Recognizing and treating heart failure as soon as possible may help to slow the progression of this serious condition.
If you start feeling tired or winded more than usual, it's easy to blame it on getting older, being out of shape, or being overweight. However, if these symptoms persist, don't dismiss them, especially if you're also experiencing ankle swelling and difficulty breathing when lying down.
These are all classic symptoms of early heart failure, which occurs when the heart is unable to effectively pump blood throughout the body (see "The FACES of heart failure"). Recent advances in both detection and treatment may help to alleviate the burden of heart failure, which is the leading cause of hospitalization in people 65 and older.
People are generally unaware that they are at risk of developing heart failure, nor do they realize how dangerous it can be. "However, we have tools to detect early heart failure in people at high risks, such as those with type 2 diabetes," says Harvard Medical School cardiologist Dr James Januzzi.
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THE MANIFESTATIONS OF HEART FAILURE
To assist both patients and doctors in identifying potential heart failure symptoms, the Heart Failure Society of America devised a simple acronym: FACES.
F.Fatigue. A weakened heart is unable to deliver enough oxygen-rich blood to meet the body's needs, resulting in a general sense of tiredness or fatigue.
A.Restriction on activity. Because people with heart failure tire easily, they frequently struggle to perform everyday tasks like preparing a meal or going for a short walk.
C. Traffic congestion. Because of the heart's inability to pump blood, fluid leaks into the lungs. Coughing and wheezing may result from the resulting lung congestion.
Oedema (ankle swelling) Fluid can also accumulate in the ankles, legs, thighs, and abdomen. All of the extra fluid can also contribute to rapid weight gain.
S. Breathing difficulty.
Congestion makes it difficult for the lungs to remove carbon dioxide from the blood and replenish it with fresh oxygen, making breathing difficult. When people lie down, their shortness of breath is often exacerbated because excess fluid from the lower body moves up toward the lungs.
Congestion makes it difficult for the lungs to remove carbon dioxide from the blood and replenish it with fresh oxygen, making breathing difficult. When people lie down, their shortness of breath is often exacerbated because excess fluid from the lower body moves up toward the lungs.
Blood biomarker analysis
The American Diabetes Association now recommends that people with type 2 diabetes have yearly blood tests for brain natriuretic peptide (BNP) or N-terminal pro-brain natriuretic peptide (N-terminal pro-brain natriuretic peptide (N-terminal pro-bra (NT-proBNP). These biomarkers, which are released by heart muscle cells when they are stressed, have long been used to diagnose and monitor heart failure. Screening people who are at high risk of heart failure may reveal the problem sooner. And, according to Dr Januzzi, a timely diagnosis means earlier access to a variety of potentially beneficial therapies.
The FDA approved the expanded use of empagliflozin (Jardiance) earlier this year for treating the most common type of heart failure in older people, known as heart failure with preserved ejection fraction (HFpEF). Initially developed to treat type 2 diabetes, empagliflozin was later discovered to help keep people with heart failure (even those without diabetes) out of the hospital and alive for longer periods. Entresto, a combination of two blood pressure medications (sacubitril and valsartan), is another effective heart failure treatment. Other older, generic medications, such as beta blockers and mineralocorticoid receptor antagonists, are also extremely beneficial.
The most common cause of heart failure in the United States is coronary artery disease (a buildup of fatty plaque inside the arteries that supply the heart). However, according to a study published in the March 2022 issue of the Journal of the American College of Cardiology, only about one-third of people who are diagnosed with heart failure are tested for coronary artery disease within three months. According to Dr Januzzi, who co-wrote an editorial accompanying the study, this discouraging trend suggests that people with heart failure are frequently undertreated.
Take-home message
Dr Januzzi advises all of his patients to practice the American Heart Association's "Life's Simple 7" heart-healthy habits (see /simple7) to reduce their risk of all types of cardiovascular disease. Furthermore, people with type 2 diabetes should inquire about a yearly blood natriuretic peptide test to screen for early heart failure. Anyone who notices possible heart failure symptoms should consult a doctor. Those diagnosed with heart failure should also be evaluated for coronary artery disease, as the results will influence the treatment they receive.