Heart failure is a complex syndrome caused by the inability of the heart to provide the necessary circulatory output to meet the body's metabolic needs at the cost of symptomatically increased filling pressures in the heart.

Main causes of heart failure:

The most common cause of heart failure is ischemic heart disease, manifested mainly by myocardial infarction. Ischemic heart disease is mainly caused by coronary atherosclerosis, the narrowing of the arteries of the heart by deposits of cholesterol.

The risk factors for ischemic heart disease are smoking, high cholesterol, obesity, a sedentary lifestyle, high blood pressure, diabetes. Other causes of heart failure can include: untreated high blood pressure leading, over time, to thickening of the heart muscle and then enlargement of the heart and a decrease in ejection fraction; valvular heart valve disease - aortic stenosis or insufficiency or mitral insufficiency in their severe and prolonged forms, leading to overstenosis and enlargement of the heart; congenital heart defects that were uncorrected or superficially treated in childhood.

Excess alcohol can also lead to heart failure. Arrhythmias should not be neglected either, they lead to weakening of the heart muscle and ultimately to heart failure. There may also be genetic causes: hypertensive cardiomyopathy, dilated cardiomyopathy, etc.

Symptoms associated with heart failure:

Most often, patients report feeling short of breath (dyspnea) on exertion or at rest. Symptoms also include: fatigue, chest pain, palpitations, coughing at night or on exertion, edema (swelling) of the legs, especially the calves, due to fluid accumulation in the tissues, and in severe and prolonged forms of heart failure, weight loss, lack of appetite, nausea.

How the condition is diagnosed:

For the diagnosis, follow-up is mandatory and the following investigations are required: 12-lead ECG, transthoracic echocardiography, laboratory tests, chest X-ray. MRI, coronary angiography, myocardial viability tests - stress echocardiography, MRI, SPECT, PET, right/left catheterization are indicated for selected patients.

We must not neglect the importance of chest X-ray, which is useful in detecting cardiomegaly, i.e. enlargement of the heart, and can rule out other causes of dyspnea due to lung disease.

Treatment for heart failure:

The goal of treatment in heart failure is to reverse or stop the progression of cardiac remodeling and dysfunction, improve functional capacity and symptomatology, decrease the number of hospitalizations, decrease mortality.

Lifestyle modification, pharmacologic and non-pharmacologic treatment (interventional/surgical, implantable devices, cardiac contractility modulation device implant, cardiac transplantation) are the methods by which these goals are sought.

Patient cooperation and lifestyle changes are important. This change involves:

• Adherence to treatment
• Recognizing symptoms
• Weight monitoring
• Monitoring fluid intake
• Limit/ban alcohol intake
• Weight reduction at BMI <30 kg/mp
• Smoking cessation
• Pneumococcal and influenza immunization
• Regular physical activity

Treatment of associated conditions:

Special attention should also be paid to associated diseases as some medications for these may worsen heart failure. The interaction between certain drugs reduces adherence to treatment (e.g. beta blockers and beta agonists given in COPD/asthma) or, conversely, their interaction worsens clinical status and prognosis (e.g. diabetes mellitus).

The main associated diseases that need attention in patients with heart failure are anemia, kidney disease, lung disease, diabetes mellitus, gout, dyslipidemia, obesity, obesity, sleep disorders, neoplasms, erectile dysfunction, prostate adenoma, depression.