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Heart Failure
"Heart Failure"
The term "heart failure" can cause anxiety- it does not imply that the condition will rapidly worsen. Instead, the term covers all conditions that can cause shortness of breath due to failure of the heart to work as an efficient pump. This can occur even when the main pumping chamber of the heart is strong.
When there is significant failure of efficient function of the heart, the kidneys can retain salt and water. This fluid increases the total volume of the blood and some of this fluid can also leak out of the blood vessels and into the tissues. The lungs can become congested and result in shortness of breath at rest or when a person lies down. Fluid can leak out into the ankles and can swelling. Medication is requires to remove this excessive fluid and prevent the body from retaining excessive amount of fluid.
Shortness of Breath due to Weakness of the Heart Pump
The heart muscle can be damaged significantly by a large heart attack and cause shortness of breath. This is the most common cause of weakness of the heart.
When there is extensive and widespread heart artery disease, the heart muscle may not function normally even at rest. But the heart's function improves with angina medication, or after heart bypass surgery and stent treatment. A number of investigations are often required to ascertain the likelihood of improvement of the function of the heart after heart bypass surgery or stent treatment.
A number of other disease processes can also cause weakness of the heart. Viral infections can affect the heart and cause weakness.
Shortness of Breath due to Abnormality of the Heart Valves
The heart has valves which allow blood to flow in the forward direction. The valves can be damaged and become stiff- this restricts the forward flow of blood.
The valves may not close properly and some blood flows backwards instead of forwards.
The heart can accommodate and compensate for these abnormalities to an certain extent only before problems with shortness of breath occur.
Shortness of Breath due to Stiffening of the Heart Muscle
The heart muscle can become stiffer than is should be. The effect of this is similar to narrowing of the heart valve that allows blood to enter the main pumping chamber of the heart. The pressure of the blood in the veins of the lungs has to increase to allow the blood to fill the stiff main pumping chamber. This high pressure, although providing compensation also increases the chance of fluid leaking out of small blood vessels and causing congestion of the lungs.
Shortness of breath can occur in this condition even though the main pumping chamber of the heart is strong.
The most common cause of this problem is high blood pressure. In response to high blood pressure the heart muscle has to thicken (this makes the heart wall stiffer). This is an increasingly common cause of shortness of breath in older persons.
It is very likely that good control of high blood pressure will prevent this problem.
Shortness of Breath due to Abnormality of the Heart Rhythm
The heart requires a normal rhythm to function efficiently.
A slow heart rhythm can cause shortness of breath by preventing an increase in the heart beat that is necessary to meet the demands of exercise.
Conversely, an excessively fast heart beat can also cause of shortness of breath by reducing the amount of time available for the heart chambers to fill with blood.
On occasions, a slow heart rhythm is due to medication provided to treat high blood pressure or angina.
Shortness of Breath Caused by Heart Artery Disease
Disease of the heart arteries can cause chest discomfort referred to as angina. However, some will develop a sensation of chest tightness and breathlessness instead of chest discomfort.
Approach to Treatment of Shortness of Breath
An accurate diagnosis is essential- several factors may be present in the one individual. Correct identification of all the causes of shortness of breath in a particular individual enables appropriate treatment.
Even when the heart has become weak, marked improvement can occur with correct treatment.
Dr Hitesh Patel
Cardiologist
April, 2007