Heart Failure
What is Heart Failure?
Heart failure is a condition where the heart’s function weakens, causing blood circulation to stagnate, leading to fluid accumulation in the lungs and resulting in difficulty breathing. The heart acts as a pump to circulate blood throughout the body, but when it weakens, blood circulation deteriorates. When the heart’s pumping function declines, blood returning to the heart from the body creates congestion in the lungs, the organ just before the heart. This is called ‘pulmonary congestion,’ which causes fluid to accumulate in the lungs during heart failure. Additionally, if blood congestion extends to the legs, it can cause swelling in the feet and overall body fatigue. Symptoms include shortness of breath during activities like walking, difficulty breathing when lying flat in bed, and swelling in the legs. However, it can also manifest with various symptoms such as sudden weight gain over a few days, increased phlegm, increased coughing, and easy fatigue, making diagnosis based solely on symptoms sometimes challenging.
Causes of Heart Failure
There are various causes of heart failure. Generally, the following conditions can lead to heart failure:
- Ischemic heart disease (myocardial infarction, angina): The blood vessels (coronary arteries) that supply blood to the heart muscle can narrow due to atherosclerosis, leading to insufficient oxygen and nutrients reaching the heart, causing its function to decline. This condition often results from advanced ischemic heart disease, with long-term diabetes, hypertension, dyslipidemia, and smoking usually in the background.
- Cardiomyopathy: The heart muscle (myocardium) can weaken or stiffen due to various causes, leading to reduced pump function. This cardiac muscle dysfunction can be caused by hypertension, alcohol, genetic abnormalities, chronic myocardial inflammation (myocarditis), but the cause is often unknown.
- Heart valve disease: When the function of valves that prevent blood backflow in the heart declines (valvular disease), it can put strain on the heart. This can result in heart failure.
- Arrhythmia: Arrhythmias can cause the pulse to become extremely fast or slow, which can lead to poor blood circulation and result in heart failure.
- Other systemic factors: Heart failure can also be related to factors outside the heart, such as systemic endocrine or metabolic disorders, inflammatory diseases, malnutrition, drugs, or chemicals.
Since heart failure is caused by many factors, appropriate examinations and treatments tailored to each patient’s condition are necessary. It’s important to identify the cause and provide appropriate treatment.
Diagnosis of Heart Failure
Blood tests: Check for anemia and whether there’s strain on the liver or kidneys. Hormones like BNP or NT-proBNP, which are secreted when the heart is under stress, are also measured.
Chest X-ray: Check if the heart has enlarged or if there’s fluid accumulation in the lungs.
Electrocardiogram: Check for signs of ischemic heart disease (myocardial infarction, angina) or the presence of arrhythmias.
Echocardiography: Evaluate heart function, including the degree of contraction and the presence of valvular disease.
Cardiac CT/Nuclear Medicine Tests/FDG-PET/Cardiac MRI: Performed to evaluate ischemic heart disease (myocardial infarction, angina) or cardiomyopathy.
Cardiac catheterization and myocardial biopsy: Measure blood pressure inside the heart and check for problems in the coronary arteries that supply blood to the heart muscle. Myocardial biopsy involves taking a sample of heart tissue via catheter for examination. This test is useful for diagnosing cardiomyopathy.
Treatment of Heart Failure
Medication: Drug therapy is the central treatment for heart failure. For heart failure with reduced ejection fraction, there are multiple medications proven to reduce the risk of death and rehospitalization due to heart failure, and several of these medications are taken together. These oral medications include:
・Angiotensin-Converting Enzyme Inhibitors (ACE inhibitors)
・Angiotensin Receptor Blockers (ARBs)
・Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
・Beta-blockers
・Mineralocorticoid Receptor Antagonists (MRAs)
・Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2 inhibitors)
In addition to these, diuretics are used to improve heart failure symptoms, and treatment involves a combination of these medications.
For heart failure with preserved ejection fraction (in most cases, the heart muscle has stiffened, preventing the heart from expanding flexibly and accommodating sufficient blood volume), the number of proven effective medications is somewhat limited. Among these, SGLT2 inhibitors have been shown to improve prognosis and are used in combination with diuretics.
Additionally, we have adopted soluble guanylate cyclase stimulators and If channel inhibitors at our hospital, and we use these medications to treat heart failure. Also, steroids and other immune-suppressing drugs are effective for sarcoidosis, a type of cardiomyopathy, while tafamidis is effective for transthyretin amyloidosis.
Our hospital is one of the limited facilities in Tokyo that can introduce tafamidis.
Treatment for valvular heart disease: We provide treatments such as surgical operations and catheter-based treatments (TAVI, MitraClip, MICS, robotic surgery, etc.). (For more details, please see valvular heart disease.)
Treatment for ischemic heart disease: We provide treatments such as medication, catheter-based treatments, and bypass surgery. (For more details, please see ischemic heart disease.)
Treatment for arrhythmias: We provide treatments such as catheter ablation, pacemakers, and implantable cardioverter-defibrillators. (For more details, please see arrhythmias.)
Treatment for severe heart failure: In cases where medication alone is difficult to control, we use machines to support the heart, such as extracorporeal membrane oxygenation (ECMO) and catheter-based percutaneous left ventricular assist devices (IMPELLA).
Chronic heart failure nursing: At our hospital, certified chronic heart failure nurses provide support for post-discharge treatment and daily life through ‘heart failure nursing outpatient services’. For more detailed information, please see the dedicated page via the link below.
Palliative care: As heart failure patients experience various forms of distress, our hospital collaborates with the palliative care department and home-visit nursing stations to provide support for heart failure palliative care, including home medical care, from before the end-of-life stage to improve the quality of life for patients and their families.
Chronic Heart Failure Nursing
For more details, please click here.
