Heart failure affects more and more people. Fatigue, shortness of breath first due to exercise, then even at rest, coughing after exercise, at night, ankle swelling are just some of the symptoms of heart failure. Where does this disease come from and how to treat it - explains the cardiologist, prof. Janina Stępińska.
Heart failureis increasingly being discussed in terms of an epidemic that is spreading across Europe and the Americas. In 70 percent. of cases is to blame for coronary heart disease, especially a history of myocardial infarction, 10% is the result of valve disease, another 10 percent. is a consequence of cardiomyopathy. In Europe, 15 million people suffer from heart failure. The incidence of the disease is related to age, and it increases particularly rapidly in people over the age of 60. What is the disease, what arecauses and symptoms of heart failure , we ask prof. dr hab. n. med. Janina
Stępińska, cardiologist, head of the Intensive Cardiological Therapy Clinic at the Institute of Cardiology in Warsaw.
- Is the prevalence of heart failure really so great that it can be said to be an epidemic?
Prof. Janina Stępińska: According to our estimates, over a million people in Poland have heart failure, so talking about an epidemic is legitimate. One of the characteristics of an epidemic is its prevalence and spread. In Poland, the number of patients with heart failure is growing; there are more than twice as many of them as patients with neoplastic disease. There are many reasons for this.
- Before we list them, please explain where does heart failure actually come from?
J.S .: Any disease of the cardiovascular system can lead to failure. Sometimes because she was treated too late or not well-treated.
70 percent cases of heart failure is a consequence of coronary artery disease, especially a recent heart attack, 10% is the result of valve disease, another 10 percent. is a consequence of cardiomyopathy.
Sometimes because, in spite of proper treatment, the heart weakened over time. But the growing number of people with heart failure is also a success of medicine, because now we are able to save people, for example, with extensive myocardial infarction, we are able to surgically treat valve defects.There are greater treatment options and access to specialized clinics. In short, thanks to modern medicine, people who once died survive today, but their hearts remain failing. We must not forget that we live longer and longer and our hearts, like all other organs, are also aging. We see new wrinkles on the face, but we do not see that the heart becomes fibrotic over the years, and this also contributes to its failure. The number of people with a malfunctioning cardiovascular system is constantly increasing. In order to establish a ranking of cardiological causes of heart failure, it can be said that coronary artery disease comes first in Poland. Subsequently, they are: hypertension, heart rhythm disturbances, including atrial fibrillation, diseases or damage to the valves, cardiomyopathies, i.e. diseases of the heart muscle itself, congenital heart defects, infection of the heart valves or the heart muscle. One cannot forget about the non-cardiac causes of heart failure.
- How is heart failure manifested?
J.S .: First of all, fatigue. Initially, the patient gets tired when, for example, he has to go to the 3rd floor. Gradually, his physical capacity is limited - he can no longer enter the 2nd or 1st floor.
Initially, the sick person gets tired, e.g. when he has to enter the 3rd floor. Gradually, his physical capacity is limited - he can no longer enter the 2nd or 1st floor. Later he has shortness of breath while walking the straight road.
Later he has shortness of breath while walking on a straight road. With more advanced heart failure, there is a problem with the simplest of daily activities. The sick person cannot wash, dress or prepare a meal. There may also come a time when lying in bed, he has shortness of breath that requires him to sit down. To assess the degree of heart failure, we use the NYHA scale, proposed by the New York Cardiac Society. Other symptoms include: coughing with exercise, a feeling of fullness in the abdomen, edema, decreased appetite, weight gain, and in the case of very advanced heart failure - cachexia. The severity of heart failure is assessed on the basis of information obtained from the patient about the reduction of exercise tolerance.
- But why does weakness of the heart produce such strange symptoms?
J.S .: The heart is a pump consisting of two atria and two chambers. The left ventricle pumps oxygen-rich blood to all organs. From there, through the venous system, blood returns to the right atrium, flows to the right ventricle, and is pumped to the lungs. Here it is saturated with oxygen and pumped to the leftthe atrium, from where it flows into the left ventricle and is again distributed to our organs. When the heart is inefficient, inefficient, it does not pump as much blood as the body needs. As a consequence, too little oxygen reaches individual organs, or too much blood remains in the organs of the body. This leads to impairment of the functions of important organs, e.g. kidneys, liver, and in the case of very advanced heart failure - also to disturbed consciousness.
ImportantHeart failure: what is this disease?
Heart failure is a group of symptoms, although it is considered a separate disease. According to the current definition, heart failure is a group of ailments in which the heart's ability to pump blood is impaired and to maintain blood flow in accordance with the body's needs. In other words, the heart cannot pump as much blood as all the body's tissues need, and therefore the organs and tissues do not get as much oxygen as they need to function properly. Patients complain that they tire quickly, have shortness of breath, swelling, enlarged liver etc.
