In all patients with heart failure, it is important to carefully consider the underlying cause as there may be specific exacerbating factors or other diseases that influence the holistic treatment to be given.
This is quite a sobering topic so please forgive me if I forbear to make you laugh in the hope that I can make you think deeply about the lifestyle changes you need to make in order to live a longer healthier life.
I’ll start with the underlying causes and then move on to the exacerbating factors (precipitants).
1. Uncontrolled Hypertension: this is actually the leading cause of heart failure in the black population. (Emphasis on uncontrolled)
2. Valvular Heart Disease: There are 4 valves in the heart that ensure blood flows in the right direction. When they get damaged by infectious organisms or your own immune system after an infection like a sore throat (I kid thee not. A heart can fail because a kid’s sore throat went untreated… Scary. Right?), the abnormal flow of blood can cause the heart to fail over time.
3. Ischaemic heart disease: This is the leading cause of heart failure in the developed world. It arises from obstruction of blood flow to the heart. This often begins gradually and worsens over time. Warning features of a condition called Angina are in keeping with this disease.
4. Idiopathic Cardiomyopathy: This is most often a problem in which the heart is severely enlarged and doesn’t pump well. It could also be restrictive or involve thickening of the heart muscles in which the heart cannot relax adequately.
Other Cardiomyopathies: include Peripartum, Alcoholic and Postviral types.
5. Peripartum Cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction toward the end of pregnancy or in the months after delivery, in the absence of any other cause of heart failure. PPCM may be diagnosed.
6. Alcoholic Cardiomyopathy on the other hand is a clinical diagnosis made in a patient presenting with a constellation of findings that includes a history of excessive alcohol intake, possible physical signs of alcohol abuse (eg, skin lesions, mental status changes), heart failure, and supportive evidence consistent with Dilated Cardiomyopathy.
7. Thyroid disease: Over functioning or Under functioning of the Thyroid gland, which regulates metabolism can cause the heart to be severely affected to the point where it fails.
8. Beri beri (lack of vitamin B1): Wet beriberi is the term used for thiamine deficiency with cardiovascular involvement. The chronic form of wet beriberi consists of 3 stages. In the first stage, peripheral dilation of blood vessels occurs, leading to a high cardiac output state. This leads to salt and water retention mediated through the kidneys. The resulting fluid overload leads to swelling of the legs.
By the time significant swelling occurs, the heart has been exposed to a severely high workload in order to pump the required cardiac output needed to satisfy end organ requirements. Parts of the heart muscle undergo overuse injury, expressed as fast heart beat and chest pain.
A more rapid form of wet beriberi is termed acute fulminant cardiovascular beriberi, or Shoshin beriberi. The predominant injury is to the heart, and rapid deterioration follows the inability of the heart muscle to satisfy the body’s demands because of its own injury. In this case, swelling may not be present. Instead, bluish discolouration of the hands and feet, fast heart beat, distended neck veins, restlessness, and anxiety occur. If no treatment is available, death occurs just as rapidly (within hours or days).
9. Infiltrative disease: Excessive deposition of large amounts of substances in the muscles of the heart is one of the rarer causes of heart failure. This includes deposition of iron (haemochromatosis) and amyloid protein (amyloidosis).
10. Autoimmune diseases: Certain diseases are associated with damage to the heart caused by the individual’s immune system in response to something else. It could get so severe as to cause the heart to fail.
11. Cancer treatment: Cumulative dose-related damage to the heart may occur. Potentially fatal Congestive heart failure (CHF) may occur months to years after completion of therapy. The risk of developing CHF increases with increasing total cumulative doses of certain chemotherapy drugs (anthracylines).
PS: Cancer drugs should be administered under the supervision of an experienced cancer chemotherapy physician
To be continued…