The basic mechanisms of heart failure

Written by Wang Li Bing
Intensive Care Medicine Department
Updated on September 20, 2024
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Heart failure is not an independent disease; it can be caused by various factors, such as myocardial infarction, cardiomyopathy, and various myocarditis, which lead to changes in the heart structure and subsequent cardiac dysfunction. Heart failure is mainly due to a disturbance in the heart's contractile function or diastolic function, which prevents the heart from adequately ejecting the returning blood volume. This results in pulmonary congestion, systemic circulation congestion, and a series of syndromes caused by insufficient arterial perfusion.

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Can heart failure be cured?

We say that some early-stage heart failure can be cured, such as peripartum cardiomyopathy and thyrotoxic cardiomyopathy. If discovered and treated early, there is hope for a cure. However, most heart failure cannot be cured. Although some psychological failures cannot be cured, if patients can receive early treatment and effective treatment, take their medication on time, and have regular check-ups as advised by their doctor, most heart failure can still be controlled or alleviated. However, if heart failure is detected and not actively treated, even mild heart failure may gradually worsen, or even become end-stage heart failure.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Is the heart rate fast or slow in heart failure?

Heart failure is also relatively common in clinical practice, primarily due to dysfunction in the heart's contractile or relaxation capabilities. This leads to ineffective expulsion of venous blood returning to the heart, resulting in venous congestion and a series of symptoms. Patients typically experience varying degrees of breathing difficulty, coughing, expectoration, coughing up pink frothy sputum, as well as gastrointestinal symptoms. Following the onset of heart failure, a patient's heart rate generally increases as a compensatory response to promote increased cardiac output. If a patient enters the terminal stage of heart failure, a decrease in heart rate may occur, and can even lead to death.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Which department should I go to for heart failure?

Heart failure primarily includes left heart failure, right heart failure, and total heart failure. Patients should visit the cardiology outpatient clinic. Left heart failure mainly manifests as pulmonary congestion, which can cause varying degrees of breathing difficulty, coughing, expectoration of pink frothy sputum, palpitations, and fatigue. Right heart failure primarily appears as liver congestion and other symptoms related to the digestive system, such as nausea, vomiting, and gastrointestinal discomfort. Total heart failure includes symptoms of both left heart failure and right heart failure, and medical attention should be sought promptly after the onset of heart failure.

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Written by Wang Li Bing
Intensive Care Medicine Department
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How is acute heart failure treated?

Acute heart failure presents with significant respiratory distress and symptoms of hypoxia. Immediate intervention is necessary to alleviate breathing difficulties. Clinically, the following measures are generally adopted: First, position the patient to sit up with legs dangling to decrease venous return to the heart. Second, administer high-flow oxygen through a nasal cannula, and if necessary, proceed with endotracheal intubation and ventilator support. Third, administer morphine subcutaneously or intravenously to reduce agitation and myocardial oxygen demand. Fourth, use rapid diuretics, such as furosemide. Fifth, utilize vasodilators such as nitroglycerin or nitroprusside. Sixth, use positive inotropic agents such as dopamine or dobutamine as appropriate. Seventh, employ digitalis drugs, but avoid use in acute myocardial infarction within the first 24 hours. Eighth, consider using an intra-aortic balloon pump or other cardiopulmonary support systems, etc., and after stabilization of acute heart failure, further treat the underlying cause, etc. (Use medications under the guidance of a doctor.)

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Written by Wang Li Bing
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Acute heart failure typical symptoms

The typical symptoms of acute heart failure include sudden severe difficulty breathing, increased respiratory rate, and patients generally presenting a forced sitting position, with pale, grayish complexion and cyanotic lips. They often have profuse sweating, restlessness, frequent coughing, and coughing up pink frothy sputum. The condition can be critical, leading to consciousness disturbances due to lack of oxygen. Once acute heart failure occurs, active treatment is essential. The most common clinical approaches include strengthening the heart, diuresis, and vasodilation for symptomatic active management.