Ashley Brown

English 1201-219

Dr. Cassel

6 November 2018

Heart Failure Causes and Management

Heart disease is known globally as the leading cause of death. Most people do not know

or understand heart disease until it personally affects them, therefore a basic comprehension of

its causes and effects, and a management of symptoms is necessary for treatment. I am one of the

naïve few who did not seek out the basic knowledge of heart disease when family members had

advised me to be leery of our predisposition to bad heart genes (American Heart Association).

2018 has been an eye opening medical turmoil in my personal life. Issues arose in March

while unbeknownst to me I was plagued with the burdening symptoms of heart failure. It all

began with a difficulty of breathing that had been swept under the rug with the thought that

maybe it was just seasonal bronchitis. As a teen, I had been diagnosed with a slow heart rate, so

it was doubly alarming when my heart rate had spiked during this. It was as if my heart was

trying to run a marathon without my consent and I was weeping to catch up. Nurses later

informed me that this feeling was known as tachycardia (a high heart rate exceeding 100 beats

per minute, or BPM). The lack of an ability to breathe, and a newly developing high heart rate

caused dizziness upon any movement. After almost a week of overall crappiness, sharp pains

started radiating on the left side of my chest so I begrudgingly drove myself to the Emergency

Room. Upon arrival, they immediately admitted me for observations and extensive testing. By

the end of this adventure, I had been diagnosed with a slew of heart problems including
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Congestive Heart Failure or CHF. My heart would remain in tachycardia until weeks later when

an ablation could be performed.

My diagnosis was never formally discussed with me. In fact, discharge paperwork had to

be read upon my release from the hospital to even know what my diagnosis was. Throughout this

entire experience, I had to overcome my sense of denial about the seriousness of heart disease.

My doctors were not the best at helping me comprehend what was happening with my body, and

my overall lack of knowledge on heart disease brought on an overwhelming feeling of just how

quickly of a death sentence this could become. It has been with the utmost of importance to me

to learn as much as possible about this disease. It feels as though this subject matter of CHF and

its stigmas that surround it, have increased my anxiety disorder. My physician informed me

during our last appointment that my increase in anxiety will also contribute directly to a decrease

in heart functionality. It has put me in an overwhelmingly anxious state that causes most days to

be spent in a haze of motions to just get by. Self-awareness is brought on by the terrors of this

disease encountered in research when articles state the reality of the mortality rate of those

diagnosed with late stages of CHF are really low. Though there are differences in research, most

articles state that 50% of people will die within one year of their diagnosis, and 90% will die

within 5 years of their diagnosis.

Given this opportunity to change my mindset, this research can help me take heart

disease head on to provide all the medical information that will help others to better understand

heart disease, and the medical processes of managing it. In my personal observations, most

people have at some point in their lives been affected by this disease simply by knowing

someone else that has been diagnosed with heart related conditions. This is typically an older

family member such as grandparents, however heart disease does not discriminate and can effect
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anyone at any age. What is heart disease and what causes CHF? What are ways that the different

branches of heart diseases can be managed? Congestive Heart Failure alone is different for every

person, but research shows some of the most common causes of dysfunction are genetics, birth

defects, unmanaged high blood pressure, artery diseases, and arrhythmias (my case).

In the BMH Medical Journal, Dr. K.V. Sahasranam writes an article titled “Heart Failure

Management-Evolution Over the Ages,” about the general recognized history of heart disease

and Failure. Heart failure has an extensive history and evolution of its treatments, and has

effected many individuals. The earliest case of notable heart failure was documented from a

study of the Egyptian mummy known as Nebiri, who had lived over 3500 years ago. Ebners

papyrus (1556-1550 BCE) have documented some of the earliest cases of observations of heart

failure symptoms. Hippocrates (460-370 BCE) documented numerous cases of heart failure.

Emperor Alexander I Comnenus suffered from heart failure in the twelfth century as written by

his daughter Anna Comnenus in a description of his symptoms (Sahasranam).

The earliest forms of “treatment” for HF were nothing more than surgical bleed outs

performed with small incisions, and leeches. Purifying the blood was considered the only

treatment option for this unknown sickness in ancient times. Thankfully, medicine has improved

throughout the centuries. The 19th century introduced the cannula to help drain the swelling from

the limbs. In 1785, a revolution in the management of HF began with the use of the foxglove

plant as a treatment option. In this article, Dr. Sahasranam makes the claim that previous to any

pharmaceutical advancements that had occurred in the 1980’s, management of heart failure

consisted only of comfort measures for the patient. This included dietary and fluid restrictions,

frequent bed rest, positions to allow an ease of breathing, and diuretics which were just making

their debut (Sahasranam).

