Top Heart Failure Causes

What is Coronary Heart Failure?

Heart failure is a condition that kills hundreds of thousands of people in the United States annually. People often put their hearts at risk without fully understanding just how much damage they can cause. Being overweight, eating unhealthy foods, not being physically active, and smoking could all promote heart failure. Additionally, other health issues can create more wear on the heart, which can lead to a higher risk.

The Effects of Coronary Artery Disease to Heart Failure

Coronary artery disease tends to cause high blood pressure, as the arteries become more and more clogged with cholesterol and fatty deposits. High blood pressure could lead to heart failure over time. If someone has suffered a heart attack in the past, it can weaken and damage the heart tissue, which reduces its ability to pump blood. This can also lead to an increased risk of heart failure.

What Can Cause a Weak Heart

Abnormal heart valves and heart defects at birth can cause a weakened heart, as can heart muscle diseases and inflammation. The hearts of people who suffer from severe lung disease must work hard to get oxygen to the rest of the body, which causes a lot of wear. Over time, this can lead to heart disease. Some of the other potential causes of failure and heart disease include sleep apnea, diabetes, abnormal heart rhythm, severe anemia, and hyperthyroidism.

As you can see, there’s no single factor that will cause heart disease. It can stem from a range of conditions and lifestyle choices.

Types of Heart Failure

When discussing this condition, it is important to understand that there are not only multiple causes, but also multiple types of heart failure.

Left Ventricular Heart Failure

The left ventricle of the heart pumps blood to the rest of the body and is responsible for most of the pumping power. It is larger than the other chambers of the heart.

There are two types of left ventricular heart failure.

First, there is a systolic failure, which means the left ventricle is no longer capable of contracting properly, so the blood can’t be pushed through the body. Second is a diastolic failure. This means that the left ventricle cannot relax normally because the muscle has stiffened.

Right Ventricular Heart Failure

The right ventricle pumps blood from the heart to the lungs, so it can be filled with oxygen. This type of failure usually happens because there is a left ventricular failure. Fluid pressure is pushed back through the lungs, damaging the right ventricle. This may cause swelling in the legs and ankles, as well as the abdomen.

Congestive Heart Failure

Congestive heart failure requires that patients get medical attention right away. In these cases, the blood is pumping out of the heart slowly, and when it returns, it begins to back up and cause congestion in the body, which causes swelling. The fluid could also collect in the lungs, which can make breathing difficult, especially if the patient is lying down. This is known as pulmonary edema, and it could cause respiratory distress when not treated promptly.

Stages of Heart Failure

There are four stages of heart failure—A, B, C, and D.

Stage A

Someone who is at Stage A is considered at high risk for heart failure, but they haven’t yet developed structural heart disease or symptoms associated with heart failure.

Stage B

At Stage B, the person has identifiable structural heart disease or cardiomyopathy, but they still don’t have the usual symptoms associated with heart failure.

Stage C

When someone reaches Stage C, they have structural heart disease and will likely have prior or current heart failure symptoms.

Stage D

Stage D involves refractory heart failure and requires medical intervention and treatment for the patient.

Ideally, a patient will already be speaking with their cardiologist and taking steps to prevent further damage to their body. Treatments vary for the different stages, and it’s always best to follow the advice of the doctor.

How Is Heart Failure Diagnosed?

Doctors can administer a wide range of tests to determine whether someone has heart failure. This includes blood tests, as well as electrocardiograms (ECGs). The ECG will record the electrical activity in the heart to look for any issues. Some of the other options include echocardiograms, chest x-rays, ejection fraction, stress tests, CT scans of the heart, cardiac MRIs, coronary angiograms, and myocardial biopsies.

The test a patient is given will depend on their current condition and what the doctor feels will provide the best results. The doctors will also discuss various methods of treatment if heart failure or other issues are discovered.

