Causes of Heart Failure 

Introduction

Have you ever wondered why heart failure is becoming a major health crisis in India? With increasing cases linked to high blood pressure, diabetes, and changing lifestyles, it has become a major health concern¹.

In fact, studies have shown that every year, 0.4% to 2.3% Indians develop heart failure due to coronary heart disease which could lead to fatal outcomes^2,3. Addressing this challenge requires better public awareness, early detection, and stronger healthcare support¹. 

What is Heart Failure?

Heart failure, also known as congestive heart failure, occurs when the heart is unable to pump enough blood to meet your body’s needs. Despite its name, heart failure does not mean the heart has stopped working, but it is a serious condition requiring medical care⁴. 

A healthy heart pumps oxygen-rich blood to organs and tissues. In heart failure, one or both sides of the heart struggle to circulate blood properly. Your heart may not be able to fill enough blood, or your heart may be too weak to pump blood properly. Heart failure can be divided into right heart failure and left heart failure^4,5.

• Left-sided heart failure: This occurs when the left ventricle fails to pump blood effectively, leading to fluid buildup in the body including lungs. Common causes include hypertension, coronary artery disease, and myocardial infarction. 
• Right-sided heart failure: This is when the right ventricle cannot pump blood efficiently causing fluid retention in the body (legs, abdomen). The main causes of right heart failure include left-sided heart failure, pulmonary hypertension, or chronic lung diseases. 

Whatever be the causes of right heart failure or left heart failure, it can lead to life-threatening consequences if not managed properly^4,6.

Causes of Heart Failure

Are you wondering what causes heart failure? It often results from the added strain caused by certain health issues that either damage the heart or force it to work harder than it should^7,8.

The main causes of heart failure include:

• Coronary Artery Disease: Coronary artery disease occurs when your blood vessels supplying the heart become hardened and narrowed due to deposition of material known as plaque. Fatty deposits in the heart’s arteries reduce blood flow and oxygen which can lead to heart failure⁹. 
• Past Heart Attack (Myocardial Infarction): A heart attack occurs when an artery blockage restricts blood flow, damaging heart tissue and weakening its pumping ability, potentially causing heart failure. 
• Abnormal Heart Valves: Heart valve problems can occur due to disease, infection (such as endocarditis), or defects present at birth. The reasons for heart failure in these conditions is your heart valves not opening or closing fully. In such cases, your heart must work harder to pump blood, which may lead to heart failure. 
• Heart Muscle Disease (Cardiomyopathy): Conditions like dilated cardiomyopathy (enlarged or stiffened heart) or myocarditis (heart muscle inflammation) can weaken the heart, reducing its ability to pump blood and causing heart failure. 
• Congenital Heart Defects: Heart defects present from birth can cause parts of the heart to be malformed or not work correctly. As a result, the healthy parts of your heart must work harder to compensate, which can eventually lead to heart failure. 
• Other Conditions: Several factors may cause temporary heart strain, leading to heart failure symptoms:
  • Hypertension: High blood pressure may overwork and weaken the heart¹⁰.
  • Severe Anaemia: Low red blood cells may reduce oxygen, making the heart work harder. 
  • Hyperthyroidism: An overactive thyroid may increase heart strain. 
  • Arrhythmia: The reason for heart failure is that irregular heart rhythms may prevent efficient blood pumping. 

Understanding the various causes of heart failure highlights the importance of early detection, proper management, and lifestyle modifications to reduce the risk and maintain heart health.  

What is Your Risk of Heart Failure?

Though there are many unpredictable causes of heart failure, there are some known factors that increase your risk of facing this condition. These include¹¹:

• High blood pressure: Constant high pressure makes the heart work harder, which weakens it over time and can lead to heart failure. 
• Type 2 diabetes: It often leads to high blood pressure and atherosclerosis, increasing the risk of heart failure. 
• Metabolic syndrome: This is a group of conditions (high blood sugar, obesity, and high blood pressure) that may increase the risk of heart disease and heart failure. 
• Improper functioning of thyroid gland: An overactive thyroid can speed up the heart rate and lead to heart problems. 
• Increasing age: People over 65 are more likely to develop heart failure as the heart naturally weakens with age. 
• Lifestyle: Smoking, being overweight, and alcohol or drug abuse can increase the risk of heart failure. This is how these conditions can lead to heart failure: 
  • Smoking may damage your blood vessels and reduce oxygen supply to the heart 
  • Obesity can put additional strain on the heart muscle functioning.  
  • Alcohol and drug abuse can weaken the heart over time, leading to complications that affect its ability to pump efficiently. 
• Race and ethnicity: Black people have a 19% higher risk of heart failure than white people, often developing it earlier and more severely. Hispanic people also face a higher risk due to multiple factors like health disparities and increased heart disease risk. 

These conditions may contribute to what causes heart failure in many individuals. It is best to consult your doctor and seek medical care to manage your health and improve your quality of life¹¹.

Diagnosis of Heart Failure

Diagnosing heart failure involves reviewing medical history, a physical exam, and various tests to assess heart function¹².