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Beta blockers were first introduced in 1975 and the trial studies of this drug directly

influenced what Dr. Sahasranam calls the “Era of Pharmacological Intervention.” Beta blockers

led to the discovery of another beneficial pharmaceutical known as Angiotensin Converting

Enzyme Inhibitors (ACE Inhibitors or ACEIs). Next was the Angiotensin-Neprilysin inhibitors

(ARNI), but due to its serious side effects, its complications outweighed its benefits and is now

rarely used (Sahasranam).

The use of technology and its long-term benefits are on a steady rise. Artificial devices

were developed to aid in the increase of a hearts functionalities. Dr. Sahasranam testifies that the

20th century brought on the “Device Era” also known as “Electrophysiologic Intervention”. The

machine-like apparatuses now used include Implantable Cardioverter Defibrillators (ICD),

Cardiac Resynchronization Therapy devices (CRT), and pacemakers. All of these intricately

designed gadgets have separate attributes that help alleviate the stress to the heart caused by an

abnormality. For example, by physically regulating a hearts beats, that heart then becomes

capable of rest. This is achieved with a surgically implantable electronic device that will take

over for the heart, where it was once overworked and underappreciated (Sahasranam).

In a medical article titled, “The Causes, Consequences, and Treatment of Left or Right

Heart Failure,” Dr. J. Peteiro makes a claim that there are numerous factors to Heart Failure

including the rising age of the population. Misdiagnosis by medical professionals will cause 65%

of patients to die within the first 5 years after their onset of symptoms. Heart failure patients also

contribute to 1-2% of all health care costs. The main marker to diagnose HF is done with an echo

and shows the ejection fraction of the individual. An ejection fraction (EF) is the amount of

oxygenated blood the heart is able to pump out from the lungs. An EF in a normal, healthy heart,

is 70% or higher. In HF, the EF drops to 50% or less. The main causes of heart failure listed in
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this journal are as follows; high blood pressure, congenital heart disease, myocardial ischemia,

pulmonary hypertension (PHT), cardiomyopathies, and valvular heart disease. There are also two

main types of heart failure categorized as right sided and left sided. The image listed below from

this medical journal breaks down the two types of heart failure (Peteiro) (Sossalla).

Figure 1. The Causes, Consequences, and Treatment of Left or Right Heart Failure

Also according to Dr. Howard Eisen, due to the increase of heart dysfunction across the

world, the increase in population age, and high medical bills accumulated by patients with heart

disease, HF is regularly studied and ever changing to increase a patient’s mortality rate. Heart

Failure can be acute or chronic depending on its underlying causes. There are a plethora of

treatment options available to help control the underlying cause of the failure to prolong the life

of the patient, however there is still no clinical reversal or cure of the disease once the damage

has started. Some of these treatment options include cardiac ablations, pharmaceutical treatments

such as beta blockers and ace inhibitors, surgeries to repair blockages, fixing or replacing valves,

pacemakers to regulate a hearts rhythm, limited exercise to strengthen the heart muscle, dietary

restrictions (such as decreased sodium and fluid intake), and the end result would be a total heart

replacement (Eisen).
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In an article about heart disease and the youth written in the Journal of the American

College of Cardiology, Dr. Chih Wong shares the details about the prevalence and lack of

knowledge among heart failure occuring in young adults. This study of heart failure was

intentionally performed on a younger class of individuals versus the typical “senior” age group.

Few studies have been performed on the effect of heart failure on the younger age groups and is

still somewhat trivial. There were five categories in this study and broken down as ages 20-39,

40-49, 50-59, 60-69, and 70+. The youngest group of adults diagnosed with HF were typically

either obese, black in ethnicity, or born with a malfunction in their heart. Young patients are

more likely to manifest their symptoms differently as opposed to the older population. With the

youth, the diagnosis is often more complex than the typical black and white symptoms of HF and

is frequently overlooked (Wong).

