Heart failure #1 : What is heart failure ?

I) Heart failure and cardiovascular diseases

Cardiovascular diseases are a group of disorders related to the heart and blood vessels [1]. Each year, these diseases are the leading cause of death worldwide [1]. In 2015, 7.4 million deaths worldwide were due to coronary heart disease and 6.7 million to strokes [1]. Heart failure (HF) is a cardiovascular disease that is a major public health problem. Also called congestive heart failure (CHF), it is a condition that indicates a heart dysfunction. The heart loses its normal muscular strength and ability to contract, and no longer pumps enough blood to allow the organs to receive enough oxygen and nutrients to function properly [3].

Heart failure can be:

• Systolic, in which case the ventricle is unable to expel enough blood into the body [6].
• Diastolic, in which case the ventricle is able to expel blood but struggles to fill up following contraction (due to a lack of flexibility in its walls for example) [6].

Focus on heart failure worldwide and in Africa

• More than three-quarters of cardiovascular disease-related deaths occur in low- and middle-income regions, including Africa. [1]
• Heart failure affects approximately 26 million people worldwide [2].
• In 2015, CHF was the cause of 36.4% of hospitalizations in Africa [2].
• 50% of patients hospitalized for CHF in Africa are under 55 years of age [2].

II) What are the main pathologies that can cause heart failure ? 

Heart failure can be the consequence of different pathologies.

1. Myocardial infarction

Myocardial infarction, often called “heart attack”, is the most common cause of heart failure [3]. Myocardial infarction occurs when arteries become blocked by fat that builds up and forms patches. These patches can break off and migrate into the arteries that supply the heart. In this case, a blood clot forms and prevents the heart from receiving the blood and oxygen it needs to function. This is called a heart attack. [4].

When a patient survives a heart attack, the heart suffers many damages and can no longer function normally, it loses its strength. Irreversible damage is done to parts of the heart muscle, which can result in heart failure [3].

2. High blood pressure

When not properly controlled, high blood pressure can also lead to heart failure [3]. In patients with high blood pressure, the walls of the arteries become stiffer, which increases their blood pressure. The heart thickens to withstand this pressure and remain efficient, but eventually weakens and leads to heart failure [3].

3. Diabetes

Cardiovascular diseases are strongly linked to diabetes and are one of the causes of death in diabetics.  Diabetics suffer from an excess of glucose in the blood. This glucose sticks to elements in the blood such as proteins or fats. This sticking can create a clot and therefore suddenly stop the blood flow. Heart attack and heart failure are the health problems most strongly correlated with diabetes [8,9].

4. Other conditions

Other less common factors can cause HF. These include:

• Heart valve diseases.
• Rhythm disorders.
• Lung diseases such as pulmonary hypertension [3].

III) What are the risk factors for heart failure ? 

1. Behavioral risk factors

The occurrence of heart failure can be encouraged by habits and behaviors that patients are able to avoid or eliminate. These are known as modifiable risk factors and it is essential to act on them.

Thus, to reduce the risk of heart failure, it is recommended to avoid:

• Smoking [5]
• Sedentary lifestyle [5].
• Obesity [5]
• Excessive cholesterol [5].
• Excessive consumption of alcohol or drugs [3].
• Too much salt in the diet [5].
• An unbalanced or insufficient diet [5].

2. Non-modifiable risk factors

Although adopting a healthy lifestyle can help protect you from heart disease, some factors cannot be modified. These factors may play a role in the development of HF and cannot be changed [10].

These include:

• Age: the probability of developing heart disease increases significantly after age 50 in men and after age 60 in women [11].
• Gender: Men are at greater risk of developing heart disease, including before the age of 60 [11].
• Heredity: people who have parents with heart disease at an early age have an increased risk of experiencing cardiovascular diseases. [11]
• Ethnicity: people of African and South Asian origin have a higher risk. [10]

IV) What are the symptoms of heart failure ?

