Let’s Have a Heart-to-Heart: The Signs & Symptoms of Heart Failure

Your heart really IS the most powerful muscle in your body. It keeps blood flowing through a vast network of vessels — as long as 75,000 miles! Now that's a lot of ground to cover! With each beat, it squeezes out a powerful burst of blood — 70 millilitres at a time. Over a lifetime, that adds up to thousands of gallons, all delivered with enough force to keep your body healthy and active.

What is congestive heart failure?

Congestive heart failure is a chronic and progressive condition in which the heart is unable to pump blood efficiently to meet the body’s needs. This results in a build-up of fluid in the lungs, limbs, and other tissues, leading to symptoms such as breathlessness, fatigue, and swelling, particularly in the legs and ankles. The condition can develop due to various underlying issues, including coronary artery disease, high blood pressure, or damage to the heart muscle. Recognising the signs of heart failure, such as persistent coughing, rapid weight gain from fluid retention, and difficulty exercising, is crucial for timely diagnosis and management. 

So, what happens when the heart muscles become weak and begin to fail? As the heart struggles to pump blood efficiently, it leads to a cascade of effects within your body. Around 8-10 million people in India are living with chronic heart failure. This is a growing concern, especially because it tends to affect people at a younger age in India than in other parts of the world. The good news is that early detection and management can make a big difference. Let’s begin by understanding what heart failure is.

When your heart doesn’t want to go on and on

Heart failure isn't what it sounds like. It doesn't mean your heart stops working completely. Instead, it describes a condition where the heart muscle weakens and can't pump blood as efficiently as it should. Various factors can cause this, ultimately leading to cardiac insufficiency. This simply means your heart is unable to meet your body's demands for oxygen-rich blood.

There are different ways this weakness can manifest:

Left ventricular failure is the most common type, affecting the left ventricle, the heart's main pumping chamber that sends blood throughout the body.

Right ventricular failure happens when the right ventricle, which pumps blood to the lungs, weakens.

Congestive heart failure refers to fluid buildup in the lungs and other parts of the body due to heart failure.

What are the different types of heart failure? 

Heart failure can be categorised into several types, depending on which part of the heart is affected and how its function is impaired.

Left-sided heart failure is the most prevalent and occurs when the left side of the heart struggles to pump blood efficiently to the body. This may lead to a build-up of fluid in the lungs, causing breathlessness. It can be further classified into heart failure with reduced ejection fraction (HFrEF), where the heart's pumping ability is weakened, and heart failure with preserved ejection fraction (HFpEF), where the heart pumps normally but doesn't fill properly.

Right-sided heart failure is less common and involves the right side of the heart failing to pump blood effectively to the lungs. This often leads to swelling in the legs, ankles, and abdomen due to fluid retention. It may occur independently or as a consequence of left-sided failure.

In some cases, individuals may experience biventricular or congestive heart failure, where both sides of the heart are affected, leading to more widespread symptoms. 

What are the four classes of heart failure?

To understand the severity of heart failure, doctors use a classification system from I to IV developed by the New York Heart Association (NYHA). 

NYHA Class I (At High Risk): You don't experience any symptoms of heart failure at rest, but you may have a risk factor like high blood pressure or a previous heart issue.

NYHA Class II (Mild Symptoms): You may experience fatigue or difficulty breathing when engaging in physical activity but not when you are at rest.

NYHA Class III (Moderate Symptoms): Shortness of breath and fatigue make daily activities challenging, even when resting.

NYHA Class IV (Severe Symptoms): This is the most severe class, with significant limitations on daily activities and frequent episodes of shortness of breath, even while resting.

But how can we avoid developing NYHA Class IV Heart failure? Can congestive heart failure be detected early?

Heart skipping a beat? Signs and symptoms of heart failure

A wake-up call.

Ravi, a 58-year-old banker, was happy with his morning walks and fairly controlled diet. His routine kept him feeling good even after his heart attack 10 years ago. But over the past few months, things had changed. Even climbing a flight of stairs left him breathless upon reaching the top. He dismissed this as part of getting older. Then came the night sweats and the constant need to use the restroom. The cough that wouldn't go away started to worry him. Finally, after waking up in the middle of the night gasping for air, Ravi knew something was seriously wrong.

Are these simply weak heart symptoms? Or are they more specific signs of congestive heart failure? A visit to the doctor resulted in being diagnosed with chronic heart failure.

Heart failure often creeps up slowly. What are the possible signs that you may be dealing with heart failure?

Shortness of breath (dyspnea): This is a hallmark symptom of heart failure. You might experience difficulty catching your breath, especially during activities or while lying at night.

Fatigue and weakness: Feeling constantly tired and lacking energy is another red flag. Simple tasks that used to be easy may become overwhelming.

Swelling in the legs, ankles, and feet (oedema): Fluid buildup due to impaired blood flow can cause swelling, particularly in the lower extremities.

Rapid or irregular heartbeat (palpitations): Your heart might feel like it's racing, fluttering, or skipping beats.

Persistent cough or wheezing: As fluid accumulates in the lungs, you might develop a persistent cough or wheezing due to congestion.

Increased need to urinate at night (nocturia): When the body tries to get rid of excess fluid at night, you may experience a frequent urge to urinate.

Don’t phunk with my heart: What causes heart failure?

Heart failure doesn't develop in a vacuum. Some of the most common diseases that weaken heart function include:

• Coronary Artery Disease (CAD), which occurs when blood vessels become clogged with plaque, restricting blood flow and damaging the heart muscle. “When undiagnosed and therefore untreated, this can lead to complications such as heart attacks (Myocardial Infarction), which can further be complicated by heart failure and sudden death,” says Dr Alok Shah, MBBS, DNB, DM — Cardio, a cardiologist in Mumbai affiliated with Breach Candy, Saifee, Wockhardt, and Bhatia Hospital.

• Chronically high blood pressure (hypertension) forces the heart to work harder over time, eventually leading to strain and potential failure.

• Uncontrolled diabetes can damage blood vessels and weaken the heart muscle.

• Bearing excess weight significantly burdens the heart. It’s forced to pump blood throughout the body with much more effort, thereby raising the risk of its failure.

• Cardiomyopathy enlarges the heart's walls — making them thick or stiff, hindering the heart’s pumping ability.

• An infection can sometimes infiltrate the heart muscle, causing inflammation (myocarditis) and weakening it.

• Birth defects (congenital heart disease) affecting the heart structure — like the walls or valves — can predispose someone to heart failure later in life.

Family matters: Genes and heart failure risk

Your genes play a part in your heart failure risk. Since you inherit genes from your parents, a family history of the condition can be a red flag. Having a parent with heart failure bumps up your risk by a significant 70% compared to someone with no family history. Even siblings with heart failure can increase your risk by about 40%. Conditions like dilated cardiomyopathy and high cholesterol levels are inherited conditions that damage your heart and may lead to heart failure in the future.