Heart failure is a serious condition which can affect anyone, however, it can be a difficult disease to diagnose since the symptoms may be subtle at times. “Symptoms may be variable depending on the underlying cause and severity of the patient’s heart failure,” said Sean A. Virani MD, MSc, MPH, FRCPC, FCCS.
Dr. Virani is an Associate Professor of Medicine at UBC, Senior Medical Advisor of Cardiac Services BC, President of the Canadian Heart Failure Society, and Medical Director at the HeartLife Foundation. He explains that there can be significant overlap between the symptoms of heart failure and other common cardiac and respiratory diseases.
“Not infrequently, heart failure will be incorrectly diagnosed as pneumonia, asthma or COPD (chronic obstructive lung disease) since the symptoms may be similar.”
Heart failure symptoms
Patients with heart failure will, in general, complain of shortness of breath, initially with exertion, but then progress to having “difficulty breathing, even at rest.”
Dr. Virani explains how, oftentimes, patients will be unable to lay flat in bed at night and will prop themselves up on pillows to help with labored breathing. Also, that some patients describe waking up in the night “to catch their breath”.
“Commonly, patients will note swelling in their legs and abdomen, which is due to fluid retention, and fatigue resulting from poor heart function.” Each heart failure case is unique, and the symptoms of heart failure may come and go over time, according to the Ted Rogers Centre For Heart Research.
The question presents itself; how long does it take for an individual who injures their heart to notice the symptoms of heart failure?
“There is no rule or best guestimate on the delay between developing dysfunction of the heart muscle and the onset of symptoms. Some patients may go years before experiencing symptoms, while others have symptoms right away,” said Dr. Virani.
“In general, the more severe the symptoms and the more functional impairment the individual experiences (i.e. inability to perform exercise, walk short distances or even care for themselves) the worse the prognosis for heart failure.”
Factors which contribute to diagnosis
Heart failure is very common. Every year, 50,000 new people are diagnosed with the chronic condition, according to the Ted Rogers Centre For Heart Research.
“The diagnosis of heart failure is primarily made on clinical grounds – that means that healthcare providers rely heavily on taking a history and performing a physical exam in order to make the diagnosis.” Dr. Virani notes that a comprehensive history and physical exam will also help the practitioner to identify the underlying cause for why a patient may have developed heart failure.
“Once the clinical diagnosis of heart failure is made, additional diagnostic testing may be used to confirm the diagnosis, provide insight on the cause of heart failure, identify the optimal treatment strategy and determine prognosis. This may include blood tests, an ultrasound of the heart which is also called an echocardiogram, an electrocardiogram (ECG), and in some cases an invasive test called an angiogram or heart catheterization.”
Heart failure has many causes or underlying risk factors. “The most common is damage to the heart muscle caused by a heart attack (myocardial infarction),” according to the Heart and Stroke Foundation.
High blood pressure can lead to heart failure if left undiagnosed and untreated for a long period. That’s why it’s important to get your blood pressure checked at least once every two years, or more often if your physician recommends you do so.
If heart failure is left untreated
“For all corners with heart failure, regardless of cause, symptom and disease severity, the average survival is 50% at 5 years. That means that 50% of patients will not be alive at five years if their disease is left untreated,” Dr. Virani added.
“Hospitalization is a major risk factor for mortality and this is why healthcare providers work hard to ensure patients don’t get hospitalized for their heart failure.” Despite this, more than 100,000 Canadians are hospitalized annually due to heart failure, according to the Ted Rogers Centre For Heart Research.
“In BC, approximately 12% of patients will be re-hospitalized for heart failure in 30-days and approximately 25% will be re-hospitalized at one year. After the first hospitalization, average survival drops to 30 months and after four hospitalizations, the average survival is only six months. Death and hospitalization can be significantly reduced with medication and adherence with lifestyle recommendations,” Dr. Virani concluded.
Always speak to a medical professional if you experience one or more of the common symptoms of heart failure.
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