Heart failure is a medical condition characterized by the inability of the heart to pump sufficient blood to meet the metabolic demands of body tissues or when it is able to do so only at an elevated filling pressure. In other words, when the heart can no longer cope with the needs of the body tissues, it can be said to have failed. Some of the more important causes of heart failure include hypertension, ischaemic heart disease (especially in the western world), valvular heart disease as well as congenital heart diseases, particularly in children.
Evidently, the increasing incidence of this disease nowadays is not unrelated to risk factors like smoking, diabetes mellitus, sedentary lifestyles, excessive alcohol intake and dietary indiscretion among others. Arguably, a basic understanding of the physiology (or functioning) of the heart is fundamental to the recognition of the signs and symptoms of heart failure.
The heart comprises four chambers. The right atrium and right ventricle (right side of the heart) receive deoxygenated blood from the body tissues and deliver it to the lungs for reoxygenation. From the lungs, the fully oxygenated blood is carried to the left atrium and left ventricle (left side of the heart) from where it is subsequently pumped throughout the body to be utilized by the tissues. When the heart is unable to perform this vital function, it is known as left or right heart failure depending on which side is affected. However, in some conditions, both sides of the heart can fail leading to congestive (or biventricular) cardiac failure.
Highlighted below are some of the warning signs of impending or ongoing heart failure:
1. Cough productive of frothy whitish sputum
A lot of conditions can cause cough but you need to suspect heart failure when your cough is accompanied by difficulty with breathing (dyspnoea) especially when you lie down such that you need to sleep with two or more pillows to breathe normally at night (orthopnoea). Similarly, some people often find themselves gasping for breath which interrupts their sleep and they would walk to the window to breathe in some fresh air for relief (paroxysmal nocturnal dyspnoea). All these symptoms arise due to fluid accumulation in both lungs and point to a failing left heart. If any of these looks like what you experience, you need to visit your doctor to have urgent evaluation for heart failure.
2. Easy Fatiguability
Since a failing heart is incapable of coping with the needs of the body due to inability to pump sufficient blood, affected individuals tend to get tired very easily depending on the stage of heart failure. This is referred to as exercise intolerance. Simple activities like climbing the stairs, lifting objects and walking become increasingly difficult. In the worst case scenario, people with advanced heart failure feel very tired even at rest and need assistance to even dress up or undress. The bottom line is if you get tired very easily, you may need to see your doctor to be sure that your heart is not failing.
3. Swollen Lower Limbs
Whenever the right heart fails, it loses the ability to receive blood from the circulation resulting in a backflow of blood that may eventually lead to swelling of both lower limbs sometimes up to the thighs and sacrum. Furthermore, chronic liver disease and kidney failure are also very important conditions to look out for in a person with swollen lower limbs. However, it is important to note that swollen limbs can be a normal finding in some pregnant women and your doctor will only reassure you, provided no other abnormality is detected.
4. Distended Abdomen
Have you observed that your abdomen has been distending or protruding progressively of late? Then you need further evaluation to rule out heart failure. A failing right heart ultimately leads to fluid accumulation within the abdominal cavity and consequent distension of the abdomen (ascites). Because of the pressure on the stomach, this can be accompanied by early satiety (a feeling of fullness after eating very little) in some people. Also, a protruded belly in a patient with heart failure can be due to enlargement of the liver which feels tender (painful) when pressure is applied over it.
5. Distended or Prominent Neck Veins
As insignificant as this may appear, it can be a pointer to congestive heart failure in which the right atrium is not able to receive blood flowing in from the head and neck. This is even more significant if the neck veins become more conspicuous on applying gentle pressure over the right upper abdomen (hepatojugular reflux).