Cardiovascular Research and Training Institute

Researchers at the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI) are studying what causes heart muscle to fail and are developing therapeutic strategies to both stop heart failure progression and recover failing hearts.  CVRTI Investigators are experts in muscle gene regulation (Franklin), muscle metabolism (Chaudhuri, Drakos), muscle architecture (Hong, Shaw), diagnosing (Hong, Shaw) and failing heart muscle treatment (Selzman, Drakos, Dosdall, Hong, Shaw).  One therapeutic program involves using surgically implanted left ventricular assist devices (LVADs) to recover failing hearts (Selzman, Drakos).  Another involves a promising CVRTI generated gene therapy that rescues failing heart muscle, reverses the damage heart failure does to heart muscle, and improves mortality from heart failure (Dosdall, Hong, Shaw).  The therapy is known as cBIN1 gene therapy and is being advanced to clinical trials.

The Early Signs, Symptoms, Diagnosis, and Stages of Heart Failure

The term “heart failure” may sound as though your heart completely stopped working, but that’s not the case. Heart failure means that the heart is no longer capable of pumping blood as well as it should be. It is a serious long-term condition that worsens over time. When the heart doesn’t pump blood properly, your organs will not be getting the blood needed to perform.

The Early Warning Signs and Symptoms of Heart Failure

Signs and symptoms of heart failure vary in type and severity. Some of the common signs include shortness of breath, swelling in the legs, ankles, and abdomen, and feelings of fatigue when you are active.

People with heart failure might also notice they need to get up more and urinate during the night. They may have irregular heartbeats or a dry, hacking cough. Weight gain can occur, as well. Sometimes the symptoms are mild or they could vanish entirely. It is important to note that this doesn’t mean that you no longer have heart failure. They may vanish for a time and then return.

For most patients, heart failure will continue to worsen. After a diagnosis, make your doctor aware of any changes to your symptoms.

How Is Heart Failure Diagnosed?

Your doctor will need to know more regarding your medical history, as well as your heart failure symptoms. They may ask whether you have a family history of heart disease or sudden death, whether you smoke or use tobacco, and how much alcohol you drink. They will also want to know what medications you are taking.

They need to know about other health conditions you may have, such as kidney disease, diabetes, high blood pressure, high cholesterol, coronary artery disease, or other heart issues.

The doctor will provide a physical exam to look for early signs of heart failure or other diseases that could have affected your heart muscle. They will often check your ejection fraction, which will let them know how well your ventricles are pumping blood. This can be done relatively easily with noninvasive tests. Normal left ventricular EF is between 53% and 70%.

Other tests that will determine the severity of your heart failure and its cause include various blood tests, cardiac catheterization, chest x-rays, ECGs, MRIs, EKGs, echocardiograms, stress tests, and MUGA scans.

Once the doctor determines the type of heart failure you have and the cause, they can begin treatment. The types of treatment often vary based on the stage.

The Stages of Heart Failure

Below are the stages of heart failure, along with potential treatments used at each stage.

Heart Failure Stage A

When you are at risk but haven’t suffered heart failure yet, you are considered in Stage A. Those who are at this stage can undergo a treatment plan that can help them to reduce their risk of further damage. This includes becoming more active and getting regular exercise, stopping the use of tobacco products, getting treatment for high blood pressure and high cholesterol, and not drinking or using recreational drugs.

Doctors may prescribe angiotensin-converting enzyme inhibitors or an angiotensin II receptor blocker for those who have high blood pressure, diabetes, coronary artery disease, or other cardiac issues. Beta-blockers might also be prescribed for those with high blood pressure.

Heart Failure Stage B

This is also considered pre-heart failure. The doctor has found that you have systolic left ventricular dysfunction, although you don’t have symptoms of heart failure.

In addition to the Stage A treatments, the doctor might also prescribe an aldosterone antagonist if you have diabetes or have had a heart attack and have an ejection fraction of 35% or less. In some cases, surgery may be required.

Heart Failure Stage C

Those with Stage C heart failure currently or previously had some or all of the signs and symptoms mentioned above. The Stage A and B treatments are still employed along with medications that can slow the heart rate if it’s above 70 bpm and the symptoms remain.

If Symptoms Continue

Diuretic pills may be used if symptoms continue, and sodium will be restricted. At this stage, patients must track their weight daily and let the doctor know if there is a change of more than four pounds. Fluid restriction could be required in some patients. The use of a biventricular pacemaker could also be required as a means of cardiac resynchronization therapy.

