The symptoms such as shortness of breath, fatigue and/or swelling of the legs indicate heart failure and should be diagnosed as early as possible. The important aspects that a doctor needs to know to prescribe a optimal therapy and decrease the progression of heart failure are

a) Whether a patient has heart failure,

b) What type of heart failure the patient has, and

c) What the underlying cause may be.

Does the Patient Have Heart Failure?

This may be easy to answer. By analyzing the medical history and performing a careful physical examination, a doctor can easily get idea of whether heart failure is present. Further, a definitive diagnosis can be made by performing an echocardiogram, which creates an “image” of the beating heart and it is a non-invasive method.

What Type of Heart Failure Does the Patient Have?

The three general types of heart failure are:

a) Dilated cardiomyopathy (cardiomyopathy is heart muscle disease),

b) Hypertrophic cardiomyopathy,

c) Diastolic dysfunction.

The three types can be distinguished by physical examination as well,apart from well-performed echocardiogram. Echocardiogram reveals the enlarged, weakened ventricle typical of dilated cardiomyopathy. The thickened heart muscle is indicative of hypertrophic cardiomyopathy. However, the cardiac changes with diastolic dysfunction are slightly more subtle during echocardiography, but they can readily detectable when they are specifically sought.

What Is the Underlying Cause of Heart Failure?

When the presence of heart failure is confirmed by echocardiogram, it is important to identify the underlying root cause.  By identifying the cause and treating aggressively the cause, the progression of heart failure and further complications may be reduced or stopped or slowed. Identification of the cause is important especially in the case of dilated cardiomyopathy as it is almost always a “secondary” condition and it is always caused by some other primary condition. Major disorders which lead to dilated cardiomyopathy are coronary artery disease, heart valve disease, hypertension and viral infections. Although, the echocardiogram reveals any heart valve disease that may be present, a heart catheterization may be necessary to diagnose for coronary artery disease. Cardiac viral infections are commonly diagnosed by elimination process, but measuring anti-viral antibodies in the blood can also reveal specific viral exposures.

Althugh hypertrophic cardiomyopathy is genetic, aortic stenosis or high blood pressure can also produce it. Both of the causes (aortic stenosis or high blood pressure) can be treated. Aortic stenosis can be readily diagnosed with the echocardiogram. The underlying cause for diastolic dysfunction is usually not identifiable. However, the patients with significant underlying high blood pressure have this form of heart failure. By aggressively controlling blood pressure, patients with diastolic dysfunction recover well.

Filed under: Heart Failure Signs Symptoms

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