Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body’s tissues.

MY uncle had a heart attack. We rushed him to the hospital, and he had to go into CCU (Coronary Care Unit). After that, the doctor informed us that he was suffering heart failure. This sounds terrible. How can a heart fail? Does this mean he is going to die?

The term “heart failure” sounds terrible, as if your heart is no longer working at all and there’s no hope left. But the actual term means that your heart is no longer meeting the requirements needed by your body. Hence, the heart has “failed” to deliver the pumping quota that is required.

Your heart functions to pump blood throughout the entire body so that oxygen and nutrients as well as other substances can reach every cell of your body.

When you have heart failure, your poor heart cannot supply your tissues and cells with enough blood.

Yes, heart failure is a serious condition. But no, it doesn’t mean your uncle is necessarily going to die.

How does heart failure occur?

It can occur in two ways:

·If your heart muscles have been weakened to such an extent that they can no longer pump enough to supply your body with what it needs.

·If your body’s requirements rise to such an extent that your relatively normal heart cannot cope.

Your heart tries to make up for this failure by enlarging (to provide capacity) as well as developing thicker muscles, and also by pumping faster to increase output.

Your body tries to help by constricting blood vessels to maintain blood pressure, and then by diverting blood away from less important organs like the skin to focus on vital organs like the heart and brain.

Then comes the point when the heart and body can no longer keep up, and you start to experience symptoms.

The doctor mentioned that my uncle had left-sided heart failure because the left side of his heart was affected by the heart attack. What does this mean? Does it mean that the left side of his body will be affected?

No. Left-sided heart failure does not mean that only the left side of your body will be affected. The left side here refers to your heart.

Your heart has four chambers – two atria and two ventricles. On each side of the heart, there is one atrium and one ventricle.

The left ventricle is responsible for pumping blood out of the heart into the circulation of the body. In left-sided heart failure, the left ventricle has lost its ability to contract normally, and so it cannot pump enough blood into the circulation. Left-sided heart failure can also be caused by the left ventricle losing its ability to relax normally, thus not allowing enough blood to fill in from the left atrium.

Is there such a thing as right-sided heart failure?

Yes. The right ventricle is needed to pump blood into your lungs so it can be replenished with oxygen. But if your left ventricle fails, there will be a backlog of blood in your lungs, which will then cause the pressure to increase.

The right ventricle is then pumping against this increased pressure, and is unable to maintain output into your lungs. As a result, it fails as well (right-sided heart failure).

Sometimes, isolated right heart failure can occur as a result of lung disease that causes hypertension that is confined to the lungs (pulmonary hypertension).

Congestive heart failure is a term used when both sides of the heart fail.

How would I know if I have heart failure?

It is only when the heart – which initially tries to compensate by all those mechanisms I outlined above – cannot keep up that you start to develop signs and symptoms.

But before that, you can do an annual medical check-up with a chest x-ray to determine the size of your heart. And if more investigation is warranted, an echocardiogram can be done to see your heart’s ejection fraction.

All this can be done prior to you developing any symptoms. When you actually have symptoms, then your heart has failed.

You may feel very tired or fatigued, especially during exertion, because your heart is not pumping out enough blood to meet the demands of your body. You may have nausea or lack of appetite, because your body is shutting down its blood flow to your gut as it tries to conserve blood for your vital organs.

You may feel palpitations because your heart rate has gone up. Someone may notice you are confused because there is lack of blood flowing to your brain.

With right-sided heart failure setting in, you may have fluid (oedema) accumulating in your body, such as your ankles when you are upright and your back when you lie down.

With left-sided heart failure, blood may accumulate in your lungs and result in shortness of breath or persistent coughing or wheezing.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health advice, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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