Heart Failure Stage D

At this point, the patient has advanced symptoms that will not get better with treatment. It is the final stage of heart failure. At this point, in addition to the treatments used for the earlier stages, more advanced treatments are needed. This may include ventricular assist devices, a heart transplant, heart surgery, or hospice care.

Patient outcomes will vary. Those who have heart failure or who are worried they are at risk should speak with their doctor as soon as possible. Getting a diagnosis and treatment as early as possible can make a difference.

Cardiovascular Research and Training Institute

Researchers at the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI) are studying what causes heart muscle to fail and are developing therapeutic strategies to both stop heart failure progression and recover failing hearts.  CVRTI Investigators are experts in muscle gene regulation (Franklin), muscle metabolism (Chaudhuri, Drakos), muscle architecture (Hong, Shaw), and treating failing heart muscle (Selzman, Drakos, Dosdall, Hong, Shaw).  One therapeutic program involves using surgically implanted left ventricular assist devices (LVADs) to recover failing hearts (Selzman, Drakos).  Another involves a promising CVRTI generated gene therapy that rescues failing heart muscle, reveres the damage heart failure does to heart muscle, and improves mortality from heart failure (Dosdall, Hong, Shaw).  The therapy is known as cBIN1 gene therapy and is being advanced to clinical trials.

What Is Heart Failure Therapy? 6 Potential Heart Failure Treatments

Cardiovascular disease resulting in heart failure is the leading cause of death for people living in developed countries. In an effort to find better ways to treat CVD, scientists have been researching a variety of heart failure therapies. Some of those are discussed in this article.

Omecamtiv Mecarbil

Omecamtiv mecarbil was developed as a safer alternative to inotropic agents while still having similar pharmacological effects. It specifically acts as a cardiac myosin activator. It binds to myosin and causes a shift in the equilibrium of ATP hydrolysis during a stroke.

Studies of omecamtiv mecarbil show that it was well tolerated by patients. Phase two trials had promising results as well, so expectations are high for phase three trials.

Ularitide

Elevated levels of a family of hormones called natriuretic peptides indicate heart failure. Three main natriuretic peptide receptors exist, NPR-A, NPR-B, and NPR-C. NPRs have been a component in the beneficial treatment of heart failure, so they are targeted for pharmacological therapies.

Ularitide is a synthetic version of urodilatin, a kidney peptide hormone. Ularitide binds with NPR-A, which causes diuresis and natriuresis to increase. Studies of ularitide therapy indicate that it can reduce cardiac wall stress and produce beneficial hemodynamic effects, but it doesn’t affect disease progression.

Serelaxin

The location of the receptors in the body is important in cardiovascular therapy. Serelaxin is a synthetic version of relaxin; the peptides in relaxin have a structure similar to insulin. Currently, four relaxin receptors are known to be present in major body organs. These receptors exist in the kidney, blood cells, heart, and lungs.

Trials of Serelaxin have had mixed results. Tests with primarily Caucasian patients indicated that infusions of Serelaxin were more effective than oral doses. However, similar trials with Asian patients showed no significant improvement or change in mortality rates with Serelaxin therapy.

Tolvaptan

A consequence of heart failure is fluid retention. This fluid retention leads to edemas and pulmonary congestion. During heart failure, arginine vasopressin levels increase, and higher levels are part of the advanced stages of the disease. Sodium retention and neurohumoral abnormalities are the leading causes of fluid retention. 

Loop diuretics are one of the common treatments for heart failure, but this therapy doesn’t work in approximately 30% of patients. Loop diuretics also cause hypotension or electrolyte imbalances in some patients. Tolvaptan is a treatment that is less likely to worsen kidney functions than typical diuretics.

The benefits of using tolvaptan to treat heart failure have been assessed in various studies. Results of one such study showed that symptoms of heart failure were decreased, but some patients developed hypernatremia at increased doses of tolvaptan.

CT-1

CT-1 is connected to multiple heart-related issues. CT-1 is associated with myocardial fibrosis, the stimulation of fibroblasts, and heart valve disease, among others. CT-1 affects the entire cardiac muscle, not just single cardiomyocytes. The pathological changes created by CT-1 are similar to the physiological changes seen in athletes.

