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64 HEART FAILURE
Authors:
Kurmanaliev Nurlanbek Kambaralyevich
Abhishek Singh
Abhishek Sharma
Abu Bakar
Arqam Bahar
Akash Meshram
Oviya raghuraman
Aarifa shaikh
(1, Teacher, Department Of surgery, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.
2,3,4,5,6,7,8 Medical Student, International Medical Faculty, Osh State University, Osh, Kyrgyzstan. )
ABSTRACT
This study explores about the Heart Failure or may be heart attack, cardiac infarction, it is known by different medical names. It is a well pronounced cause of death all over the globe, and the death caused by this cardio vascular disease are expected to increase in nearby future due to our modern lifestyle practices. This course explores the complexities surrounding HF's extensive etiologies, assessment, classification, and staging. This activity for healthcare professionals is designed to enhance the learner's competence in identifying HF, performing the recommended multifaceted evaluation, and implementing an appropriate interprofessional approach when managing this condition, which is essential to improve patient outcomes and quality of life.
Keywords: coronary disease, cardiovascular disease, cardiac infarction, heart attack, lifestyle practices.
I. INTRODUCTION
Heart failure (HF), is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. HF is a common disorder worldwide with a high morbidity and mortality rate. With an estimated prevalence of 26 million people worldwide, CHF contributes to increased healthcare costs, reduces functional capacity, and significantly affects quality of life. Today we are talking about heart failure a term coined by William Harvey during his research on the circulation in 1628. Heart failure today known as Congestive heart failure(CHF) is when heart cannot supply blood to muscles or organs or heart cannot meet the demands, this can happen in two ways either the hearts ventricles can’t pump hard enough during systole called Systolic heart failure or not enough blood fills into the ventricles during diastole called Diastolic heart failure and in both cases blood flow back into lungs causing congestion or fluid buildup which is why it is often known as congestive heart failure. The etiology of HF is variable and extensive. Ischemic heart disease is the leading cause of HF. The general management of HF aims to relieve systemic and pulmonary congestion and stabilize hemodynamic status, regardless of the cause. The treatment of HF requires a multifaceted approach involving patient education, optimal medication administration, and decreasing acute exacerbations.
Few questions
1. List the leading cause of heart failure along with their differences in developed and developing countries?
2. List the risk factors for heart failure?
3. Difference between SHF and DHF?
4. How do lifestyle factor affects individual with heart failure?
Staging:
The ACC/AHA stages of HF are as follows:
• Stage A: At risk for HF. No current or past symptoms, structural heart disease, or evidence of elevated cardiac biomarkers, but risk factors are present. Risk factors include hypertension, diabetes, metabolic syndrome, cardiotoxic medications, or having a genetic variant for cardiomyopathy.
• Stage B: Pre-HF. Patients have no signs or symptoms of HF but have risk factors and structural heart disease, evidence of elevated filling pressures (by invasive or noninvasive assessment), or persistently elevated cardiomarkers in the absence of other reasons for elevated markers, like chronic kidney disease or myocarditis.
• Stage C: Symptomatic HF. Patients with current or past history of HF symptoms.
• Stage D: Advanced HF. Patients with refractory symptoms that interfere with daily life or recurrent hospitalization despite targeted guideline-directed medical therapy.
Symptoms:
LSHF:
1. Dyspnea on excretion – shortness of breath on excretion
2. Orthopnea – shortness of breath lying down flat
3. Paroxysmal nocturnal dyspnea – waking in the middle of night gasping for air
4. Coughing with mucus
5. Lung crackles on auscultation due to pulmonary edema
RSHF:
1. Peripheral edema
2. Distended jugular veins (veins filled with excess blood)
3. Tachycardia
4. Hepatomegaly – enlarged liver due to back flow of blood from inferior vena cava into hepatic veins and hepatic vessels, over a long period of time may lead to liver failure
5. Ascites – swollen abdomen (fluid filled abdomen) due to increased pressure within the hepatic vessels, causing the fluid to be exuded into the abdominal cavity
6. Fatigue – caused due to blood not being pumped effectively to the major organs of body
7. Cognitive deficits – memory issues, anxiety, disruption of sleep, it is due to reduced blood flow to nervous system
8. Chest pain – it may be pain or pressure, it can be secondary to the underlying coronary artery disease, hypotension, and hypoxia
9. Generalized fluid retention can cause anasarca, a condition in which all the serous cavities of the body are filled with fluids.