1. Medical History and Physical Examination

Your doctor will ask about symptoms, when they start, frequency, medications, and risk factors. A physical exam may be done to check for any swelling or fluid retention, heart/lung sounds, and to assess your overall health¹². 

2. Blood Tests

This includes¹²:

• Brain Natriuretic Peptide (BNP) Test: Increased BNP levels indicate heart failure 
• Kidney and Liver Function Tests: Since heart failure can affect kidney and liver function, these tests check for any abnormalities. 
• Electrolyte and Thyroid Tests: Electrolyte imbalances and thyroid issues can contribute to heart failure symptoms. 

3. Imaging Tests

This includes¹²: 

• Echocardiogram: This ultrasound of the heart provides images of heart size, structure, and function. It helps measure ejection fraction which is the percentage of blood pumped out of the heart per beat to determine your risk of heart failure. 
• Other Imaging Tests: This includes CT scan, MRI, nuclear scan, or angiography to check blood flow and heart structure. 

4. Electrical Activity Tests

This includes¹²: 

• Electrocardiogram: Records electrical signals in the heart to detect irregular rhythms, past heart attacks, or strain on the heart. 
• Holter or Event Monitor: A portable device worn for 24-48 hours (or longer) to record heart activity over time. 

These diagnostic tests help doctors determine the type and severity of heart failure, leading to better treatment and management options. 

Treatment for Heart Failure

Heart failure is a chronic condition that may require a comprehensive approach to manage symptoms, improve quality of life, and extend survival. While there is no cure, heart failure treatment options may help control the condition and prevent complications¹³.

1. Lifestyle Changes 

Heart-healthy habits, such as reducing sodium intake, maintaining a healthy weight, staying active, quitting smoking, and limiting alcohol, could help patients with heart failure. Additionally, managing blood pressure, stress, and sleep quality may also support heart function¹³. 

2. Medications

Medications that may help improve heart function and reduce complications include¹⁴: 

• Angiotensin Converting Enzymes (ACE) Inhibitors & Angiotensin II Receptor Blockers (ARBs) – Help lower blood pressure and reduce heart strain. 
• Beta-Blockers – Lower the heart rate and improve function. 
• Aldosterone Antagonists & Diuretics – Manage fluid balance and reduce swelling. 
• Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors – Mainly for diabetes but may also benefit heart failure. 
• Vasodilators like Hydralazine & Nitrates – Relax the blood vessels and improve blood flow. 
• Cardiac Glycosides like Digoxin – Help regulate heart rate and strengthen contractions. 
• Additional Medications – May include potassium/magnesium supplements, blood thinners, statins, and oxygen therapy when needed. 

Always take these medications only when prescribed by a registered doctor in the dose and frequency advised by them. 

3. Surgical Procedures & Device Implants

If medications and lifestyle changes are insufficient, procedures or devices may be considered¹³: 

• Biventricular Pacemaker – Could help coordinate heart contractions. 
• Implantable Cardioverter Defibrillator – Could detect and correct irregular heart rhythms. 
• Ventricular Assist Device/Total Artificial Heart – May aid circulation. 
• Heart Surgery/Transplant – May be necessary for structural defects or end-stage failure. 

It is always recommended that you consult your healthcare provider and follow their instructions to understand the best line of treatment for you. 

Complications of Heart Failure

The complications of heart failure include¹⁵:

• Trouble breathing due to fluid in your lungs (heart failure) 
• Kidney or liver damage, including cirrhosis 
• Poor nutrition if fluid buildup makes eating hard or if your stomach doesn’t get enough blood to digest food 
• Heart problems like irregular heartbeat or sudden heart failure 
• High blood pressure in the lungs (pulmonary hypertension) 

Early detection and appropriate treatment are key to managing complications of heart failure and preventing further harm to organ function and overall health¹⁵.

Prevention Tips

Preventing heart failure starts with managing risk factors. Alongside, you can promote your heart health by following certain tips, such as¹³:

• Reducing Sodium Intake: This helps by avoiding fluid retention, which may worsen your symptoms. 
• Maintaining a Healthy Weight: As extra weight may strain the heart muscles, reducing weight can help. 
• Staying Active: Though exercise is said to strengthen the heart, but it is best to consult your healthcare provider to determine the intensity.  
• Quitting Smoking & Limiting Alcohol: This is beneficial as both of these may affect blood vessels and increase risk of blockages. 
• Managing Conditions: Control associated medical conditions such as blood pressure, rhythm disorders, and anaemia, which can increase the risk of complications. 
• Reducing Stress & Improving Sleep: Lowered stress and good sleep quality may help reduce inflammation, regulate blood pressure, and avoid straining of heart overtime.  
• Staying Hydrated: Staying hydrated helps maintain proper blood circulation and reduces the risk of heart failure by supporting optimal heart function. 
• Monitoring Symptoms: Checking for any signs of worsening symptoms, such as fluid retention or shortness of breath can help avoid complications. 
• Regular check-ups: Consulting your healthcare provider in time ensures early detection and appropriate heart failure treatment. Regular check-ups and following medical advice improve outcomes^15,16,17.

