An Overview of End Stage Heart Disease

Coronary Artery Disease (CAD)
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What is End Stage Heart Disease?

Any heart disease that is not adequately or successfully treated ends up in heart failure. This end-stage condition of heart disease may result from any of the following:

  • Reduced myocardial contractility – inability of damaged and weakened heart muscles to pump blood effectively

  • Increased resistance to blood flow - the heart meets resistance from the blood vessels - usually in people with high blood pressure – resulting in heart enlargement from constant damming back of blood

  • Reduced filling of the heart chambers - due to stiffening of the heart muscles from disease

The result of these is failure of the heart to supply enough blood to the circulation, causing many symptoms leading to general weakness. When damming occurs, the lungs may be flooded with fluids that are not pumped out of the heart, and a condition called congestive heart failure results.

What Causes Heart Failure?

The most common cause of heart failure is coronary artery disease, or atherosclerosis, where the blood vessels supplying the heart are thickened with cholesterol leading to a decrease in blood supply to the heart muscles. This can lead to episodes of ischemia (lack of oxygen in the tissues) or to a heart attack. Unless fatal, a heart attack ultimately weakens the heart muscles.

Other causes of heart failure are:

  • Congenital heart diseases involving the valves, blood vessels or muscles of the heart
  • Viral infections affecting the heart such as endocarditis and/or myocarditis
  • Abnormal heart rhythms
  • Acquired diseases involving the valves and other parts of the heart like rheumatic heart disease
  • Chronic hypertension leading to heart enlargement
  • Previous heart attack

These conditions are usually related to other diseases like diabetes, hypertension, lung disease and others that may involve heart and circulatory function.

Common Symptoms of Heart Failure

Symptoms of heart failure are usually experienced gradually although they may also occur suddenly after a heart attack. These include:

  • Respiratory symptoms - shortness of breath, difficulty in breathing and “drowning” sensation when lying flat in bed
  • General body symptoms – faintness, weakness, fatigue, loss of appetite, difficulty in sleeping and performing daily activities
  • Edema or swelling of the feet and ankles which gradually involves the rest of the legs and abdomen
  • Weight gain resulting from edema
  • Palpitations and rapid heart beats

Diagnosis and Treatment of End Stage Heart Disease

Medical history and physical examination provide strong indications of heart failure. Extensive laboratory work-ups are usually required to track down the cause and extent of heart damage. Blood and urine tests, electrocardiograms, imaging exams and more may be asked by the attending physician or cardiologist to evaluate the cause of heart disease.

Treatment of heart failure begins with complete rest which reduces the demand for oxygen in the heart and the rest of the body. Modification of daily activities is important to achieve balance in the oxygen supply to the tissues of the body. The patient’s diet is also adjusted to decrease salt, fat and sugar content that can aggravate the disease.

Lifestyle factors like smoking, alcohol consumption, controlling weight, demands of one’s job and other stressful situations have to be modified to prevent worsening of the disease and to relieve symptoms.

Medications vary according to the cause of heart disease. Examples of these are:

  • Antihypertensives
  • Diuretics to decrease fluids in the lungs and edematous parts of the body
  • Drugs to augment heart muscle contraction
  • Drugs to control and regulate heart rate
  • Anti-cholesterol and anti-diabetic drugs

Other modes of treatment may involve the implantation of a pacemaker, heart surgery or a possible heart transplant, depending on the need of the patient. An implantable defibrillator may also be used to prevent sudden death due to a heart attack.

Heart failure is a serious and chronic disorder that needs a modification of lifestyle and compliance to therapy. The prognosis of end stage heart disease ultimately depends on the stage of heart failure, the inherent cause of the disease, the age and condition of the patient and the adequacy of treatment.

References

American Heart Association, “Congestive Heart Failure” accessed 2/19/11

https://www.americanheart.org/presenter.jhtml?identifier=4585

Medline Plus, “Heart Failure” accessed 2/19/11

https://www.nlm.nih.gov/medlineplus/ency/article/000158.htm