Reviewed by Mansukh J Gandhi, Leading Cardiologist, Mumbai
 Most people mention Xerox while referring to a photocopy. Xerox has become synonymous with photocopy just as iPod to an MP3 player. I cite this example because very often, as doctors, we hear people referring to heart failure as heart attack. Heart attack and heart failure are not synonymous terms; neither are they acquired synonyms as in the examples above. So how is heart failure different from heart attack? Heart, despite all poetic associations, is essentially a pump. Despite the way it sounds, "heart failure" simply means that your heart isn't pumping blood as well as it should. It does not mean either that your heart has given up working or that you are having a heart attack. Heart failure is also called congestive heart failure (CHF). "Congestive" means, fluid is building up in your body because your heart isn't pumping properly. A heart attack (medically called as myocardial infarction), on the other hand, happens when a part of your heart muscle gets damaged or dies because it stops receiving blood and oxygen. This depletion occurs because either there is an impediment or a complete obstruction in the flow of blood through the blood vessels towards its destination i.e. the heart muscle. What causes this obstruction is a build-up of fatty deposits inside your blood vessels. This build-up is like gunk that builds up in a drainpipe and progressively slows the flow of water till finally no more water can flow. This build up, for reasons best known to linguists, is medically referred to as atherosclerosis. This build up creates a plaque. When the plaque ruptures in the lumen of the vessel, the blood clots on it and creates a complete block. The most common causes of heart failure are:
- Coronary Artery Disease (also known as CAD): The arteries that supply blood supply to the heart is partially or completely blocked, causing impaired function of the heart muscle.
- Hypertension: High Blood Pressure has always been a perennial reason for heart failure. It causes enlargement of the heart, making it difficult to cope up with high blood pressure. Ultimately it gives way to failure.
- Previous History of Myocardial Infarction: Heart attack, as I said before, is one of the worst enemies of your heart. It damages your heart muscle.
- Problems with any of the Heart Valves: Heart valves open and close to aid in pumping blood to and from the heart by letting it flow in one direction. A defect in the valves can restrict this process and cause heart failure. When the valve does not open properly, it leads to obstruction of the flow (stenosis). When the valve does not close properly, it leads to backward leakage (incompetence).
- Abnormal Heart Rhythms: - The heart’s electrical wiring goes for a toss and as a result the heart starts beating either very fast or very slow and could be a possible reason for heart failure.
- Congenital Heart Disease: If one is born with a defective heart, one is susceptible to heart failure.
- Infections of the heart: These could be endocarditis (infection of the inner layer of heart) or myocarditis (infection of the muscle layer of the heart), or of the valves.
- Metabolic Disorders: These are diabetes, obesity and thyroid gland related disorders and can impart a telling blow to your heart, leading to heart failure.
- Substance abuse: Excessive alcohol or drug abuse may also be a cause for concern because these are toxic in nature.
Heart failure differs from a heart attack the way chalk differs from cheese.
While there could be no or very minimal symptoms in the initial stages of heart failure, as heart failure progresses, you will notice signs and symptoms like:-
- Shortness of breath – often occurs when walking, climbing stairs or being active.
- Shortness of breath when lying down – this occurs at a later stage.
- Waking up in the night, sudden breathless medically referred to as Paroxysmal Nocturnal Dyspnoea.
- Frequent night time urination or nocturia ensures that there is sleep deprivation too.
- Swelling of the legs, feet or ankles, a condition called Edema. There could be occasional swelling of abdomen too.
- Rapid or irregular heartbeat.
- Rapid weight gain (1 or 2 pounds a day for 3 days in a row) – mostly because of fluid overload.
- Chronic cough or wheezing with frothy sputum.
- General tiredness or weakness, including the reduced ability to exercise and lack of appetite.
Heart failure cases, post examination, are often found to have high rate of breathing (tachypnoea); often sounds of crackles can be heard over the lungs. At a later stage, a bluish discoloration of the skin is noticed.
In case of a heart attack, the heart experiences a different set of signs and symptoms. Principally, amongst these, is a pain that can feel like a bad heartburn similar to what you may encounter if your gastric acid levels go up. Some of the other experiences could be:
- Mild to severe discomfort in the centre of the chest, arms, upper back or jaw. The character of the pain is similar to angina, but is usually severe and lasts longer than 20 minutes. Unlike in angina, it is not relieved by nitroglycerine or rest.
- Feeling of a pressure or crushing pain in your chest, many a times accompanied by sidekicks like sweating, nausea or vomiting, breathlessness, palpitations, severe weakness or even a sense of impending doom.
- At times, it is silent (without pain), usually in diabetics. They may experience only breathlessness, sweating or weakness.
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