The physiological changes are not as beneficial as the ones brought about by CT-1. Another difference is the reversibility of the changes. The CT-1 changes are completely reversible.

Gene Therapy

Some doctors and scientists believe gene therapy is the best hope for rare congenital diseases. However, there hasn’t been a tremendous success with it, so many scientists think the expectations of success are unfounded. There is also hope that gene therapy could be of great benefit to the field of cardiology.

The main targets of gene therapy are proteins that regulate calcium levels. This is because people with CV (chronic venous) insufficiency often have imbalances when it comes to calcium regulation within the cardiomyocytes within their hearts. There are two main problems of gene therapy for cardiovascular diseases. They are the reaction of the patient’s immune system to the treatment and the effect of the treatment getting worse over a long time.

While there have been problems with gene therapy, scientists are still trying to improve the techniques. The continued gene therapy testing is a sign that the hope for its success continues to be justified.

Conclusion

Cardiovascular disease is the number one killer of people in developed countries. Scientists have been increasingly working on therapies for heart failure patients due to the increased number of people who suffer from cardiovascular disease. Continued progress means they have hope of finding a therapeutic solution for treating heart failure. All of the therapies discussed in this article show promise for success; however, they need continued research before they are deemed effective treatments.

Cardiovascular Research & Training Institute’s Heart Failure Research

Cardiovascular disease resulting in heart failure is the leading cause of death for people living in developed countries. In an effort to find better ways to treat CVD, scientists have been researching a variety of heart failure therapies. At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), researchers are interested in how cardiac muscle biology relates to the mechanistic basis of heart failure(HF). The CVRTI is committed to focusing on learning what drives heart muscle failure and how best to treat it. 

Our Heart Failure Research in the Areas of Gene Therapy and Therapeutic Devices

Researchers are working on changing the standard of care for HF patients through drug therapy, gene therapy and therapeutic devices. Specifically, CVRTI investigators are trying to understand how the failing heart can recover in order to improve outcomes for HF patients. Our investigators are focused on identifying molecular and metabolic targets to develop new therapeutic tools for myocardial recovery. They also evaluate myocardial ultrastructure, microstructure, and function in normal, diseased, and aged hearts. Preserving and optimizing the cellular cytoskeleton and the mitochondrial function in the failing heart are major research interests of our investigators. Specifically, our investigators define the mechanisms by which the cytoskeleton delivers ion channels to their respective subregions on the cardiac membrane, and how delivery is changed during heart failure. 

Targeted Delivery 

This work defined the paradigm of ‘targeted delivery’ which describes how the cytoskeleton delivers membrane proteins directly to their functional membrane subdomain and why there is less delivery in failing heart.  Our CVRTI models involve exploration of Connexin43 gap junction trafficking to the cardiomyocyte intercalated disc and L-type calcium channel trafficking to cardiomyocyte T-tubules. In the process we identified that the mRNA of Cx43 is alternatively translated to generate endogenously up to six different truncated isoforms which are essential to trafficking. These isoforms we identified have a different biophysics and biology as Connexin43 and thus function as new proteins with important roles in basic cell biology. 

cBIN1

A major current focus of our investigators is cardiac BIN1 which regulates L-type calcium channel trafficking, T-tubule folds and is also released into blood as T-tubule origin microparticles, and available as a biomarker of muscle remodeling. We have found that not only is cBIN1 important to calcium hemostasis and electrical stability in ventricular cells, but is reduced in acquired heart failure and is turned over into blood in levels that reflect cardiac content.  We have helped developed a cBIN1 score (CS) as a first of its kind biomarker of cardiac muscle health that could be used as a screen for heart failure, prognosticate heart failure outcomes, and prognosticate the occurrence of ventricular arrhythmia. cBIN1 is now also tested by CVRTI investigators as potential gene therapy for chronic heart failure. 

With these research programs in place, the CVRTI is committed to improving how acute and chronic heart failure patients are diagnosed and treated.

What is Congestive Heart Failure and How is it Treated?