Systolic Heart Failure: Symptoms, Causes, Treatment

What are the symptoms of systolic heart failure?

Systolic heart failure, also known as heart failure with reduced ejection fraction (HFrEF), occurs when the heart’s ability to pump blood effectively is compromised. Symptoms can vary in severity but typically include:

• Shortness of Breath: Often occurring during exertion or while lying down, it can be due to fluid accumulation in the lungs (pulmonary congestion).
• Fatigue: A feeling of extreme tiredness or lack of energy, even with minimal physical activity.
• Swelling (Edema): Fluid retention leading to swelling in the legs, ankles, feet, or abdomen. This is due to the heart’s reduced ability to pump blood effectively.
• Coughing: A persistent cough, particularly at night or when lying flat, often with pink, frothy sputum, can be a sign of pulmonary congestion.
• Difficulty Breathing: Particularly when lying flat, leading to orthopnea or needing to sleep propped up.
• Rapid Heartbeat or Irregular Heartbeat: Palpitations or an abnormal heart rhythm can occur as the heart tries to compensate for its reduced pumping ability.
• Reduced Exercise Tolerance: Difficulty with physical activities that were previously manageable, due to reduced cardiac output.
• Weight Gain: Sudden weight gain due to fluid retention is a common sign of worsening heart failure.
• Nausea and Loss of Appetite: Fluid buildup in the abdomen can lead to gastrointestinal symptoms such as nausea and decreased appetite.
• Confusion or Impaired Cognition: In severe cases, reduced blood flow to the brain can lead to confusion or difficulty concentrating.

These symptoms result from the heart’s inability to pump blood effectively, causing fluid to back up in the lungs and other parts of the body. Managing systolic heart failure often involves medications, lifestyle changes, and sometimes surgical interventions to improve heart function and alleviate symptoms.

What are the causes of systolic heart failure?

Systolic heart failure, characterized by a reduced ejection fraction (HFrEF), arises from various conditions that impair the heart’s ability to pump blood effectively. Common causes include:

• Coronary Artery Disease (CAD): Narrowing or blockage of the coronary arteries reduces blood flow to the heart muscle, leading to damage and weakening of the heart.
• Hypertension (High Blood Pressure): Chronic high blood pressure forces the heart to work harder, which can cause the heart muscle to thicken (left ventricular hypertrophy) and eventually weaken.
• Myocardial Infarction (Heart Attack): Damage to the heart muscle from a heart attack impairs its ability to contract effectively.
• Cardiomyopathy: Diseases of the heart muscle, including dilated cardiomyopathy, where the heart chambers enlarge and weaken, can lead to systolic heart failure.
• Valvular Heart Disease: Conditions affecting the heart valves, such as aortic stenosis or mitral regurgitation, can force the heart to pump against increased resistance or handle backflow, leading to heart failure.
• Arrhythmias: Abnormal heart rhythms, such as atrial fibrillation, can reduce the heart’s efficiency and contribute to heart failure.
• Congenital Heart Defects: Structural abnormalities present from birth can impair heart function and lead to heart failure.
• Alcohol Abuse: Chronic excessive alcohol consumption can weaken the heart muscle, leading to cardiomyopathy.
• Infections: Certain infections, such as viral myocarditis, can cause inflammation and damage to the heart muscle.
• Toxic Exposures: Exposure to certain drugs or toxins can damage the heart muscle and contribute to heart failure.
• Obesity: Excess body weight increases the risk of high blood pressure, diabetes, and other conditions that can lead to heart failure.
• Diabetes: Diabetes can contribute to heart failure through its effects on blood vessels and the heart muscle.

These conditions can weaken the heart’s ability to contract and pump blood efficiently, leading to the symptoms and complications of systolic heart failure. Managing these underlying causes is crucial for treating and preventing the progression of heart failure.

What is the treatment for systolic heart failure?

Treatment for systolic heart failure, or heart failure with reduced ejection fraction (HFrEF), aims to improve symptoms, enhance the quality of life, and prevent disease progression. Strategies typically include:

• Medications:
• ACE Inhibitors (e.g., enalapril, lisinopril) or ARBs (e.g., losartan, valsartan) to reduce blood pressure and decrease the heart’s workload.
• Beta-Blockers (e.g., metoprolol, carvedilol) to improve heart function and reduce heart rate.
• Diuretics (e.g., furosemide, bumetanide) to reduce fluid retention and alleviate symptoms of edema and pulmonary congestion.
• Aldosterone Antagonists (e.g., spironolactone, eplerenone) to help prevent fluid buildup and improve heart function.
• SGLT2 Inhibitors (e.g., empagliflozin, dapagliflozin) to help manage symptoms and reduce hospitalization rates.
• Hydralazine and Nitrates for certain patients to help reduce symptoms and improve heart function.
• Lifestyle Changes:
• Dietary Adjustments: Reducing salt intake to manage fluid retention and maintaining a balanced diet to support overall health.
• Weight Management: Addressing obesity and maintaining a healthy weight to reduce strain on the heart.
• Exercise: Engaging in a supervised exercise program to improve cardiovascular fitness and overall health.
• Medical Devices:
• Implantable Cardioverter-Defibrillators (ICDs) to prevent sudden cardiac death in patients with a high risk of life-threatening arrhythmias.
• Cardiac Resynchronization Therapy (CRT) to improve the heart’s pumping efficiency by coordinating the contractions of the heart’s chambers.
• Surgical Interventions:
• Heart Valve Repair or Replacement for patients with valvular heart disease contributing to heart failure.
• Coronary Artery Bypass Grafting (CABG) or Percutaneous Coronary Interventions (PCI) for patients with significant coronary artery disease.
• Left Ventricular Assist Devices (LVADs) for advanced heart failure to help the heart pump blood.
• Monitoring and Follow-Up: Regular check-ups with a healthcare provider to monitor heart function, adjust medications, and manage any complications.
• Education and Support: Patient education on managing heart failure, recognizing symptoms of worsening heart failure, and engaging in support networks for emotional and practical assistance.

These treatments are tailored to the individual patient based on the severity of their condition, underlying causes, and overall health.