- Does being tired quickly always indicate heart failure?
J.S .: No, there are many more reasons. The fact that it is easy to tire may be a consequence of other diseases, such as diabetes or severe anemia. Patients with hypothyroidism or hyperthyroidism or renal failure will complain about fatigue quickly. Of course, the reasons are determined by the doctor on the basis of an interview, examination of the patient, as well as additional tests, e.g. blood analysis. Careful assessment of them allows us to identify non-cardiac causes of fatigue. By treating the underlying disease, we free the patient from such ailments. But most cases of heart failure are caused by the muscle itself not working properly. The heart may fail after a heart attack that has damaged some area of the muscle. The extent of the damage depends on the time when the treatment was introduced. If this occurs within the first hour of the onset of chest pain, it may not become scarred or necrotic, limiting the heart's ability to contract. Therefore, do not hesitate to call for help in case of chest pain.
- Making the diagnosis: Heart failure seems easy. Is it the same with the treatment of this disease?
J.S .: Treatment should begin with determining the cause of heart failure. The next step must be to try to eliminate it. Symptomatic treatment is also an important element of the therapy. We mainly use drugs that relieve the heart, but also, for example, medicationsdehydrating if the patient has edema, slowing down the heart rate if it is too high or lowering blood pressure if high blood pressure has not been properly treated. Treatment of heart failure also includes rehabilitation, physical activity adapted to the individual capabilities of the patient.
- Can lifestyle cause heart failure?
J.S .: Indirectly, yes. A sedentary lifestyle, lack of physical activity, poor nutrition, overweight and obesity all contribute to cardiovascular disease, and these lead to heart failure. It is known that cigarettes do not serve the heart. Alcohol can also damage it. There is a concept of alcoholic cardiomyopathy that occurs in people who overuse strong drinks. The patient does not have atherosclerosis, hypertension, or heart defects, but his heart is damaged by alcohol. This damage prevents the heart from contracting properly. Drugs can also impair heart function. Unfortunately, some drugs used in oncology can also damage the heart and cause heart failure. However, I would like to reassure cancer patients. There is a risk of heart failure during chemotherapy, but we are working with oncologists to keep it to a minimum. Before starting potentially heart-toxic chemotherapy, patients are given medications to take the strain off the heart. But when it comes to your lifestyle, the most important thing is to avoid diseases that can lead to heart failure. I am thinking of primary prevention: active lifestyle, preventing overweight, not smoking, controlling blood pressure, testing blood sugar, total cholesterol and its LDL fraction. Each of us should take our heart seriously and think about it not only when we have troubles.
- The season of autumn colds is approaching. Can downplaying viral infections cause heart failure?
J.S .: Maybe. The heart is sensitive to viruses. Myocarditis may be a consequence of the infection. This is a common problem among young people who do not take infection seriously and often put a career over he alth. Some forms of inflammation progress quickly and lead to severe heart failure quickly. Viral myocarditis is not always cured, sometimes the course is dramatic, of the organ. So it's better to get rid of every flu or infection with a fever, give up playing sports, going to the gym, so as not to overburden your heart.
- Is heart failure treated in Poland as in the rest of the world?
J.S .: We have nothing to be ashamed of. Polish patients are treated in the same way. We have good and effective methods of diagnosing and treating heart failure. We also have the option of implanting devices that improve the work of the heart, because they help it contract better. Other devices protect against dangerous arrhythmias. Maybe it is a bit worse with the availability of devices supporting the work of the heart, but we are coping with this problem better and better. At the end of the list of treatment options for heart failure is a heart transplant. We have several excellent transplant centers, but the problem remains the lack of donors.
ImportantClassification of heart failure
The NYHA scale was developed by the New York Cardiac Society and is used around the world to measure the severity of symptoms of heart failure. The NYHA scale distinguishes between four classes of heart failure.
- Class I - the patient has no restrictions in physical activity. Normal physical activity and daily activities do not cause shortness of breath, fatigue or palpitations.
- Class II - the patient has little limitations in physical activity. Symptoms worsen with exercise but disappear with rest.
- Class III - limiting the possibilities of physical effort is significant. Even such a small effort as getting dressed or washing the body aggravates the symptoms of the disease, mainly shortness of breath. But at rest, the symptoms of the disease do not appear.
- Class IV - patients are unable to perform the simplest activity without exacerbation of symptoms. They also occur at rest, which means that patients become dependent and require constant care.
Among Poles over 65, approx. 39 percent patients with heart failure qualify for NYHA class III or IV.
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