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Heart failure is a condition where the muscle in the heart wall weakens and is not able to pump as well as it should to supply blood and nutrients to the body. While the heart and the body may make compensatory responses to accommodate decline in heart function, this will take its toll on the body over time. It is a chronic and progressive condition and not an abrupt occurrence as the term might imply.

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Causes of heart failure

Heart failure could be brought about by various heart problems and conditions, including coronary heart disease and heart attack, heart muscle inflammation or damage, heart valve problems or other health conditions such as high blood pressure or diabetes.

In Singapore, heart diseases or stroke account for 1 out of 3 deaths or 29.3% of all deaths in  2019. This translates to 17 deaths every day from cardiovascular disease.

Consequences of heart failure

When the heart is not able to pump as well as it should, it could respond by in a few ways to meet the shortfall in output:

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1. The heart could stretch more so it could contract more strongly to help it pump more blood. Over time, this could cause the heart to be enlarged.
2. With greater contractions, the heart cells expand and this could cause the heart to develop more muscle mass.
3. The heart could also pump faster to increase the flow of blood to the body.

The body also tries to compensate by narrowing the blood vessels to keep blood pressure up.  The heart might also divert blood away from less important tissues and organs (like the kidneys), the heart and brain.

All these adaptive responses in the heart and the body also explain why heart failure might not be detected initially. When the body is not able to keep up, some common signs of heart failure will become more apparent. These symptoms could include:

• Fatigue – due to a decline in the amount of oxygen-rich blood being pumped from the heart to the body to meet its energy needs
• Swelling in the feet, ankles, legs, or abdomen as more fluid is retained in the body in response to a decline in the level of blood flow. Blood backing up in the blood vessels also causes fluids to leak and accumulate in the these parts of the body. 
• Weight gain from excess fluids accumulated in the body
• Shortness of breath, coughing, wheezing due to fluid build-up in the lungs which also inhibits the exchange of carbon dioxide in used blood for oxygen
• Nausea or lack of appetite due to fluid accumulation in the liver and digestive organs

Heart failure is a serious condition which cannot be cured but it can be managed with regular monitoring, medication and lifestyle changes.

This article has been verified medically by Dr Lim Chong Hee, consultant thoracic and cardiovascular surgeon at Surgi-TEN Specialists, Farrer Park Hospital (Singapore).

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