Heart failure
Failure of the heart to provide sufficient blood flow / From Wikipedia, the free encyclopedia
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to fill with and pump blood.
Heart failure | |
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Other names | Congestive heart failure (CHF), congestive cardiac failure (CCF)[1][2] |
A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow. | |
Specialty | Cardiology |
Symptoms | Shortness of breath, exhaustion, swollen legs[3] |
Duration | Lifetime |
Causes | Heart attack, high blood pressure, abnormal heart rhythm, excessive alcohol use, infection, heart damage[4] |
Risk factors | Smoking, sedentary lifestyle, obesity, exposure to second-hand smoke[5] |
Diagnostic method | Echocardiogram[6] |
Differential diagnosis | Kidney failure, thyroid disease, liver disease, anemia, obesity[7] |
Medication | Diuretics, cardiac medications[4][6] |
Frequency | 40 million (2015),[8] 1–2% of adults (developed countries)[6][9] |
Deaths | 35% risk of death in first year[10] |
Although symptoms vary based on which side of the heart is affected, HF typically presents with shortness of breath, excessive fatigue, and bilateral leg swelling.[3] The severity of the heart failure is mainly decided based on ejection fraction and also measured by the severity of symptoms.[7] Other conditions that have symptoms similar to heart failure include obesity, kidney failure, liver disease, anemia, and thyroid disease.[7]
Common causes of heart failure include coronary artery disease, heart attack, high blood pressure, atrial fibrillation, valvular heart disease, excessive alcohol consumption, infection, and cardiomyopathy.[4][6] These cause heart failure by altering the structure or the function of the heart or in some cases both.[6] There are different types of heart failure: right-sided heart failure, which affects the right heart, left-sided heart failure, which affects the left heart, and biventricular heart failure, which affects both sides of the heart.[11] Left-sided heart failure may be present with a reduced ejection fraction or with a preserved ejection fraction.[10] Heart failure is not the same as cardiac arrest, in which blood flow stops completely due to the failure of the heart to pump.[12][13]
Diagnosis is based on symptoms, physical findings, and echocardiography.[6] Blood tests, and a chest x-ray may be useful to determine the underlying cause.[14] Treatment depends on severity and case.[15] For people with chronic, stable, mild heart failure, treatment usually consists of lifestyle changes, such as not smoking, physical exercise, and dietary changes, as well as medications.[16][17][18][needs update] In heart failure due to left ventricular dysfunction, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors, along with beta blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors are recommended.[6] Diuretics may also be prescribed to prevent fluid retention and the resulting shortness of breath.[19] Depending on the case, an implanted device such as a pacemaker or implantable cardiac defibrillator may sometimes be recommended.[15] In some moderate or more severe cases, cardiac resynchronization therapy (CRT)[20] or cardiac contractility modulation may be beneficial.[21] In severe disease that persists despite all other measures, a cardiac assist device ventricular assist device, or, occasionally, heart transplantation may be recommended.[19]
Heart failure is a common, costly, and potentially fatal condition,[22] and is the leading cause of hospitalization and readmission in older adults.[23][24] Heart failure often leads to more drastic health impairments than failure of other, similarly complex organs such as the kidneys or liver.[25] In 2015, it affected about 40 million people worldwide.[8] Overall, heart failure affects about 2% of adults,[22] and more than 10% of those over the age of 70.[6] Rates are predicted to increase.[22]
The risk of death in the first year after diagnosis is about 35%, while the risk of death in the second year is less than 10% in those still alive.[10] The risk of death is comparable to that of some cancers.[10] In the United Kingdom, the disease is the reason for 5% of emergency hospital admissions.[10] Heart failure has been known since ancient times; it is mentioned in the Ebers Papyrus around 1550 BCE.[26]