Several symptoms can reveal the presence of heart failure in the patient. These symptoms are due to the bad circulation of blood in the organism which causes 2 effects: the retention of liquids and the decrease of the blood supply to the various parts of the body.

Some of these symptoms, when combined, are warning signs to be taken seriously. If you experience any of the following symptoms, it is imperative that you seek medical attention:

• Sudden weight gain
• Unusual fatigue
• Presence of edema
• Shortness of breath

V) The diagnosis of heart failure

According to the United Nations, a large majority of deaths from cardiovascular disease occur in low-income countries [1]. The average age of deceased patients is much lower in these regions [1]. This is because these diseases are easier to treat when detected early. However, people in low-income countries often lack integrated primary health care programs that can diagnose and support patients properly [1]. In addition, the health care costs associated with treatment are often expensive and out of reach for patients.

The diagnosis of heart failure is only made by a healthcare professional. At first, the patient has no symptoms and then his or her quality of life deteriorates through the appearance of palpitations, fatigue, shortness of breath and other symptoms. The physician usually performs a medical workup and other tests to evaluate the stage of the disease and to investigate its cause [7].

In addition to questioning the patient and taking a medical and family history, the physician may perform the following tests:

• A clinical examination by the cardiologist or physician [7].
• A blood test to look for fatty abnormalities, kidney dysfunctions, etc. [7]
• Chest X-ray to check the size of the heart and the condition of the lungs [7]
• Cardiac Doppler ultrasound [7].
• Electrocardiogram [7]
• Cardiac MRI in special cases [7]
• Stress test

If you experience any symptoms that may be indicative of heart failure, make an appointment with your doctor immediately.

If you want to know more about the treatments and the changes to make to better live with heart failure, please click here

SOURCES:

[1] Cardiovascular Diseases – WHO – Available at: https://www.who.int/fr/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

[2] Heart Failure in Africa, Asia, the Middle East and South America by Hisham Dokainish et al – The burden of heart failure in Africa by Gad Cotter et al.

[3] Definition and causes of heart failure – Ameli- Available at: https://www.ameli.fr/assure/sante/themes/insuffisance-cardiaque/definition-causes

[4] Definition and precipitating factors of myocardial infarction- Ameli- Available at: https://www.ameli.fr/assure/sante/themes/infarctus-myocarde/definition-survenue-facteurs-favorisants

[5] RISK FACTORS OF HEART FAILURE- VIDAL- Available at: https://www.vidal.fr/maladies/coeur-circulation-veines/insuffisance-cardiaque-chronique/facteurs-risque.html

[6] SYMPTOMS AND EVOLUTION OF HEART FAILURE- VIDAL – Available at: https://www.vidal.fr/maladies/coeur-circulation-veines/insuffisance-cardiaque-chronique/symptomes-evolution.html

[7] Symptoms, diagnosis and evolution of heart failure – Ameli – Available at: https://www.ameli.fr/assure/sante/themes/insuffisance-cardiaque/symptomes-diagnotic-evolution#text_5722

[8] Diabetes and heart failure: what is the relationship and how to prevent it – Harmanium Pharma Rooted in Diabetes – Available on : Diabetes and heart failure: what relationship and how to prevent it – Harmonium Pharma (harmonium-pharma.fr)

[9] Diabetes and heart disease: three frequently asked questions – CoeuretAVC – Available on : Diabetes and Heart Disease: Three Frequently Asked Questions | Heart and Stroke Foundation (heartandstroke.ca)

[10] Non-modifiable risk factors – Health at Home – Available at Non-modifiable risk factors – Heart – HealthAtHome.com

[11] Cardiovascular risk and its factors – Ameli – Available at: https://www.ameli.fr/assure/sante/themes/risque-cardiovasculaire/definition-facteurs-favorisants

[12] – Symptoms of heart failure – Heart Failure Matters – Available at: https://www.heartfailurematters.org/fr/comprendre-linsuffisance-cardiaque/symptomes-de-linsuffisance-cardiaque/

POI 0717-09/22