WOMEN & HEART FAILURE
Heart failure, or cardiac failure, is a weighty condition in today’s society, affecting approximately 480,000 people in Australia and more than 25 million world-wide. The Cinderella of cardiovascular disease; it is much less known than heart attack or stroke, yet heart failure (HF) is a serious condition with a worse outcome than most cancers. And it affects more women than men.
What is Heart Failure?
Heart failure occurs when the heart loses its ability to pump properly, causing a cascade of issues within the body.
As the heart is the pump that supplies blood to all the body’s organs:
• the circulation will be compromised, and
• any number of the body’s organs can be harmed.
As the heart deprives itself, and other body organs and tissues, of oxygen and nutrients:
• fluid builds up in various parts of the body causing swelling.
• fluid builds up in the lungs causing shortness of breath.
• fatigue is the other classic symptom.
Types of Heart Failure.
There are several types of HF: 1. Left-sided, or left ventricular (LV), heart failure, in which the left-hand side of the heart has impaired function.
• HF with Reduced Ejection Fraction (HFrEF), in which the LV does not contract properly and, so, cannot pump enough blood into the circulation, and
• HF with Preserved Ejection Fraction (HFpEF), in which the left ventricle loses its ability to relax. When the muscle becomes stiff, the heart cannot fill with blood correctly during the rest phase between each beat, and
2. Right-sided heart failure, which is most commonly a result of left-side failure, when the fluid pressure backs up through the lungs.
Women and Heart Failure.
Women represent a higher proportion than men with the preserved ejection fraction (HFpEF) heart failure sufferers and is the harder of the two to treat. This prevalence could be because:
1. Women have smaller hearts than men, and they seem to be more prone to inadequate relaxation of the heart.
2. Women may be more disposed to microvascular disease, a disease of the exceedingly small arteries that supply the heart muscle.
3. As there is a noticeably high incidence in post-menopausal women, they
could be a link between hormonal changes and underlying mechanisms which lead to HFpEF.
4. Another significant group of women is those who have been exposed to chemotherapy during breast cancer treatment and, later in life, present with shortness of breath. Some of the agents used in treating breast, and other, cancers can impact the functioning of the heart.
Action on obesity & blood pressure lessens heart failure risk.
Risks can be reduced.
1. Red flag risks that together contribute about two-thirds of HF in women are: • obesity • high blood pressure – both are amenable to intervention so – potential problems should be targeted and dealt with early in life • diabetes – which involves a number of
unhelpful heart scenarios.
2. Two other significant factors for women are: • a HFpEF diagnosis can be overlooked when they present with one of the three classic symptoms: – shortness of breath – swollen legs – fatigue • depression is more common (than for men): – leading to a poorer quality of life.
Prognosis.
While the prevalence of HF is increasing, so, too, are its survival rates. With the aid of drug, device and lifestyle combination treatments, the heart function for some patients may improve and, for others,
even recover after the initial episode or diagnosis. Damage to the heart muscle may be lessened and deterioration stabilised. While there is no cure, many patients lead a fulfilling life even with a diagnosis of HF.
Summary.
• Heart failure is a weighty and complex medical condition that occurs when the heart does not pump properly.
• Women are more likely to suffer HF, especially the hard-to-treat HFpEF where the heart muscle becomes stiff.
• Risk factors such as obesity, hypertension and diabetes should be tackled before they contribute to HF.
• Modern treatments are increasing survival rates and allowing many sufferers to live fulfilling lives.
Dr Warrick Bishop is a cardiologist with special interest in cardiovascular disease prevention incorporating imaging, lipids and lifestyle. He is author of the books ‘Have You Planned Your Heart Attack?’, ‘Atrial Fibrillation Explained’ and a new book ‘Cardiac Failure Explained’. The books are written for patients and doctors about how to live intentionally to reduce cardiovascular risk and save lives! Dr Bishop can be contacted via his website.