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Heart Failure

Heart failure is a complex collection of symptoms in which a person experiences symptoms of heart failure (typical shortness of breath at rest or during activity, accompanied by fatigue or not), signs of fluid retention (pulmonary congestion or ankle edema), and there is objective evidence of the disorder. The structure оr function of thе heart аt rest. This condition can occur due to heart failure to pump blood in sufficient quantities for the body's metabolic needs. Based on the time span of symptom development, heart failure can be divided into 2 types, namely chronic and acute.

Chronic heart failure develops gradually and over a period of time. Meanwhile, symptoms of acute heart failure develop rapidly. In the diagnosis of heart failure, it will usually be classified into classes, either based on the heart's structural or functional capacity (refer to NYHA). The structural classification of the heart is as follows:
  1. Stage A. Has a high risk of developing heart failure. There are no structural or functional heart problems, as well as signs or symptoms.
  2. Stage B. A structural disease of the heart that is associated with the development of heart failure has developed. There are no signs or symptoms.
  3. Stage C. Sуmрtоmаtіс hеаrt failure associated with undеrlуіng structural hеаrt disease.
  4. Stage D. Advanced structural heart disease and very significant symptoms of heart failure at rest, despite maximal (refractory) medical therapy.
The classification based on functional capacity (NYHA) is divided into:
  1. Class I. There are no restrictions on physical activity. Daily physical activity does not cause fatigue, palpitations, or shortness of breath.
  2. Class II. There are limitations to light activity. There are no complaints at rest, but daily physical activity causes fatigue, palpitations, or shortness of breath.
  3. Class III. There are limits to meaningful activities. There are no complaints at rest, but light physical activity causes fatigue, palpitations, or shortness of breath.
  4. Class IV. Cannot do physical activity without complaint. There are symptoms at rest. Complaints increase when doing activities.
Heart failure is caused by various factors. The most important prevention effort is to minimize the risk factors that can cause disruption of heart function. There are modifiable risk factors, such as maintaining a lifestyle by regulating a healthy diet intake, regular and appropriate exercise, maintaining ideal body weight, and maintaining blood pressure, cholesterol levels, and blood sugar levels.

Hypertension is known as one of the causes of heart failure. Therefore, hypertension prevention management needs to be optimized to reduce the risk of heart failure. Meanwhile, in patients who have been diagnosed with heart failure, the aim of prevention efforts is to prevent damage and deterioration of the myocardium, reduce fluid accumulation, and prevent re-hospitalization. In this condition, prevention is carried out by applying optimal treatment, both non-pharmacologically and by selecting drugs according to the patient's condition.

Typical symptoms of heart failure include shortness of breath at rest or activity, fatigue, leg edema, tachycardia, tachypnea, pulmonary crackles, pleural effusions, increased jugular venous pressure, peripheral edema, and hepatomegaly. Objective signs may include structural or functional impairment of the heart at rest, cardiomegaly, third heart sounds, heart murmurs, abnormalities in echocardiographic images, or elevated concentrations of natriuretic peptides.

Heart failure can be caused by the following:
  1. History of coronary heart disease.
  2. Heart defects from birth.
  3. Heart rhythm disturbances
  4. Diabetes.
  5. Hypertension or high blood pressure.
  6. Cardiomyopathy or heart muscle disorders.
  7. Damage to the heart valve.
  8. Hyperthyroidism or an overactive thyroid gland.
  9. Anemia or lack of red blood cells.
  10. Myocarditis or inflammation of the heart muscle.
The diagnosis of heart failure begins with a physical evaluation based on the patient's symptoms. To make sure, the following supporting examinations can be done:
  1. Electrocardiogram (EKG). EKG examinations in patients with symptoms of or suspected heart failure should be performed. ECG abnormalities usually accompany heart failure patients. However, the predictive value is quite small.
  2. Chest X-ray. Is an important component in the diagnosis of heart failure. Chest X-rays can detect cardiomegaly, pulmonary congestion, pleural effusion, and lung disease or infection that causes or worsens shortness of breath.
  3. Laboratory examination. Routine laboratory tests in patients with suspected heart failure include complete peripheral blood (Hb, leukocytes, platelets), electrolytes, creatinine, glomerular filtration rate, glucose, liver function tests, and urinalysis. Other additional investigations were considered according to the clinical presentation. Significant hematological or electrolyte disturbances are rarely seen in patients with mild to moderate symptoms who have not been treated, although mild anemia, hyponatremia, hyperkalemia and decreased renal function are common, especially in patients on diuretic therapy or ACEI (angiotensin-converting enzyme inhibitor), AR. (angiotensin receptor blockers), or aldosterone antagonists.
  4. Natriuretic peptides. There is evidence to support the use of peptidanatriuretic plasma levels for diagnosis, making decisions to treat or discharge patients, and identifying patients at risk of decompensation.
  5. Troponin I or T. Troponin examination is performed in patients with heart failure if the clinical picture is accompanied by a suspicion of acute coronary syndrome. Mild elevations in cardiac troponin levels are common in severe heart failure or during episodes of heart failure decompensation in patients without myocardial ischemia.
  6. Echocardiography. This term is used for all ultrasound imaging techniques of the heart. Confirmation of the diagnosis of heart failure or cardiac dysfunction by echocardiography is imperative and is carried out as soon as possible in patients with suspected heart failure.
Treatment or therapy for heart failure includes non-pharmacological therapy, which is education to patients about the disease and its therapeutic process, as well as the people closest to supporting the therapy process. Efforts to prevent or modify risk factors for heart failure are efforts that can be done, such as maintaining blood pressure, blood sugar, and lipid levels. Regular physical exercise and according to recommendations has a good effect on heart failure patients. While treatment with drugs will focus on reducing morbidity and mortality, as well as improving the quality of life for heart failure patients by helping to correct the cause.

In general, the use of agents that can improve or reduce cardiac output and cardiac contractility is an option. For example, administration of antihypertensive class angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, aldosterone antagonists, digoxin, diuretics, and other supportive drugs to control risk factors that cause heart failure.