The Diagnosis and Treatment of Heart Failure

What Signs and Symptoms Indicate Heart Failure? 

By gathering medical history, doing physical exams, and ordering testing, doctors can identify heart failure. 

If you have any additional health issues, such as diabetes, renal disease, angina (chest discomfort), high blood pressure, or other cardiac issues, your doctor will want to know during the medical history, also he would want to know about your smoking habit. If yes, how much do you drink? Do you take any medications? 

During the examination, the doctor will take your blood pressure, listen to your heart and lungs for noises indicative of heart failure, check for swollen neck veins, an enlarged liver, and swollen feet.

How Are Heart Failure Tests Diagnosed? 

Blood tests to look for anaemia, thyroid issues, and high cholesterol, illnesses that might be associated with heart failure, are among the tests your doctor could request to diagnose heart failure. B-type natriuretic peptide (BNP) blood testing is another option that can detect current heart failure. 

Testing the urine for diabetes or renal issues, two conditions that might lead to heart disease. 

ECG or EKG, which measures the heartbeat's rhythm and pace. This examination frequently reveals cardiac problems, heart attacks, an enlarged heart, or irregular heart rhythms that might lead to heart failure. 

X-ray of the chest to determine whether the heart is enlarged and whether the lungs are fluid-filled.

An Echocardiogram is an ultrasound test used to assess heart muscle activity, determine how effectively the heart pumps, and diagnose issues with the heart valves that may lead to heart failure. Ejection fraction (EF) can also be calculated. 

The EF measures how much blood is pushed out of the heart and how much blood flows through the heart with each beat. A typical EF is larger than 50%, which implies that each beat expels more than half of the blood volume in the heart's main pumping chamber.

The left and right ventricles, the heart's two main pumping chambers, may be seen pumping during a heartbeat using radionuclide ventriculography. This examination can help gauge EF. This test, which is seldom done by itself, could be a component of an exercise stress test. 

Cardiac MRI to identify anomalies in the heart muscle from normal tissue and scar tissue. This can measure EF as well. Rarely is this test utilized as the initial step in the diagnosis of heart disease since it is often only accessible in big cardiac centers.

Exercise stress testing, which involves taking an ECG while exercising—such as walking on a treadmill, cycling on a stationary bike, or taking drugs that imitate exercise—is done to look for any cardiac function issues that could be caused by exercise and could be signs of coronary artery disease. 

To see the heart's chambers up close, your doctor may also carry out a number of more invasive procedures including cardiac catheterization. 

This examination can reveal the presence of coronary artery disease and quantify EF.

What are Heart Failure Treatments? 

The goal of heart failure treatment is to reduce or reverse its development. The earlier therapy begins, the better the result. 

Following a diagnosis, your doctor will advise you to make a number of lifestyle modifications. 

You may be urged to achieve and maintain a healthy weight, raise your exercise level (as directed by your doctor), limit your salt intake, limit your hydration intake, and abstain from alcohol. If you smoke or chew tobacco, you should stop. 

You'll need to work with your doctor to establish the correct combination of rest and activity; movement is essential for keeping blood flowing. 

To identify fluid retention, you will also need to weigh yourself everyday and keep track of your weight.

Your doctor will also prescribe drugs to treat your heart failure or the underlying disease that caused it. The following medications are frequently used in combination to treat heart failure: 

Diuretics or water tablets can help minimize or prevent the progression of heart failure symptoms. For example, they may aid in the removal of fluid from the lungs, making breathing easier. When you initially start taking a diuretic, you will pee a lot. 

Bumetanide (Bumex), furosemide (Lasix), and torsemide are the most common diuretics prescribed for heart failure (Demadex).

A thiazide diuretic such as chlorothiazide (Diuril) or metolazone may also be prescribed (Zaroxolyn). Another alternative is a mineralocorticoid receptor antagonist, such as eplerenone (Inspra) or spironolactone (Aldactone), which not only eliminates excess salt and fluid but also retains potassium. 

Potassium supplements replenish potassium lost as a result of diuretic-induced increased urination.

ACE inhibitors, which have a variety of therapeutic benefits in heart failure patients, including acting as vasodilators (they enlarge blood vessels and improve blood flow, allowing the heart to pump more effectively). 

ACE inhibitors are crucial heart failure medications since they have been found to dramatically lengthen life and enhance quality of life in the majority of heart failure patients. 

Captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace), and trandolapril are examples of ACE inhibitors (Mavik).

ARBS (angiotensin-converting enzyme inhibitors) function similarly to ACE inhibitors. 

They are recommended when patients have ACE inhibitor side effects such as coughing or excessive potassium levels. Candesartan (Atacand), losartan (Cozaar), and valsartan are examples of ARBs (Diovan). 

Angiotensin Receptor-Neprilysin Inhibitor (ARNs) is a neprilysin inhibitor and an ARB combined. Entresto (sacubitril/valsartan) is being considered as an alternative to ACE inhibitors or other ARBs.

Beta-blockers can help the heart relax and reduce the generation of damaging hormones by the body in reaction to heart failure. Carvedilol (Coreg) and metoprolol are two beta-blockers used to treat heart failure. 

Digoxin, marketed as Lanoxin, may increase heart pumping performance and regulate some cardiac rhythm issues. 

Digoxin is an older medicine that is not as widely used as it once was since numerous newer medications appear to have greater impact on symptom management and overall outcome. 

Nonetheless, it may be a reasonable supplement for those whose symptoms do not improve with diuretics and ACE inhibitors.

Selective sinus node inhibitors are a kind of medication that targets the sinoatrial pacemaker in the heart. Ivabradine (Corlanor) slows the heart pace and improves the efficiency of the lower left ventricular contraction. 

Soluble Guanylate Cyclase (sGC) stimulators relax and expand blood arteries, allowing blood to flow more freely. 

Patients with persistent heart failure who have been hospitalized or require IV diuretics might be administered vericiguat (Verquvo). It lowers the chance of death and subsequent hospitalization. 

Some of these medications may have unfavourable side effects. Before quitting or reducing the dose of any prescription drugs, always consult with your doctor about any concerns you are having

When medications do not improve heart function sufficiently or cannot be tolerated, surgery or other intervention may be required. 

Doctors recommend surgery for a variety of reasons, including correcting certain problems that cause heart failure (such as coronary artery bypass graft surgery), repairing or replacing valves, implanting devices to help the heart pump (such as an intra-aortic balloon pump, specialized pacemakers, ICDs, or ventricular-assist devices), or transplanting a new heart. To treat severe CHF, heart transplants are utilized.