Younger adults seemingly have a problem following doctors’ orders because it is noted

by Dr. Wong that younger adults were more likely to be non-compliant with their medications,

their diet restrictions, as well as the necessary lifestyle changes. Despite higher hospitalization

rates, the younger age groups have been documented to have longer survival rates, but a more

significant decrease in the quality of their life. Doctors are more likely to use the more invasive

procedures to treat younger patients such as repair surgeries and ablations, as opposed to the

possible rejections the 70+ age group faces due to their weakened body states. Dr. Wong states,

Compared with older patients, younger patients with HF have a markedly different

clinical profile, including a different pattern of symptoms and signs that could lead to

delayed diagnosis, a greater reduction in HRQL, more hospitalizations attributed to

nonadherence to treatment but better survival, with relatively low rates of death until the

age of 60 years. (Wong)

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Upon further research, I located an article titled “Arrhythmia-Induced Cardiomyopathy

Causes, Clinical Significance, and Treatment,” that directly correlated with my own personal

heart dysfunction. In this article written by Dr. Samuel Sossalla and Dr. Dirk Vollmann, one of

the possible causes of HF could be due to a cardiac arrhythmia. A cardiac arrhythmia is an

occurrence where the heart is not in a normal sinus rhythm. This irregular occurrence can have

an end result of heart failure. The abnormality is typically caused by an extra electrical pulse sent

within the heart itself causing it to beat out of rhythm. Due to these extra beats, the heart is

overworked and the muscle is over-stretched like that of a rubber band and loses its elasticity and

ability to bounce back to a normalcy. Dr. Sossalla expresses in this article,

Cardiac arrhythmias are often a result of heart failure, but they can cause left-

ventricular systolic dysfunction (LVSD) as an arrhythmia-induced cardiomyopathy

(AIC). This causal relationship should be borne in mind by the physician treating a

patient with systolic heart failure in association with cardiac arrhythmia…. The

underlying pathophysiologic mechanisms are incompletely understood; the increased

ventricular rate, asynchronous cardiac contractions, and neurohumoral activation all seem

to play a role…. Together with the ever-aging population, heart failure poses one of the

greatest challenges to modern medicine and health economics. (Sossalla)

Heart disease is still surrounded by variables that cannot seem to be explained to the

fullest extent. The studies gathered by Dr. Sossalla and Dr. Vollmann in the Deutsches

Aerzteblatt International journal on arrhythmia-induced cardiomyopathy, are done to get a better

understanding of the how and why of arrhythmia, and their direct correlation with heart failure.

An arrhythmia-induced cardiomyopathy (AIC) has different classes of arrhythmias depending on

the case of the individual. The most common arrhythmias that can trigger AIC are as follows;
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atrial flutter, atrial fibrillation (also known as a fib and is the most common source of an

arrhythmia), supraventricular tachycardia (SVTs), frequent premature ventricular contractions

and ventricular tachycardia (PVCs or PVTs) (Sossalla) (Vollmann).

To get a better understanding of an arrhythmia induced heart failure, one must understand

the underlying causes. These studies are often times completed on individualized cases for each

tier of AICs and their end result of left-ventricular systolic dysfunction. These studies give

medical professionals some insight to the course of action to complete in each instance as well as

the various results and outcomes. Unfortunately, CHF is a lifelong disease that will continue to

degenerate the heart. More often than not, the initial symptoms may be treatable, but once the

damage has started, it is hard to move backwards in the process (Sossalla) (Vollmann).

We may not be able to beat heart disease yet, but we have vast systems available to help

patients manage their symptoms through well planned and patient specific treatments. Some

easily recognizable symptoms of heart failure are shortness of breath, light-headedness or

dizziness, swelling of the legs and abdomen, fast weight gain (3lbs or more within one day),

weakness and fatigue, sudden chest pains, a loss of appetite, sleeplessness or narcolepsy, and the

incapability of lying flat on your back due to the excess fluid that backs into the lungs. Proper

education is a must for patients to be able to live life to their fullest potentials (Bader).

A study was performed at a cardiac center in Kuwait on the necessity for nurse led

education programs. These programs were created and put into place as a tool of easily

accessible knowledge for a patient from well-educated nurses to ensure that a patient’s care plan

is working for them and that they comprehend what is happening so they can better manage their

lives. Doctors are great to diagnose diseases, but more often than not they do not have the time or

mannerisms for a bed side life comprehension an individual may need. That is where nurse teams
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step in, to guide us in the right directions and work as a communication builder between the

doctor and the patient (Bader).

Just in the past 43 years technological and pharmaceutical improvements have drastically

increased the mortality of HF patients. Advancements made in the way researchers are able to

study and physically see the body on a molecular level in the past two decades alone have given

doctors new opportunities to significantly increase their knowledge on cellular makeup and the

body’s infrastructure. In this current age of stem cell and genetic research, studies are being

performed on the use of stem cells for tissue regrowth. These studies are currently conflicting on

the lasting effect of these cells, which cells produce the best results, and how to administer them,

but it is slowly gaining encouragement as a possible therapy treatment for genuine tissue

regeneration (Vittorio)(Alkan).

