heart failure Heart failure (HF), commonly referred to as cardiac failure, refers to a syndrome caused by various factors leading to impaired cardiac pumping function, resulting in an inadequate cardiac output to meet the basic metabolic needs of the body's tissues. Its main manifestations include dyspnea, limited physical activity, and fluid retention. As the clinical presentation primarily involves congestion of tissues and organs, it is also known as congestive heart failure. The terms "cardiac dysfunction" or "cardiac impairment" have broader implications, and when clinical symptoms of cardiac dysfunction appear, it is referred to as heart failure.

Heart failure (HF), also known as congestive heart failure, refers to a syndrome in which the pumping function of the heart is compromised due to various reasons, leading to an inadequate cardiac output that cannot meet the basic metabolic needs of the body's tissues. Its main manifestations include difficulty breathing, limited physical activity, and fluid retention. As it primarily presents with tissue and organ congestion, it is also referred to as congestive heart failure. When the clinical symptoms of cardiac dysfunction appear, it is referred to as heart failure.

Primary myocardial damage

Myocardial damage caused by ischemia (myocardial infarction, coronary atherosclerotic heart disease), inflammation, immune reactions (myocarditis, dilated cardiomyopathy), genetic diseases (hypertrophic cardiomyopathy, incomplete myocardial densification), etc.

Secondary myocardial damage

Metabolic diseases (diabetes, hyperthyroidism), systemic infiltrative diseases (amyloidosis), connective tissue diseases, myocardial toxicity from drugs, etc.

Excessive cardiac load

This mainly refers to diseases that can lead to excessive cardiac load. These diseases cause the heart and myocardium to change their structure to meet the demand for cardiac pumping, but this is not a long-term solution. The compensatory ability of the heart is limited, and over time, beyond a certain limit, the myocardial structure and function will lose their compensatory ability, leading to heart failure.

Excessive pressure load

Seen in conditions such as hypertension, pulmonary arterial hypertension, aortic valve stenosis, etc.

Excessive volume load

Seen in conditions such as valvular regurgitation, congenital cardiovascular diseases, chronic anemia, hyperthyroidism, etc.

Inadequate ventricular pre-load

Seen in conditions such as mitral valve stenosis, cardiac tamponade, restrictive pericarditis, constrictive pericarditis, etc.

Heart failure is the final stage of heart disease. Understanding the precipitating factors can reduce the acute onset of heart failure.

Infection: Respiratory tract infections are the most common, and infections can worsen pulmonary circulation congestion.

Arrhythmia: Atrial fibrillation is common, as are various rapid and severe bradycardia.

Increased systemic blood volume: Excessive and rapid infusion, high-salt diet, etc.

Excessive physical exertion or emotional excitement: Late pregnancy, childbirth, anger, etc.

Improper treatment: Improper discontinuation of diuretics, antihypertensive drugs, etc.

Others: Exacerbation of pre-existing heart disease or the onset of other complications, such as myocardial infarction in patients with coronary heart disease, etc.

Chronic heart failure

Left heart failure is common and can often lead to secondary right heart failure, i.e., progressing to global heart failure.

Difficulty breathing

Symptoms range from mild to severe: exertional dyspnea, where there is difficulty breathing during heavy physical labor, which can be relieved after rest; paroxysmal nocturnal dyspnea, where the individual suddenly wakes up feeling breathless at night and needs 30 minutes or more to relieve symptoms; orthopnea, where the patient feels breathless after lying flat for a few minutes and can only breathe when sitting up; severe cases can lead to acute pulmonary edema, characterized by sudden severe difficulty breathing, orthopnea, accompanied by coughing, often coughing up pink frothy sputum, and the patient may also experience profuse sweating, restlessness, and cyanosis of the lips.

Cough, sputum production, hemoptysis

When the lungs are congested, the alveoli and bronchial mucosa are irritated, leading to coughing, usually producing white frothy sputum, occasionally streaked with blood.

Fatigue, dizziness, palpitations, reduced exercise tolerance

Due to inadequate organ and tissue blood supply, and an increased heart rate.

Oliguria and symptoms of renal impairment

Due to reduced renal blood flow, oliguria can occur, and long-term renal function impairment may develop.

Right heart failure

Distended and engorged neck veins: The earliest sign of right heart failure.

Gastrointestinal symptoms: Gastrointestinal congestion leads to abdominal distention, anorexia, vomiting, etc.

Difficulty breathing: Right ventricular enlargement affects left ventricular diastole, leading to pulmonary congestion.

Edema: Initially, there is bilateral foot and leg edema, gradually spreading upwards to the whole body.

Pleural effusion and ascites: Due to systemic circulation congestion.

