Heart failure, the term for what happens when the heart cannot efficiently circulate blood to the organs of the body can have many causes. Depending on the cause, we can bring the heart back to normal.
What is heart failure?
In most cases, heart failure occurs due to a decrease in the pumping ability of the heart, which is called “systolic heart failure.” But heart failure can also occur when the heart is working normally – this is known as “diastolic heart failure.”
In diastolic heart failure, with normal pumping function, the heart has trouble relaxing, resulting in poor circulation.
Here we will focus mainly on systolic heart failure. Symptoms of systolic heart failure include shortness of breath and fluid retention, but some people with this type of heart failure may have less severe symptoms.
How is heart failure diagnosed?
We can measure the pumping ability of the heart by calculating what is called the ejection fraction, which measures how hard the heart is able to contract with each beat. This is determined using imaging studies such as an echocardiogram.
The normal ejection fraction is 50-55% and above. From 40% to 50% decreases slightly, from 30 to 40% – moderately, and below 30% – sharply.
What causes heart failure?
There are many potential causes of heart failure, but they are generally divided into two groups: ischemic causes and non-ischemic causes.
Ischemic refers to a lack of blood flow to the heart, usually due to coronary artery disease. If there is a blockage in the coronary arteries that has led to a heart attack, this can reduce the pumping ability of the heart and cause heart failure.
Non-ischemic causes cover a large number of causes not related to coronary artery disease, including:
- High blood pressure, which can weaken the heart if not controlled for a long period of time.
- Heart valve problems such as severe aortic stenosis, aortic regurgitation, and mitral valve regurgitation
- Myocarditis, or inflammation of the heart, often caused by viral infections.
- Use of certain medications, such as certain chemotherapy treatments, or other substances, such as alcohol or illegal drugs.
- Arrhythmias such as atrial fibrillation or frequent premature ventricular contractions that cause an abnormal or very fast heartbeat for an extended period of time.
- Other systemic diseases such as sarcoidosis, thyroid disease, or autoimmune disease.
- Genetic cardiomyopathies due to genetic mutation
Although there are many specific causes of heart failure, many of them can be considered idiopathic, meaning that a specific cause has not been established.
What does it mean to reverse heart failure?
I consider heart failure to be “reversible” when the reduced ejection fraction returns to the normal range.
How can heart failure be reversed?
The ability to reverse heart failure depends on the cause of the heart failure.
If heart failure is caused by high blood pressure, then treating and controlling that hypertension can improve ejection fraction. If it is due to a heart valve problem that is being resolved or a controlled arrhythmia, the ejection fraction may return to normal.
If the heart failure is caused by the use of alcohol or other substances, stopping those substances may also reverse the heart failure.
Some underlying causes of heart failure, such as myocarditis due to infection or stress-induced cardiomyopathy, usually disappear over time, returning the pumping function of the heart to normal.
When someone has heart failure due to coronary artery disease, sometimes the heart failure can improve with revascularization of the blockage in the coronary arteries.
When is it most likely to stop heart failure?
The longer and more severely the heart is damaged, the more difficult it is to stop heart failure. For example, if someone has been drinking too much alcohol or suffering from an uncontrolled arrhythmia for a long time, the heart is more damaged and there is less chance of recovery.
Most causes of heart failure cause damage to the heart itself and can lead to fibrosis or scarring of the heart. Once a scar is present, it usually does not disappear, and if too much scarring has formed, ejection fraction or pumping may not improve even with therapy.
Sometimes we can do an MRI of the heart to assess how much scarring is present in the heart, which helps us determine if any viable tissue remains. This gives us a better idea of the chances of heart failure reversibility.
Heart attacks are a common cause of heart failure, and it occurs when there is a sudden blockage of blood flow to heart tissue, which then causes tissue death and scarring. If a heart attack is not treated quickly enough, the resulting scar can enlarge and reduce the chance of heart failure recurring.
In many cases, we simply can’t tell if heart failure can be successfully treated until we try to treat the underlying disease and test that ejection fraction again.
Early diagnosis and early treatment of heart failure is important because if the underlying cause is not corrected, it can lead to long-term changes in the heart that make heart failure difficult to manage.
Lifestyle changes are also important for both potentially reversing heart failure and preventing worsening heart failure.
People with heart failure tend to retain fluid, leading to worsening symptoms and even hospitalization. Because fluid retention is exacerbated and often caused by increased sodium or fluid intake, most people with heart failure should follow a low-sodium diet and sometimes fluid restriction.
Diet, exercise, weight loss, and quitting smoking and drinking alcohol are also important lifestyle changes that can help with other conditions, such as high blood pressure and coronary heart disease.