Have you ever felt like you were drowning in water, your chest was tight, your feet were swollen, your shoes were so swollen that you couldn't even put them on? You felt extremely tired, you couldn't even climb a flight of stairs... Don't just dismiss these as a physical ache. These could be serious symptoms of acute heart failure . This is a life-threatening medical emergency. So, don't panic. Today, we'll talk about everything in a simple, understandable way.
Okay, what is this sudden heart failure (Acute Heart Failure)?
Simply put, this refers to a condition where our heart suddenly becomes unable to pump the amount of oxygen-rich blood the body needs.
Imagine that your body is a big city, and your heart is the main pumping station that supplies water to that city. As long as this pumping station is working properly, every house and every place in the city gets water. But, what happens if this pumping station suddenly weakens or breaks? The city loses water, right? That's how it is. When the pump called our heart suddenly weakens, important organs in our body like the brain, kidneys, and liver do not get the oxygen and nutrition they need. This is called Acute Heart Failure.
This condition doesn't happen overnight. Often, when the heart has to bear an extra burden over time, it gradually begins to change.
- Enlarged heart: Just like the muscles of a person who lifts weights get bigger, when you have to work too hard, the heart muscle can thicken and the heart can get bigger.
- Reduced blood circulation: As the heart weakens, the amount of blood it pumps decreases.
- Thinning of blood vessels: As the body tries to adapt to this, even the blood vessels may thin.
- Rapid or irregular heartbeat (Arrhythmia): The pressure on the heart causes it to lose its normal rhythm.
- Stiffening of the heart muscle: The heart muscle can become stiff and inflexible.
These changes are very small at first. You may not feel any symptoms. But over time, these changes increase and when the heart can no longer handle the load, an emergency called Acute Heart Failure occurs.
This is usually the leading cause of hospitalization for people over the age of 65. But remember, this can happen to anyone of any age.
Are there different types of this?
Yes, there are mainly two types.
1. Acute Decompensated Heart Failure (ADHF): This happens if you already have heart disease (for example, coronary artery disease, high blood pressure). This is the name given to when your heart has been weak for a long time, and for some reason (such as not taking medication, eating too much salt), the condition suddenly gets worse.
2.De Novo Acute Heart Failure: In this case, you have no previous heart disease. However, another medical condition, such as diabetes, has been damaging your heart for a long time without you realizing it, and this condition can suddenly develop.
What are the symptoms of this? How can you recognize it quickly?
If you have one or more of these symptoms, go to a hospital's Emergency Department (ETU) immediately, without delay. This is not an illness that can be kept at home.
These symptoms can be clearly understood from the table below.
| Symptom | How you feel |
|---|---|
| Severe difficulty breathing (Dyspnea) | This is the main and most serious symptom . It can feel like you are suffocating, your chest is tight, and you are drowning. This is worse when you lie down in bed and feels a little better when you sit up. |
| Swelling of the legs, ankles, and feet (Edema) | When the heart can't pump blood properly, fluid builds up in the lower parts of the body. When you press on them with your finger, they feel pulsating. Sometimes, the stomach can even swell. |
| Excessive tiredness and fatigue | Feeling extremely tired even when doing nothing or just being still. Feeling too weak to even get out of bed. |
| Fast or irregular heartbeat (Arrhythmia) | Feeling like you can hear your own chest beating, or that your heart rhythm has changed. |
| Chest pain or tightness | It can feel like a heavy weight is pressing on your chest, like your chest is being squeezed. |
| Persistent cough | Due to fluid filling the lungs, a cough with white or pink mucus may occur. |
| Loss of consciousness | Dizziness and loss of consciousness can occur due to a decrease in the amount of blood reaching the brain. |
Remember! These symptoms can come on suddenly. If you see these, don't stay home. Every second of your life is precious.
Why does this happen? What are the reasons?
Anything that puts extra pressure or strain on the heart can cause this. Here are some of the main causes:
- Coronary Artery Disease: Clogging of the arteries that supply blood to the heart due to cholesterol deposits.
- Hypertension: Uncontrolled high blood pressure causes the heart to work harder over time.
- Heart Valve Disease: When the valves in the heart do not close or open properly, blood begins to flow backward.
- Cardiomyopathy: Weakening, thickening, or enlargement of the heart muscle due to various causes.
- Heartbeat irregularities (Arrhythmia): An abnormally fast or irregular heartbeat.
- Pulmonary Embolism: This is an emergency condition that causes sudden, high pressure on the right side of the heart.
- Uncontrolled diabetes: Diabetes can damage blood vessels and nerves and weaken the heart.
- Kidney disease: When the kidneys do not function properly, water and salt accumulate in the body, putting a strain on the heart.
- Alcohol Use Disorder: Long-term heavy drinking directly damages the heart muscle.
- Viral infections: Some viruses (for example, the virus associated with rheumatic heart disease) can infect the heart muscle and weaken it.
What are the risk factors that contribute to this condition?
Even if you have one of the above conditions, certain things can cause a sudden onset of Acute Heart Failure. We call these 'triggers'.
- Not taking prescribed medication properly:If you don't take your medications for high blood pressure, diabetes, or heart disease properly, the disease can get out of control and put more pressure on your heart.