Global heart failure

Global heart failure occurs in the late stages of heart disease, and the condition is critical, with clinical manifestations of inadequate blood perfusion to various organs and tissues, such as cold limbs, dizziness, oliguria, etc.

In patients who develop global heart failure from left heart failure, symptoms of dyspnea may actually diminish, but this does not indicate an improvement in the condition; rather, it is a worsening of the condition. Patients and their families should take this seriously.

Acute heart failure

Sudden severe difficulty breathing, forced upright position, profuse sweating, pallor, cyanosis of the lips, restlessness, continuous coughing, coughing up pink frothy sputum. In severe cases, there may be confusion. At the onset, there may also be a transient increase in blood pressure, and if not relieved, shock may occur.

In cases of acute heart failure or acute exacerbation of chronic heart failure, patients may experience acute pulmonary edema, shock, syncope, or even sudden cardiac arrest, which can threaten the patient's life. At this time, doctors will prioritize controlling the patient's symptoms, protecting the essential organ functions, and improving the prognosis as much as possible.

Home first aid measures

If a patient experiences acute heart failure or a sudden exacerbation of heart failure, timely rescue is necessary, as a delay can be life-threatening. The following steps can be taken at home:

The rescuer needs to remain calm, call for emergency assistance, and wait for help.

Elevate the patient's upper body (semi-recumbent or high sitting position) with legs hanging down.

If available, immediately administer oxygen to the patient.

Cut open or unbutton the patient's chest clothing to ensure unimpeded breathing.

Calm and reassure the patient.

Perform cardiopulmonary resuscitation (CPR) promptly in the event of cardiac arrest.

TCM treatment follows the principle of "determining the treatment based on syndrome differentiation" and requires adopting corresponding treatment plans based on the specific condition of the individual. It is recommended that patients seek treatment at a regular medical institution and undergo treatment under the guidance of a doctor.

The basic characteristics of heart failure in TCM syndrome differentiation are the coexistence of underlying deficiency and manifest excess. Underlying deficiency typically involves qi deficiency, often accompanied by yin deficiency or yang deficiency. Manifest excess involves blood stasis, often accompanied by phlegm and retention, which can worsen during colds or fatigue.

Heart failure is a progressive disease, and treatment varies at different stages of the disease. During the acute exacerbation period of heart failure, treatment requires actively consolidating and nourishing qi, yin, or yang to address the root cause, and also strengthening diuresis, promoting blood circulation, and resolving phlegm. During the chronic stable period of heart failure, treatment involves nourishing qi, nourishing yin, warming yang, and stabilizing the foundation, combined with promoting blood circulation and resolving stasis, diuresis, and resolving phlegm.

Management of daily life for patients with heart failure should focus on the following aspects:

Diet

- Consuming a light and bland diet, avoiding stimulating foods.

- Recommending a low-salt, low-fat diet, especially with a restricted sodium intake. Mild heart failure patients should limit daily salt intake to 5-7 grams, while moderate to severe cases should restrict it to under 5 grams.

- Moderating food intake and avoiding overeating.

- Depending on the specific condition of the patient, water intake may need to be restricted, and it is advisable to follow the advice of the attending physician.

Exercise

- For patients with acute and severe conditions, physical activity should be strictly limited. They may rest in a semi-upright or semi-recumbent position, but family members should assist them in passive exercises to prevent deep vein thrombosis, muscle atrophy, and pressure sores.

- When the condition is stable, appropriate exercise can be undertaken, but the exercise plan must be personalized according to the specific situation of the patient and should be conducted under the guidance of a professional.

Lifestyle

- Quitting smoking and alcohol consumption.

- Ensuring an adequate amount of sleep and avoiding staying up late.

- Paying attention to emotional regulation and avoiding large emotional fluctuations.

- When there are concurrent conditions such as hypertension, diabetes, or hyperthyroidism, it is important to take medication regularly and actively seek treatment.

- Adhering to medical advice for timely medication and regular follow-up visits is crucial for the long-term management of heart failure. Patients should not stop taking medication or substitute drugs with health products just because they feel their symptoms have improved. During the course of medication, it is important to understand and remember the dosage, administration methods, and precautions for each medication. In case of worsening symptoms or new symptoms during the recovery period, seeking medical attention promptly is necessary.

- Early treatment is necessary for cardiovascular diseases such as hypertension, coronary heart disease, myocarditis, and heart valve diseases.

- Paying attention to staying warm, adjusting clothing according to the weather, and actively preventing respiratory infections.

- Maintaining a healthy lifestyle, such as engaging in moderate and regular exercise, avoiding staying up late, and consuming a light diet.

- Managing stress in daily life and avoiding extreme emotional fluctuations.