Stem cell research is an expensive, and time consuming controversy, however, doctors

have been able to take stem cell research to significant levels. The overall use of stem cells is

followed by a taboo list of trials and stipulations, but there is a headway being made daily. The

stem cells that researchers have been able to currently identify and process have a specific

genetic makeup that will directly correlate to how that cell will function with each therapy it is

used towards. The light at the end of our tunnel is the hope that we will soon be able to have a

solid base of studies towards the use of stem cells that will positively correlate with one another

on the benefits and the need for the cellular regeneration of our current malfunctioning hearts

(Vittorio) (Alkan).

Heart failure management is changing from a whimsical hope of recovery, to the real

possibility of the restoration of our own hearts. This new research is already prolonging our

existence and could eventually replace the truthful and current final result of a full heart
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transplant or even death. We move forward every day with a flourishing understanding of the

human body and its dynamic circulatory system. Scientists carry the will and knowledge to be

able to extend lives on quantitative levels. The emergence of cellular research brings astounding

progression towards the systematic approach of heart disease. Technological advancements

permit a better comprehension of heart dysfunction and is responsible for the progress in the

management and treatment options available to patients. The drive towards an easier to manage

life gives the desire for an outcome of an increase in the longevity of lives globally. Sir Winston

Churchill, in my opinion, may have said it best with these personal quotes (as quoted in

Sahasranam) (Bader).

The longer you look back, the further you can look forward…. Success is not

final, failure is not final: it is the courage to continue that counts. (Churchill)
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Works Cited

Alkan, Mehmet, et al. “Regenerative Stem Cell Therapy Optimization via Tissue Engineering in

Heart Failure with Reduced Ejection Fraction.” Cardiovascular Engineering and

Technology, no. 4, 2017, p. 515. EBSCOhost, doi:10.1007/s13239-017-0325-y.

Bader, Feras, et al. “Nurse-Led Education for Heart Failure Patients in Developing

Countries.” British Journal of Nursing, vol. 27, no. 12, July 2018, pp. 690–

696. EBSCOhost, doi:10.12968/bjon.2018.27.12.690.

Churchill, Sir Winston

Eisen, Howard. Heart Failure. [Electronic Resource] : A Comprehensive Guide to

Pathophysiology and Clinical Care. London : Springer, 2017, 2017. EBSCOhost,

sinclair.ohionet.org:80/login?url=https://search.ebscohost.com/login.aspx?direct=true&d

b=cat01128a&AN=scc.b1786161&site=eds-live

KV Sahasranam. “Heart Failure Management - Evolution Over The Ages.” BMH Medical

Journal, Vol 4, Iss 1, Pp 17-22 (2017), no. 1, 2017, p. 17. EBSCOhost,

sinclair.ohionet.org:80/login?url=https://search.ebscohost.com/login.aspx?direct=true&d

b=edsdoj&AN=edsdoj.23347e344a42548d4bf9548fc077bc&site=eds-live.

Mozaffarian D; Heart disease and stroke statistics— 2015 update: a report from the American

Heart Associationhttp://www.heart.org/idc/groups/ahamah-

public/@wcm/@sop/@smd/documents/downloadable/ucm_470704.pdf. Accessed on 6

November 2018.

Peteiro J, et al. “The Causes, Consequences, and Treatment of Left or Right Heart

Failure.” Vascular Health and Risk Management, Vol Volume 7, Pp 237-254 (2011),
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2011, p. 237. EBSCOhost,

sinclair.ohionet.org:80/login?url=https://search.ebscohost.com/login.aspx?direct=true&d

b=edsdoj&AN=edsdoj.4ff1490f09524b788e6c5c86c5f49ae5&site=eds-live

Sossalla, Samuel, and Dirk Vollmann. “Arrhythmia-Induced Cardiomyopathy Causes, Clinical

Significance, and Treatment.” Deutsches Aerzteblatt International, vol. 115, no. 19, May

2018, pp. 334–341. EBSCOhost, doi:10.3238/arztebl.2018.0335.

Wong, Chih M., et al. “Clinical Research: Clinical Characteristics and Outcomes of Young and

Very Young Adults With Heart Failure. The CHARM Programme (Candesartan in Heart

Failure Assessment of Reduction in Mortality and Morbidity).” Journal of the American

College of Cardiology, vol. 62, Nov. 2013, pp. 1845–1854. EBSCOhost,

doi:10.1016/j.jacc.2013.05.072.