating

When should I go to a doctor?

Dr Devinder Singh of Cadence Heart

You should see a doctor if you are experiencing any of the above symptoms, especially if you are being treated for other conditions known to cause heart failures, like CAD or hypertension.

If you are experiencing acute pain in your chest, fainting, arrhythmia, or are coughing up white or pink blood-tinged phlegm, please seek immediate medical attention.

You should also see a cardiologist if you have already been diagnosed with heart failure but your symptoms appear to be worsening. This may mean that your body is not responding well to your current treatment plan.

What complications can arise from untreated heart failure?

Left untreated, heart failure can lead to a number of serious complications, including:

  • Various types of arrhythmia
  • Kidney failure
  • Anaemia
  • Heart valve disorders
  • Stroke
  • Cardiac cachexia
  • Liver damage
  • Lung damage
  • Extreme weight and muscle loss

Who is more likely to suffer from heart failure?

Besides the presence of any of the conditions known to cause heart failure, several factors can increase your risk of developing heart failure. These include:

  • Age

People over the age of 65 are more likely to suffer from heart failure.

  • Gender

Men are at a higher risk of developing heart failure than women.

  • Family history of heart failure
  • Obesity

In addition, certain lifestyle factors such as smoking, substance abuse, or leading a sedentary lifestyle can also increase your likelihood of developing heart failure.

What can I expect during my first consultation?

During your first consultation with a cardiologist, he or she will ask you a series of questions regarding your current symptoms as well as your personal and family medical history. Your cardiologist will most likely also perform a physical examination during your consultation.  If necessary, he or she may order various blood or diagnostic imaging tests to help them come to a more accurate diagnosis. Some examples of these include:

How is heart failure treated?

Patient with pills

Heart failure treatment is largely dependent on the underlying cause of the heart failure and can be cured assuming the cause of heart failure is treatable. For example, this could take the form of repairing a damaged heart valve or treating heart arrhythmia.

In chronic cases, however, treatment for heart failure may involve various medications or even the use of devices to help the heart beat effectively — and therefore pump blood — normally.

In the initial stages of treatment, medications like beta-blockers, ACE inhibitors, ARBs, ARNI, mineralocorticoid receptor antagonists and SGLT2 inhibitors will be prescribed in addition to making certain lifestyle changes pertaining to diet or physical activity levels. If these do not prove to be effective, patients may require the use of devices, various surgeries, or in the most extreme cases, a cardiac transplant. Some examples of these treatment options are:

  • Cardiac Resynchronisation Therapy (CRT)
  • Implantable Cardioverter-Defibrillators (ICDs)
  • Ventricular Assist Devices (VADs)
  • Heart valve repair or replacement
  • Coronary bypass surgery
  • Heart transplant

What to expect post-procedure

Following any of these procedures or surgeries, you may be required to abstain from certain activities such as contact sports, swimming, or vigorous physical activity during the immediate recovery period, which will vary depending on the procedure performed. You may also need some physical or occupational therapy, especially in cases of heart transplants. Your cardiologist will let you know what to expect during a pre-procedure consultation.

In addition, after any device implantation, some lifestyle changes are to be expected. You may have to avoid MRIs or adapt to the various sensations produced by these devices. For example, an ICD is known to cause a painless fluttering in the chest or even short-term chest pain when a high energy shock is needed to regulate heartbeat. Your cardiologist will be able to go through these lifestyle changes with you in more detail before your procedure.

As with other heart conditions, it is also important to lead a heart-healthy lifestyle after any procedures are performed to ensure that your heart remains as healthy as possible and to prevent any further issues from developing.

Summary

While heart failure cannot always be reversed, there are some definite steps that you can take in order to improve your symptoms and lead a normal life. This will involve lifestyle changes such as:

  • Eating a heart-healthy diet
  • Reducing alcohol consumption
  • Quit smoking
  • Perform regular physical activity
  • Maintain a healthy weight
  • Reduce stress levels
  • Effectively manage underlying conditions like diabetes or high blood pressure

When it comes to the heart, prevention is key. Even if you have not been diagnosed with heart failure, these are important ways in which you can prevent the development of any heart-related conditions. Early detection is also important, so do not hesitate to visit a cardiologist if you suspect that you are currently suffering from heart failure or are susceptible to developing heart failure in the future.

Dr Devinder Singh

Senior Consultant Cardiologist &
Cardiac Electrophysiologist

Dr Devinder Singh is the Medical Director of Cadence Heart Centre. He is an experienced Senior Consultant Cardiologist & Cardiac Electrophysiologist with over 20 years of clinical experience.

His expertise lies in clinical cardiology, cardiac rhythm disorders (arrhythmia), cardiac pacing (including cardiac resynchronisation therapy) and cardiac magnetic resonance imaging. He performs electrophysiology studies and radiofrequency ablation of cardiac arrhythmias, and is well versed in pacemaker and defibrillator insertions.

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    Mt Elizabeth Hospital, 3 Mount Elizabeth #14-13
    Mt Elizabeth Medical Centre, Singapore 228510
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