[ Physical Illness ]

* Illness of Heart & Vein *
Heart Failure

According to the New York Heart Disease Association's ranking, which classifies the symptoms of heart failure into four stages, patients with heart failure with severity IV have a survival rate of 50% after 2 years and a survival rate of only 30% after 3 years. Currently, the number of heart failure patients in Japan is estimated to be about 1.6 million.

The table below shows the causes of heart failure and examples of their symptoms.

[ A disease called Heart Failure ]

What kind of illness is it?

Heart failure is a condition in which the whole body cannot supply enough blood, regardless of the cause. Heart failure can come from a variety of causes. It can be caused by overwork or stress in addition to heart disease such as angina, myocardial infarction, or valvular heart disease, which can clog blood vessels, or it can be caused by high blood pressure, systemic arteriosclerosis, or arrhythmia.

Heart failure can lead to shortness of breath and tiredness due to lack of oxygen due to lack of blood in various organs. Not enough blood is supplied to the capillaries, which can cause the tips of the limbs to become cold and the complexion to become pale.

Heart failure is called acute heart failure if its onset is rapid, and chronic heart failure if it develops gradually and persists. In general, heart failure due to myocardial infarction is acute heart failure, and heart failure due to cardiomyopathy or valvular heart disease is chronic heart failure.

[ Symptom of Heart Failure ]

Typical symptoms

Poor blood flow causes congestion in the organs, causing swelling around the insteps and shins. As the symptoms progress further, you may have difficulty breathing or breathing even at rest. In severe cases, lying down can cause severe congestion in the lungs, which may require sitting breathing in a sitting position. In addition, symptoms such as palpitation, edema, and cyanosis are observed.

The cause of heart failure is mainly the dysfunction of the left ventricle, and the condition in which the left atrium and left ventricle cannot pump enough blood necessary for systemic circulation is called left heart failure. In addition, right heart failure is a condition in which the right atrium and right ventricle, which are responsible for pulmonary circulation, do not maintain sufficient pumping volume. Symptoms that appear depend on whether the cause is the left or right atrium or ventricle.

The table below shows the New York Heart Association Functional Classification (NYHA), which classifies the symptoms of daily life by the New York Heart Association.

[ Cause of Heart Failure ]

Typical Causes

Heart failure is not a single disease or disease name, but a general term for a condition in which the pumping function of the heart is impaired due to ischemic heart disease or other heart diseases, and sufficient blood cannot be delivered to organs throughout the body. Many heart diseases cause heart failure, but typical causes include myocardial infarction, valvular disease, hypertensive cardiac hypertrophy (hypertensive heart disease), arrhythmia, cardiomyopathy, and pulmonary hypertension.

In early heart failure, there are no symptoms at rest, and shortness of breath during exertion, which causes shortness of breath or difficulty breathing when exercising, appears. As the condition progresses, even light exercise will cause symptoms. In severe cases, shortness of breath can occur even at rest, which is extremely dangerous.

The table below shows the causative diseases that cause heart failure.

[ Diagnosis of Heart Failure ]

Typical diagnostic method

If heart failure is suspected, it is first diagnosed by echocardiography. Echocardiography is an ultrasonic examination that applies ultrasonic waves to the abdomen and images the reflected sound from it. Echocardiography is the most useful test to show the size and function of the heart, and echocardiography can be used to determine the causative disorder that causes heart failure.

In addition to echocardiography using ultrasound, there are other methods such as chest X-ray, electrocardiography, MRI, and pulmonary artery catheterization. Chest X-rays show magnified cardiac shadows, pulmonary congestion, and pleural effusion. An electrocardiogram helps detect abnormalities in the electrical activity of the heart. An MRI scan has the ability to produce very detailed imaging information of the heart and helps confirm the diagnosis. Pulmonary artery catheterization is a highly invasive test, but it is a test that can continuously measure cardiac function.

[ Treatment of Heart Failure ]

Heart failure treatment policy

Heart failure is a disease caused by a decrease in the functioning of the heart for some reason, so the first step is to treat the disease or disease that causes it.

Lifestyle-related diseases such as hypertension, diabetes, and hyperlipidemia are often associated with heart failure, so treatment of these is essential. There are three basic treatments for heart failure in daily life: reduction of heart burden, treatment with drugs, and diet with salt restriction.

If the cause is angina or myocardial infarction, surgery may be required, such as inserting a stent called a stent into the coronary artery to widen the blood vessel or bypassing the coronary artery.

Drug therapy

Treatment for chronic heart failure includes medications that reduce or eliminate the symptoms of heart failure. Depending on the symptoms, diuretics that remove excess water in the body, cardiotonics that improve heart output, vasodilators, beta-blockers, etc. are used.

Treatment with catheters and stents

If the direct cause of heart failure is angina or myocardial infarction, a balloon called a catheter or a small tubular wire mesh called a stent is inserted into the coronary artery.

The catheter treatment method is applied to relatively mild patients, but it is about 2 to 4 mm in diameter and 20 mm in length inside the damaged and narrowed coronary artery lesion that is the direct cause of angina and myocardial infarction. It is a method of dilating the coronary artery from the inside by inserting and inflating a small balloon. After expanding the blood vessels, the balloons are contracted and removed.

The stent method is a method in which a small tubular wire mesh is placed inside the blood vessel in the coronary artery to inflate it, widen the blood vessel, and leave it fixed as it is.

surgery

More severely ill patients require extensive surgical treatment called coronary bypass surgery. In this method, another blood vessel is connected to the end of a narrowed blood vessel or an occluded lesion to create a blood bypass path that improves blood flow.

Previously, this surgery was performed with a heart-lung machine that completely stopped the heart, but recent advances in medicine have made it possible to perform surgery without stopping the heart. However, in any case, there is no difference in surgery that requires extremely advanced equipment and techniques.