Heart Failure-Willing Mind, Tired Body

Want to learn more about heart failure? In this post, we are going to be discussing about heart failure. A case of a willing mind but tired body.

Even at 40, Alex was still a fitness enthusiast, and healthy as a horse. During a routine medical check-up though— some 10 years ago— his Doctor had told him that his BP was way too high and that he needed to be placed on drugs. However, he dismissed it with a wave of the hand— all he needed was to eat right, keep on being fit, and he would be alright, he had thought.

He used to run a mile every Saturday, but these days he hardly finished a quarter of a mile, and he would be panting like a dog that tried outrunning a Cheetah. Try all he could, he just couldn’t pass the quarter-mile mark any longer.It didn’t stop there: things got a little worse and kept getting so, until the distance shrunk so much that all he could do was walk, instead of his routine Saturday jogging. Even that seemed to be a little bit of a problem these days: he still came back from his jogging-turned-walking panting and sweating profusely.

The other day he noticed his legs to be a little bit swollen but thought that was probably because he stayed in those tight-fitting shoes of his for long hours while doing nothing but talk over a contract with his agents.Then came the night. The wife as usual had forced him to say a prayer with her before they retired to bed. Halfway through the night, he dreamt some heinous creature had him on chokehold and was trying to suffocate him. He woke up severely breathless and coughing violently. It was as if he was going to die: he couldn’t get enough air into his lungs— much like someone who was underwater.

This was exactly the same way his father died!It took his wife’s prayers before the “attack” subsided and he was able to go back to sleep.However, it happened again, and again— about three more times that night. Each time, the wife’s prayers had kept the “attack” at bay. Finally they decided to stay up all night, launching an impromptu vigil to “stay awake and keep watch” as the master instructed. Even though he couldn’t understand what language the wife was praying in, he kept on yelling amen to all the “gibberish.”

Surprisingly, he didn’t have any other attacks that night!Miracle! He was finally a believer: prayers really worked!Sunday service, testimony time. As he narrated his ordeal the previous night he couldn’t help but kneel down in full view of the congregation. Weeping, he raised his hands proclaiming his repentance and belief in the power that saved him through his wife. The congregation erupted in praise.The following day, the news was in all the national dailies, and the hashtag “saved by a praying wife” was trending on twitter. However, at the same time, he was on a hospital bed, with an oxygen mask on, struggling to for his dear life.

Diagnosis? Heart failure!

The above scenario, down to its minutest details, is a classical depiction of heart failure from a neglected, long-standing, hypertension.

What is Heart Failure?

Heart failure is the inability of the heart to meet up with the body’s need of blood and oxygen.The heart is like a pump, which functions on the basis of demand and supply, to circulate blood around the body according to the body’s need.

When there’s an increase in the body’s need for blood and oxygen— for instance during an exercise— the heart increases its pumping activity in order to be able to meet up with the increased demand. This is why you feel your heart thumping away in your chest during an intense exercise session.

heart failure

If for any reason the heart becomes weak, it’d no longer be able to meet up to this demand, no matter how hard it tries. At such a point, the heart would be said to have failed.Owing to this demand and supply philosophy that dictates the pumping activity of the heart, symptoms of heart failure are initially felt during exertion, but resolves during rest. As the heart becomes weaker, however, a point would be reached where, even at rest, it still won’t be able to meet up with the body’s demand.

Mechanism of Heart Failure

The heart is basically a muscular organ designed in the form of a pump. Like all efficient pumping devices, it is designed to receive blood from one end, and pump it out through the other end, to supply different parts of the body.

Broadly speaking, failure— the inability to meet up with the demands for supply— can arise by either of three mechanisms:

  1. Inability to RECEIVE enough blood: In this instance, the heart is unable to relax and receive enough blood. So even though it may be pumping effectively, it still won’t be able to pump enough blood to meet the body’s demand- Simply put: you can only give what you have. A wholesaler that doesn’t have enough goods, won’t be able to meet the demands of retailers.
  2. WEAKNESS of the heart muscle itself.-In this instance, the heart receives enough blood but is so weak it won’t be able to pump enough of it out, to meet with the body’s demand. See it this way: a wholesaler, weak from sickness, would still not be able to distribute goods enough to meet the demands of his retailers— even if he has a good quantity of them in stock.
  3. IMPEDANCE to flow/supply. In this mechanism, the heart receives enough blood, is strong enough to pump it out effectively to meet with body’s demand, but there’s an obstruction— impedance, to flow of blood to the parts of the body where it is needed.✓ See it this way: a wholesaler without an effective channel for distribution, would still not be able to meet the demands of retailers

