What is it?
It is a complex syndrome in which the heart becomes weak and its activity becomes inadequate for the body.
If irreversible damage to the heart develops, the heart and the entire cardiovascular system adapt by compensatory mechanisms. Should these efforts also fail, chronic heart failure develops. Without adequate functional reserve, the heart becomes destabilised and cannot respond effectively to organ metabolic demands. Such destabilisations can impair the residual function of the heart and make the situation even worse.
Despite recent advances in the understanding of pathophysiological mechanisms and the development of new therapeutic strategies, the prognosis of chronic heart failure is comparable to that of malignant neoplasms, and mortality remains high.
However, if treated and controlled at early stage, the disease can show satisfactory treatment outcomes.
Causes and risk factors
Chronic heart failure is a growing public health problem: it affects 1-2% of the population in Western countries and still has a high mortality rate, despite progress in understanding the causes and developing new treatments.
- previous heart attack;
- toxic effects;
- infectious complications;
- adverse drug reactions.
Sometimes heart weakness is caused by the valves losing their anatomical integrity or becoming excessively narrow and insufficient.
Which are the symptoms?
- weakness (asthenia);
- decreased diuresis (oliguria) and the need to urinate more often at night (nocturia);
- accumulation of fluid throughout the body (oedema);
- palpitations (arrhythmias);
- difficulty breathing (dyspnoea);
- need for extra pillows to sleep (orthopnea).
How is it diagnosed?
How is it treated?
Programme combining medication with changes in lifestyle and habits.
Administration of drugs to
- remove excess fluid that accumulates in lungs and causes swelling of legs;
- improve blood circulation by artery dilatation with subsequent reduction of cardiac load;
- improve cardiac pumping ability;
- prevent abnormal heart rhythm or irregular heartbeat;
- prevent blood clots.
It is recommended to consume as little salt as possible, as it can cause fluid retention. It is recommended to take sodium-free or low-sodium food, and to weigh regularly. Rapid weight gain can indicate fluid retention in the body. In this case examination by a cardiologist is advisable.
The causes of decompensation can rarely be resolved. Therefore, prevention remains the best strategy and includes:
- blood pressure monitoring
- coronary and rheumatic heart disease control and treatment;
- correction of valvular defects;
- control of risk factors (e.g. smoking or alcohol consumption);
- stimulating physical activity.
In case of irreversible damage, it becomes important to preserve the healthy part of the heart by keeping it functional for as long as possible and avoiding excessive functional stress.
In patients with chronic refractory heart failure heart transplantation is currently the only option that can significantly improve the long-term prognosis. In common patients being unsuitable for transplantation, alternative solutions may be used on a case-by-case basis: pharmacotherapy, surgery or even ultrafiltration, a treatment to remove excess fluid in patients with heart failure who developed resistance to diuretics.
Where do we treat it?
- Department of Clinical Cardiology @ Ospedale San Raffaele
- Department of Interventional Cardiology @ Policlinico San Donato
- Department of Cardiothoracic Anesthesia and Intensive Care @ Ospedale San Raffaele
- Department of Cardiovascular Anesthesia and Intensive Care @ Policlinico San Donato
- Department of General Intensive Care @ Ospedale San Raffaele
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