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Heart and cardiovascular system

Heart failure, what are the warning signs?

January 1, 2018

Heart failure is a typical pathology of the elderly and a frequent cause of hospitalization. The heart can no longer fulfill its pumping functions adequately and therefore provide the right blood supply to all the other organs: this is when heart failure occurs. The initial symptoms are different and can sometimes be related to other conditions or diseases, as explained by Dr. Daniela Pini, internist doctor and cardiologist at Humanitas.



Among the typical symptoms of heart failure, we find the difficulty in breathing

‘This is called exertional dyspnea. Simple moderate physical activity can determine the onset of this symptom which can even worsen until it is triggered by modest physical efforts. There is also a decubitus dyspnea, which arises when the individual is in a supine position, for example at night, thus interfering with the nocturnal rest: the patient falls asleep but then wakes up because encounters difficulties in breathing and must sit up’, explains Dr. Pini.


In addition to dyspnea, other symptoms may also suggest heart failure: ‘The edema, which is the swelling of legs, feet, ankles and abdomen, due to the accumulation of fluids and fatigue’.



These symptoms don’t necessarily occur simultaneously but, in any case, the onset of dyspnea and/or edema in patients with heart failure risk factors should trigger an alarm bell. And regarding risk factors, it is useful to distinguish the two forms of heart failure that can be diagnosed: heart failure with a reduced ejection fraction and preserved ejection fraction. Ejection fraction is a parameter that indicates how efficiently the heart can pump blood.

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Diseases that increase the risk of decompensation

The patients at higher risk of developing heart failure with a reduced ejection fraction are ‘those individuals with a past of ischemic heart disease, in particular with a previous myocardial infarction, or suffering from hypertension, especially if poorly controlled. Instead, diabetes, metabolic syndrome, obesity, yet hypertension and atrial fibrillation, in addition to female gender, are all risk factors for preserved ejection fraction’.


Symptoms of heart failure can be easily equivocated: ‘An obese individual, for example, may think that breathing difficulties are attributable to their body weight while those individuals who smoke (or used to smoke) can attribute them to chronic-obstructive pulmonary disease’, recalls the specialist . For this reason, it is good to subject to a clinical evaluation those people at risk of heart failure in the presence of the symptoms. ‘There is a blood test that is very useful to diagnose it, which is the dosage of natriuretic peptides. Normal values virtually exclude that dyspnea and edema are due to heart failure’, concludes Dr. Pini.

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