Taking some proactive steps may help keep your heart healthy in the long run. However, it’s crucial to discuss with your doctor to know how often you should go for checkups and testing based on your condition. They will also help you understand the signs where medical attention is needed^15,16,17.

When to Get Medical Advice

You should immediately consult your healthcare provider if you experience persistent or gradually worsening symptoms of heart failure, such as¹⁷:

• Breathlessness, even when resting 
• Constant tiredness and exhaustion from exercise 
• Feeling lightheaded or fainting 
• Swollen ankles and legs 
• A persistent cough, a fast heart rate, or dizziness 

You should seek immediate medical care if you are facing very symptoms such as¹⁷. 

• Extreme difficulty breathing 
• Severe swelling in the legs or ankles 
• Chest pain that does not go away 
• Feeling like you might collapse 

Prioritizing prompt medical attention for these symptoms can help prevent complications and ensure timely treatment¹⁷.

Conclusion

Heart failure is a serious but manageable condition if detected early and treated properly. Irrespective of what are the causes of right heart failure or left heart failure, maintaining a healthy lifestyle, managing risk factors like high blood pressure and diabetes, and seeking timely medical advice can help prevent complications. Prioritizing heart health through regular check-ups and healthy habits can improve quality of life. Take charge of your health today for a stronger heart and a healthier future. 

Frequently Asked Questions (FAQs)

References

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2. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an Angiotensin-Converting–Enzyme Inhibitor, Ramipril, on Cardiovascular Events in High-Risk Patients. New England Journal of Medicine [Internet]. 2000 Jan 20;342(3):145–53. Available from: https://pubmed.ncbi.nlm.nih.gov/10639539/ 

3.  Fox K. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). The Lancet [Internet]. 2003 Sep;362(9386):782–8. Available from: https://pubmed.ncbi.nlm.nih.gov/13678872/ 

4. National Heart, Lung, and Blood Institute. Heart Failure – What Is Heart failure? [Internet]. www.nhlbi.nih.gov. 2022. Available from: https://www.nhlbi.nih.gov/health/heart-failure 

5. Types of Heart Failure [Internet]. American Heart Association. 2023. Available from: https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/types-of-heart-failure 

6. Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global Burden of Heart failure: a Comprehensive and Updated Review of Epidemiology. Cardiovascular Research [Internet]. 2022 Feb 12;118(17). Available from: https://pubmed.ncbi.nlm.nih.gov/35150240/ 

7. American Heart Association. Causes of Heart Failure [Internet]. www.heart.org. 2017. Available from: https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure/causes-of-heart-failure 

8. Heart Failure [Internet]. MedlinePlus. National Library of Medicine; 2022. Available from: https://medlineplus.gov/heartfailure.html 

9. Coronary artery disease [Internet]. Medlineplus.gov. National Library of Medicine; 2019. Available from: https://medlineplus.gov/coronaryarterydisease.html 

10. High Blood Pressure [Internet]. Medlineplus.gov. National Library of Medicine; 2020. Available from: https://medlineplus.gov/highbloodpressure.html 

11. American Heart Association. Causes and Risks for Heart Failure [Internet]. www.heart.org. 2023. Available from: https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure 

12. Heart Failure – Diagnosis | NHLBI, NIH [Internet]. www.nhlbi.nih.gov. 2022. Available from: https://www.nhlbi.nih.gov/health/heart-failure/diagnosis 

13. National Heart, Lung, and Blood Institute. Heart Failure – Treatment | NHLBI, NIH [Internet]. www.nhlbi.nih.gov. 2022. Available from: https://www.nhlbi.nih.gov/health/heart-failure/treatment 

14. American Heart Association. Medications Used to Treat Heart Failure [Internet]. www.heart.org. 2023. Available from: https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/medications-used-to-treat-heart-failure 

15. Heart Failure [Internet]. MedlinePlus. National Library of Medicine; 2022. Available from: https://medlineplus.gov/heartfailure.html 

16. Horwich TB, Fonarow GC. Prevention of Heart Failure. JAMA Cardiology [Internet]. 2017 Jan 1;2(1):116. Available from: https://jamanetwork.com/journals/jamacardiology/fullarticle/2590068 

17. Heart failure [Internet]. NHS. 2022. Available from: https://www.nhs.uk/conditions/heart-failure/ 

18. American Heart Association. About Heart Attacks [Internet]. www.heart.org. 2022. Available from: https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks 

19. Skrzynia C, Berg JS, Willis MS, Jensen BC. Genetics and Heart Failure: A Concise Guide for the Clinician. Current Cardiology Reviews [Internet]. 2015 Feb 1;11(1):10–7.  Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347203/ 

20. National Library of Medicine. Being active when you have heart disease [Internet]. Medlineplus.gov. 2014. Available from: https://medlineplus.gov/ency/patientinstructions/000094.htm 

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