10. Urine output also goes low or comes down than its normal level in congestive heart failure due to decreased renal perfusion, this further leads to fluid retention.
11. Enlarged apex heartbeat, S3 gallop rhythm, tachypnea
• Heart murmurs - Aortic stenosis
• Mitral regurgitation
• Tricuspid regurgitation
• Swelling in peripheral organs
• Rapid or irregular heartbeat, it can be a sign that heart is not working properly
• Trouble sleeping, abdominal distension, lightheadedness due to inadequate blood flow.
II. RESEARCH METHODOLOGY
In the survey conducted in all over Kyrgyzstan we found that the highest risk of heart failure varies in 30-39 and 40-59 age group respectively.
According to Republican Medical Information Centre of the Kyrgyz republic, cardiovascular diseases was the leading cause of death in 2011, representing half of all deaths.
III. RESULTS AND DISCUSSION
Among all the people that we surveyed maximum people that suffer from heart attacks are of young and able bodied age group, 30-39 and 40-59 age group respectively.
Minimum age group can be even 4-5 year old.
Ejection fraction – is used to measure how well your heart pumps with beat to help determine if a systolic or diastolic problem is present. A normal ejection fraction is usually in the range of 55-70 %.
Ejection fraction = stroke volume \ total volume
Heart failure is due to following reasons -
1. Ischemic heart disease - caused by atherosclerosis is the most common cause in which less blood and oxygen gets through the coronary artery to the myocardium sometimes complete blockage of coronary artery leads to scar tissue formation
2. Hypertension – when arterial pressure increases in systemic circulation it gets harder for the left ventricle to pump blood into the hypertensive systemic circulation to deal with this the left ventricle bulk up resulting in hypertrophy, increased muscle mass means greater demand for oxygen and due to hypertrophy the coronary gets squeezed up because of this squeezing even less amount of blood is delivered to tissues this all will in last leads to systolic failure.
3. Dilated myopathy – in this the heart chamber dilates or grows in size in an attempt to fill the ventricles with larger volumes of blood and stretch out the muscle walls and increased contraction strength this will eventually put stress on muscles making them thin and at last the muscle becomes so thin that it causes systolic heart failure
4. Aortic stenosis
5. Hypertrophic cardiomyopathy
6. Restrictive cardiomyopathy
Complications of HF include:
Reduced quality of life
Arrhythmia and sudden cardiac death
Cardiac cachexia
Cardiorenal disease
Liver dysfunction
Functional valvular insufficiencies (eg, functional MR or TR)
Mural thrombi and risk of thromboembolism (brain, kidney, lung, major limb vessels)
Recurrent hospitalizations and nosocomial infection
1. Ischemic heart disease
2. Cigarette smoking
3. Hypertension ( high blood pressure )
4. Obesity
5. Diabetes
6. Valvular heart diseases ( much higher in old populations )
Hypertension: having hypertension is increased risk of heart failure it leads to complication if remain untreated
Hypercholesterolemia: here elevated level of LDL and triglycerides can lead to increase risks
Age: developing hearts diseases is proportional to the age but not this is not always the case
Other medical conditions: certain medical conditions like prediabetes, metabolic syndromes and cardio vascular disease can increase the risk of heart failure.
By making healthy life style and maintaining balance diet as well as exercise can reduce the risk of diseases.
