Cardiac failure

Definition

Cardiac failure is a condition characterized by the inability of the heart to pump an adequate flow of blood to meet the needs of the body. It is common and can be progressive with a high mortality rate. The frequency of this disorder has grown over the past years. Admissions to hospitals due to cardiac failure have tripled since 1970 and less than half the patients diagnosed with this condition survive a five year period.

Causes

Many common cardiovascular diseases can eventually develop into a condition marked by a dysfunction of the cardiac muscle. Among these conditions is disease of the coronary arteries of the heart or ischemic cardiomyopathy, hypertensive cardiomyopathy due to chronic high blood pressure, diseases of the cardiac valves or valvulopathies, diseases of the cardiac muscle or myocardiopathies, diseases of the pericardium (membrane that covers the cardiac muscle) such as constrictive pericarditis and cardiac tamponade.

Clinical manifestations

Clinical manifestations of cardiac failure appear in patients with recognized forms of cardiovascular diseases such as coronary artery disease, hypertension, diseases of the myocardium, etc.

The most frequent symptom is fatigue or breathlessness which reduces the patient’s ability to physically exert themselves. In other instances symptoms can include fatigue or nocturnal dyspnea (when going to bed) and edema or swelling of the legs and feet due to water and salt retention.

Patients usually present themselves to their physician with secondary symptoms of cardiac failure, such as fluid retention and volume overload, rather than the primary manifestations of cardiac insufficiency.

Evaluation of the patient

The most important aspects of the physical examination conducted by the doctor are measuring blood pressure, determining the strength and characteristics of peripheral pulses (arterial and venous) and an examination of the heart.

Laboratory tests are important to evaluate symptoms as well as the cardiac function itself. Several tests can help define the severity of the cardiac failure: treadmill stress test, conducted in a treadmill belt or upright bicycle, chest X-ray, electrocardiogram, measurement of the ventricular function by echocardiogram, and blood testing of kidney function and electrolytes.

Treatment

A low-sodium diet is the first step in treatment as sodium (common salt) and water retention are typical in congestive cardiac failure. In patients who are overweight or obese, losing weight complements the pharmacological treatment the physician will recommend. A pharmacological treatment using diuretics , vasodilators, inotropic drugs (which improve the contraction of the cardiac muscle), anti-arrythmics, and currently, selective beta blockers, aim at improving the quality of life, slowing the progression of cardiac failure and prolonging life.