- Not controlling salt and water intake: If your doctor tells you to reduce salt and limit your water intake, you should definitely follow them. Eating too much salt causes your body to retain water. Your weakened heart has to work harder to pump out this excess water.
- Alcohol and drug use: These directly damage the heart.
- Some painkillers (NSAIDs): Continuous use of some painkillers, such as ibuprofen, without medical advice is also not good for the heart.
How does the doctor recognize this?
When you go to the Emergency Treatment Unit (ETU), doctors will quickly examine you and try to reach a diagnosis.
1. They ask you a lot of questions: about your symptoms, other illnesses you have, whether anyone in your family has heart disease, the medications you take, and whether you smoke.
2. Physical examination: The chest and lungs are listened to with a stethoscope. The legs are checked for swelling and the veins in the neck are checked. Blood pressure is measured.
Then, several tests are performed to confirm the diagnosis.
| Test | What do you expect from it? |
|---|---|
| ECG (Electrocardiogram) | It records the electrical activity of the heart. It can detect things like a heart attack and irregular heartbeat. |
| Chest X-ray | This helps to check if the heart is enlarged or if the lungs are filled with fluid. |
| Echocardiogram (a scan of the heart) | This is like a video of the heart. You can clearly see many things like how the heart beats, the efficiency of pumping blood (Ejection Fraction), and the function of the valves. |
| BNP Blood Test | When the heart is stressed, the heart muscle releases a hormone into the blood. By measuring the level of this hormone in the blood, we can determine whether the cause of shortness of breath is heart failure or something else. |
| Other blood tests | Things like the function of organs like the kidneys, liver, and thyroid gland, and the salt levels in the blood, are checked. |
What are the treatments for this?
Treatment can be divided into two parts: emergency treatment and long-term management.
Emergency treatment
At the ETU, the doctors' first goal is to stabilize your condition.
- Oxygen Therapy: Oxygen is administered through a face mask to reduce breathing difficulty and restore oxygen levels in the blood.
- Diuretics - "water pills": These medications are given as injections to help the body quickly eliminate excess water from the body through urine. This reduces the amount of water in the lungs, making it easier to breathe and reducing swelling.
- Vasodilators: These medications widen blood vessels, reducing the resistance to the heart's ability to pump blood, and reducing the pressure on it.
Long-term treatment and management
After the emergency, the underlying disease that caused it needs to be treated.
- Medications: You will need to continue taking various medications (e.g., beta-blockers, ACE inhibitors) that improve heart function, control blood pressure, and protect the heart.
- Surgery and other methods: Sometimes medication alone may not be enough. In that case, you may have to resort to things like:
- Angioplasty and Stenting: Opening up a blocked coronary artery and inserting a mesh-like device (stent) to prevent it from becoming blocked again.
- Bypass Surgery: Surgery to create a new route for blood to flow around a blocked artery.
- Valve Repair/Replacement: Repair of defective heart valves or implantation of an artificial valve.
- Implantation of a pacemaker or ICD device: If the heartbeat is irregular, these devices are implanted under the skin of the chest to restore it to normal.
- Heart Transplant:Transplantation of a healthy heart from a brain-dead person in end-stage heart conditions that cannot be cured by any other treatment.
How to live with this situation?
To be honest, this is a pretty serious condition. A person who has had this condition has a high risk of developing it again. Some studies have shown that a significant number of people who have this condition die within a year.
But, don't worry. It's not the same for everyone. Your future path will be determined by a few things:
- The underlying disease that caused this and its severity.
- How quickly you received treatment.
- Your overall health and your body's response to treatment.
- What matters most: your commitment to a heart-healthy lifestyle.
If you are committed and follow your doctor's instructions exactly, you can manage this condition well and live a long life.
What should I do after leaving the hospital?
Going home from the hospital doesn't mean it's over. In fact, your new, heart-healthy life begins there.
- Take your medicine on time: Don't skip a single dose.
- Weigh yourself every morning: Weigh yourself at the same time, naked or wearing light clothing, and write it down in a book. A sudden weight gain of 1-2 kilos in a day or two could mean that you are retaining water. If this happens, inform your doctor immediately.
- Control salt: Completely stop adding salt to your food and eating foods high in salt, such as pickles, dried fish, sauces, and sausages.
- Water and fluids: Do not exceed the amount of fluids (including water, tea, milk, and soup) your doctor recommends drinking per day.
- Stop smoking and alcohol completely.
- Light exercise: Engage in light exercise such as walking as recommended by your doctor.
- Go to clinics on scheduled dates: Be sure to go to the doctor on the days he gives you to see him.
Take-Home Message
- Acute Heart Failure is a medical emergency . If you experience symptoms, do not stay home.
- Severe shortness of breath, swelling of the legs, chest tightness, and extreme fatigue are the main symptoms. If these are present, go to a hospital's Emergency Department (ETU) immediately.
- The primary reason for this is other medical conditions that put pressure on the heart, such as high blood pressure and coronary artery disease.
- Once emergency treatment is provided in the hospital and the condition is stabilized, this should be managed long-term through medication and lifestyle changes.
- Your life is in your hands. By following the doctor's instructions (taking medication, controlling salt and water intake, and avoiding smoking) exactly, you can live a healthy life.
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