Managing heart failure involve the composition of healthy life style and medication intervention that’s include “zero” sugar diet and proper exercise. Precautions that a person needs to take are restrictions or less intake of fluids (1.5-2L/day) and sodium intake (<2g/day), and stop smoking and alcohol,preventing respiratory infections, controlling high blood pressure and diabetes. Medications could include Diuretics that helps a person to pass more urine ultimately resulting in removal of extra fluid. There are some medical devices like implantable cardiovascular defibrillator which prevents cardiac deaths and pacemakers also known as artificial heart. Surgical Options like Valve repair/replacement (if valvular cause), Coronary artery bypass graft (CABG), Heart transplantation (in end-stage HF) etc.
As per to research around 200 million people around the globe have coronary heart disease. In which around 110 million were men and 80 million were women suffering from these diseases. According to WHO coronary heart diseases kills an estimated 9-10 million people each year.
As per the survey we are concluding that heart failure is a complex condition that is influenced by many risk factors. And we also see that the heart failure is maximum occur in 45-64 age group because there is improper functioning of heart muscles, reduced coordination.
Congestive heart failure, in the end is the end stage for all chronic or acute diseases affecting the heart whether it is ischemia, hypertension, arrhythmia, etc, which eventually leads to death. In simple words heart failure or congestive heart failure is the inability of heart to pump blood to meet the body’s demands.
For management of heart failure involves various approach includes lifestyle modifications, medication awareness and education.
Prevention is focus on promoting lifestyle, such as maintain a balance diet, avoid tobacco use and manage stress effectively.
· “Heart Failure: A companion to Braun Wald’s Heart Disease” by Douglas L. Mann and G. Michael Felker.
· “Pathophysiology of heart disease: A collaborative project of medical students and faculty” by Leonard S. Lilly.
· “Heart Failure: A comprehensive guide to pathophysiology and clinical care” by Howard Eisen and Carl Leier.
· “Heart Failure: A practical approach to treatment” by David W. Springer and Andrew J. Sauer.
· http://lectur.io/starthere
· “Heart Failure: strategies to improve outcomes” by Christopher O’Connor and Jennifer Green.
· “Cardiology Explained” by Euan A. Ashley and Josef Niebauer.
· “Mayo Clinic Heart Failure: Concise Textbook” by Joseph G. Murphy and Margaret M. Redfield.
· http://bit.ly/3hWldab
· https://bit.ly/3tj3SPJ
· Heart Failure With Reduced Ejection Fraction: A Review – Murphy SP, Ibrahim NE, Januzzi JL Jr. JAMA. (2020) – A comprehensive review of HFrEF including epidemiology, pathophysiology and therapy. JAMA Network
· Heart Failure Management in 2023: A Pharmacotherapy‑ and Lifestyle‑Focused Comparison of Current International Guidelines – MacDonald BJ, Virani SA, Zieroth S, Turgeon R. CJC Open. (2023) – Compares major global guidelines (Canada, Europe, US) focusing on pharmacotherapy + lifestyle. PMC
· Hemodynamics for the Heart Failure Clinician: A State‑of‑the‑Art Review – Hsu S, Fang JC, Borlaug BA. J Cardiac Fail. (2022) – Focuses on hemodynamic aspects of HF, helpful if you cover diagnostics/physiology. OUCI
· Heart Failure With Preserved Ejection Fraction Management: A Systematic Review of Clinical Practice Guidelines and Recommendations – (2024) – Reviews guideline recommendations specifically for HFpEF. PubMed
· Comprehensive Review of the Heart Failure Management Guidelines Presented by the American College of Cardiology and the Current Supporting Evidence – Lazareva L, Shubrook JH, Dhond M. J Osteopathic Med. (2025) – Reviews ACC guidelines and recent trials. De Gruyter Brill+1
· JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure – Japanese guideline on HF diagnosis and treatment, very up-to-date. J-STAGE+1
· Heart Failure: Diagnosis, Management and Utilization – (2016) – Older but still good for background on utilization, admission/readmission issues. PubMed
