All of the risk factors for heart disease also increase the risk for heart failure. Heart failure results from other dis-eases and conditions that damage the heart. If untreated, any one of these conditions can damage the heart and lead to heart failure. Patients who have more than one condition face an even greater risk of developing failure. These conditions include: High blood pressure (hypertension) In high blood pressure, the pressure and resistance in the body’s arteries is increased. As a result, the heart must work harder to pump blood against this elevated pressure and into the arteries. This increased workload can, over time, lead to an enlarged and poorly functioning heart.
Diabetes In some cases, diabetes seems to cause dam-age to the heart muscle, increasing the likelihood that heart failure will develop. In addition, patients with diabetes have other risk factors for coronary heart disease and therefore may be at an increased risk for developing heart failure. (See below.) Coronary heart disease When the arteries to the heart muscle (coronary arteries) become narrowed due to cholesterol deposits, the blood flow to the heart is de-creased. When the heart muscle doesn’t get enough blood and oxygen (especially during exercise, when the body needs more blood supply and oxygen), the heart does not pump as well.
This can result in fatigue and shortness of breath. If enough of the coronary arteries are affected, the heart muscles will not have enough If the decrease in blood supply to the heart muscle is critical, it can result in chest pain, what doctors call angina.When the blood supply to the heart muscle is completely cut off, the heart muscle dies. This is called a heart attack or a myocardial infarction. In some cases, when there is a large amount of heart muscle damage, the remaining heart muscle is unable to pump blood to the rest of the body adequately. This is an-other cause of heart failure. Damage to the heart valves A number of conditions, including heart attack, high blood pressure, bacterial infections of the valves (endocarditis), aging, and rheumatic fever, can damage the heart valves.
As a result of this damage, the normal forward flow of blood through the heart is disrupted. This can sometimes result in a narrowing of the valve (called stenosis) or a leaking of the valve (called insufficiency). When the valve becomes narrowed (stenotic), it causes an increased pressure within the heart. The heart has to push harder to get the same amount of blood out. Over years, this can damage the heart muscle and cause it to fail. Other times, the valve can become leaky (or insufficient). This means that when the heart pushes the blood out, some of the blood pushed out comes back into the ventricle. This backward flow of blood is called regurgitation by doctors. When a valve is leaking like this, the heart has to pump harder and faster to keep the same amount of blood circulating. This can, over time, lead to heart muscle damage and eventual heart failure.
Severely damaged valves can either be fixed or replaced by surgeons. Cardiomyopathy Cardiomyopathy is a disease of the heart muscle. The name comes from the roots cardio meaning “heart,” myo meaning “muscle,” and pathy meaning “disease.” In cardiomyopathy, the heart muscle has been damaged and it does not work as efficiently as before. Cardiomyopathy can lead to an enlarged, poorly pumping heart. In most people, the cause of cardiomyopathy is un-known. In some people, however, doctors are able to identify a cause or contributing factors, including some that affect the heart and cardiovascular system. For ex-ample, any of the following conditions may cause or contribute to cardiomyopathy:
- Sustained high blood pressure
- Heart tissue damage from a previous heart attack
- Chronic rapid heart rate
- Emphysema. Severe lung disease can result in right-sided heart failure.
- Nutritional deficiencies of essential vitamins and minerals, such as thiamin (vitamin B-1), selenium, calcium, and magnesium
- Low red-blood-cell count (severe anemia)
- Overactive or underactive thyroid gland (hyperthy-roidism and hypothyroidism)
- Pregnancy. Heart failure may develop during the last 3 months of pregnancy or several months after pregnancy. The cause of this is not well understood, but it may be due to an
abnormal immune system response. - Excessive use of alcohol over many years
- Abuse of cocaine or antidepressant medications, such as tricyclic antidepressants
- Use of some chemotherapeutic drugs to treat cancer
- Certain viral infections, which may injure the heart and trigger cardiomyopathy Hemochromatosis. This is a disorder in which your body doesn’t properly metabolize iron, causing the accumulation of iron in your heart muscle.
- Arrhythmogenic right ventricular dysplasia (ARVD). This results in muscle tissue in the right ventricle being replaced by fat, triggering abnormal heart rhythms. In many people, there appears to be a genetic basis for ARVD.
- Amyloidosis. This is a disease that results from abnormal proteins or cell products being deposited in the heart muscle. The affected heart muscle is no longer able to pump blood.
Fortunately, treating these conditions during their early stages can often prevent heart failure or significantly delay its onset. In order for a prevention strategy to work, the condition must be diagnosed early and an effective treatment strategy implemented. Treatment de-pends on what the cause of your heart failure is and what the condition of your heart is now. Medications, implantable devices, or in severe cases, a heart trans-plant are all possible treatments.
Victoria’s comment: I developed heart failure when I was in my sixties. My doctor told me it developed because of long-term high blood pressure and coronary artery disease. I’ve been treated for both those conditions now and my heart failure has improved some.