Features of a failing Heart

Whatever the mechanism of failure, the effect on the body is the same, and is basically due to :

  • Backlog Of Fluids. Due to the inability to relax and receive enough blood, or effectively pump out received blood, there is a backlog: fluid keeps dampening back in the tissues. This leads to “flooding” in the tissues, resulting in congestion and swelling.
  • Artificial Scarcity. The inability of the heart to supply the body of its needs— either because it’s not receiving enough, is too weak to pump, or there are obstacles blocking the channels for supply— creates an artificial scarcity in the body. The tissues would thus starve, and the energy to fuel body’s activities would be suboptimal, leading to weakness and several forms of organ dysfunction.

The combination of these two leads to the following symptoms :

  • Getting tired/fatigued easily
  • Feeling out of breath. This happens in the following order: — initially, the person gets breathless only while engaged in stressful activities like jogging, climbing uphill, etc. — then it worsens and progresses to happen while engaged in less stressful activities, such as walking. — finally, it culminates at breathlessness even while the sufferer is resting.
  • Cough
  • Orthopnea— this is severe breathlessness while lying down.— may get better with putting two or three pillows to raise the person’s head.
  • PND [Paroxysmal Nocturnal Dyspnea]— a sudden worsening of breathlessness and cough after lying down for a long time.— often wakes one up from sleep with a feeling of choking, being intensely out of breath, and thoughts of imminent death.— this is due to flooding of the lungs with fluid as if one is drowning. — it usually resolves once the person gets up, which can be likened to “getting the head of a drowning person out of, and above, water”.[compare with the scenario above]
  • Leg swelling
  • Swelling of the tummy.
  • Pain at the upper right part of the tummy.— this is due to enlargement of the liver from being flooded and swollen with water.
  • Chest pain.
  • Dizziness.
  • Palpitations— racing of the heart, as if one just finished running.— happens because the heart is literally struggling, working hard, to meet up with the demands.

Causes of Heart Failure

The five commonest in our environment, however, are:

  1. Hypertensive Heart Disease
  2. Heart Valve Problems
  3. Ischaemic Heart Disease [Coronary Artery Disease]
  4. Arrhythmias
  5. Heart Muscle Problems [Cardiomyopathy]

Risk Factors

These include:

  • Hypertension
  • Diabetes
  • Severe Anaemia
  • Hyperthyroidism.
  • Smoking.
  • Obesity.
  • Excessive alcohol consumption.
  • High level of cholesterol in the blood.
  • Excessive intake of refined foods.
  • Poorly treated sore throat infection.

Prevention of Heart Failure

The bedrock for the prevention of heart failure is LIFE STYLE MODIFICATION— changing from more disease prone lifestyles, to a less disease prone ones.This includes :

  • Regular exercise.
  • Cessation of smoking.
  • Healthy eating habits
  • Desisting from excessive alcohol consumption.
  • Healthy weight loss
  • Regular checking of one’s blood sugar, blood pressure, and serum lipids, including cholesterol.
  • Finally, prompt treatment of predisposing medical conditions mentioned above.

Treatment of Heart Failure

There’s currently no cure for heart failure, except for transient ones caused by something like anaemia. However, treatment options exist to prolong and improve the quality of life [this include drugs such as Diuretics, ACE Inhibitors, ARBs, CCBs, etc; relevant surgeries, including a transplant; etc]Thus this is one place where “prevention is better than cure” is more than a jingle. Eat healthily, exercise regularly, and quit not-so-heart-friendly habits — Protect your HEART!

Share this

Dr Chibuike Joseph Chukwudum

Dr Chibuike Joseph Chukwudum is a doctor who Studied Medicine and Surgery at Nnamdi Azikiwe University Awka. He is the former Medical Officer at Oakland specialist hospital,obosi.He also previously worked at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.