Heart failure: When the heart can no longer keep up

28/09/2021

Shortness of breath, fatigue, swollen ankles. Heart failure can cause a range of daily challenges, markedly impacting patients’ quality of life. Although a serious condition, it can be stabilized with medication (and in some cases surgery), as well as lifestyle changes.

Heart failure is when the cardiac muscle becomes less effective at its normal function of pumping blood throughout the body, and thereby in supplying oxygen and nutrients. This highly debilitating condition is often age-related. However, it can also occur in young people, such as those with heart valve malformations.

  • Heart failure affects 64 million people worldwide.1
  • The prevalence of heart failure is around 2% in western countries (European Union, North America). Some Asian countries report much higher figures: 4.5% in Singapore and 6.7% in Malaysia.
  • Heart failure is set to become more common as a result of population ageing: 21.4% of the global population will be over 60 in 2050, compared with 13.5% in 2020.2

The heart, a pump that wears out

The heart is made up of four chambers (two atria and two ventricles) that contract in a coordinated manner to send blood to the lungs for reoxygenation, and then to the rest of the body. This pumping action is performed by the myocardium, a muscle that is supplied by the coronary arteries.

Heart failure is characterized by a gradual loss of heart muscle strength and its ability to contract, which prevents the body from receiving a normal supply of oxygen and nutrients. First it manifests during physical exertion, and then at rest, which forces the heart to compensate by working harder: first by beating faster, then by getting larger (dilation of the chambers, thickening of the walls).

The heart expends more energy in order to circulate fluid in the body, leading to its gradual exhaustion. This creates the risk of cardiac decompensation, also known as the accumulation of water in the lungs (pulmonary edema), which makes breathing difficult and requires emergency hospitalization for intensive care. Rapidly worsening, heart failure can put a tremendous strain on the heart, lungs, kidneys, and other organs.

Heart failure also puts the patient at risk of pulmonary embolism, which is the obstruction of a pulmonary artery by a blood clot.

Initial symptoms: shortness of breath and fatigue

The first symptom of heart failure is shortness of breath, caused by the engorgement of blood in the lungs. Another symptom suggestive of heart failure is fatigue, which is caused by poor irrigation of the muscles that are deprived of adequate nutrients and oxygen.

Due to the accumulation of blood in the vessels, edema can form in certain parts of the body (liver, neck veins, legs). Heart failure also causes water retention due to reduced kidney activity, in addition to memory and libido disorders.

Doppler echocardiogram to monitor cardiac activity

In addition to a clinical examination and blood workup, heart failure is diagnosed on the basis of an electrocardiogram, which includes an exercise tolerance test for young subjects, and imaging.

Doppler echocardiogram uses ultrasound to measure heart chamber size and muscle thickness, and to evaluate the filling and contracting capacity of the left ventricle, which is responsible for pumping blood out into the body. The results distinguish 2 main types of heart failure: heart failure with reduced ejection fraction (known as “systolic” heart failure, which affects the expulsion of blood through the ventricles) and heart failure with preserved ejection fraction (known as “diastolic” heart failure, which relates to impaired atrial filling).

B-type natriuretic peptide (BNP) and N-terminal (NT)-pro hormone BNP measurement in blood helps to determine if worsening fatigue or shortness of breath are due to heart failure or another problem. BNP/NT-proBNP are released in the heart in response to changes in pressure inside the heart. In patients with heart failure, BNP and NT-proBNP levels are higher than in patients with normal heart function.

The doctor also analyses cardiovascular risk factors, such as diabetes, atherosclerosis (fatty deposits on artery walls), smoking, excess weight, and the presence of hypertension or coronary artery disease.

 

Medication and lifestyle

The principal medicines prescribed for heart failure include inhibitors, antagonists, beta-blockers, and diuretics. Diuretics promote the excretion of urine and relieve the heart by reducing the volume of water in the body.

In addition to a specific treatment for heart failure, it is essential to target the causes, such as treating coronary artery disease, including angina, high blood pressure, dyslipidemia, or performing surgery for a defective heart valve. It is equally important to adopt a healthier lifestyle: stop smoking, change dietary habits (cut down on fat, alcohol, and salt), limit fluid intake to reduce the risk of edema, moderate exercise.

 

 

And Servier?

Cardiovascular disease is the leading cause of death worldwide. Servier has been involved in cardiovascular disease treatments for more than 60 years and has acquired recognized expertise. Today, Servier is the third leading global pharmaceutical group in cardiology worldwide. 3

In cardio-metabolism, the focus is on innovation in LCM (Life Cycle Management) to capitalize on the Group’s medicines and innovation expertise, particularly in the development of Single Pill Combinations (SPC). SPCs are medicines combined in a single tablet, which simplify treatment, thereby promoting better compliance.

 

Takeaway

Heart failure is a life-threatening disease that requires regular medical follow-up, with doctor consultations at least every six months until the condition has stabilized.

In addition, it is strongly recommended to:

  • Self-monitor: weigh yourself at least twice a week, take your heart rate and blood pressure regularly, take note of any swelling of the ankles, and assess shortness of breath and fatigue. Warning signs of cardiac decompensation include severe weight gain over a few days (due to water accumulation), increased fatigue and difficulty breathing, palpitations, and loss of appetite or fever.
  • Managing your medications: it’s important that you take your heart failure medicine as prescribed so that you get the best possible outcome from your treatment. You will most likely be prescribed more than one medicine, and during the day there may be many dosing times to remember.
  • Adapting your lifestyle: in addition to managing the heart failure therapy, you may have to adapt other aspects of your lifestyle, such as diet, exercise, smoking, and alcohol consumption. Successful lifestyle adaptations are just as important as medical treatment for managing heart failure.

 


Global public health burden of heart failure, Cardiac Failure Review, April 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494150/

1 GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1211-1259

2 Figures calculated based on World Population Prospects 2019 from the WHO (World Health Organization), https://population.un.org/wpp/

3 IQVIA, Analytics Link – MAT Q1-2021