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Heart failure

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of heart failure.


Alternative Names

Cardiomyopathy; Congestive heart failure


Risk Factors

Nearly 5 million Americans currently suffer from heart failure. About 550,000 new cases of heart failure are now diagnosed each year. In 1970 there were only 250,000 new cases, so the annual numbers have risen dramatically. Such numbers represent an increasingly older population. Although there has been a dramatic increase over the last several decades in the number of people who suffer from heart failure, survival rates have been improving greatly. Of note, older men tend to fare better than older women.

Coronary artery disease and high blood pressure are the main causes of heart failure. Other diseases that damage or weaken the heart muscle or heart valves can also cause heart failure. Heart failure is most common in people over age 65, African Americans, and women.

Advancing Age

Heart failure is the most common reason for hospitalization in the elderly, and as the population ages, the incidence of heart failure is rising dramatically. According to one report, it occurs at a rate of about 10 per 1,000 people after age 65. The positive implication is, however, that people are living longer with heart failure.

Gender

Men are at higher risk for heart failure than women, although the difference narrows with age. Women also have a better survival rate than men do when heart failure is caused by valvular heart disease, high blood pressure, or alcohol abuse. (Some studies indicate that this is because men may be more susceptible to the process of heart muscle-cell remodeling, a damaging effect of hypertension.)

The survival rates of women and men are more similar, however, when heart failure evolves from coronary artery disease or heart attack. Women are much more likely to develop heart failure after a heart attack than men. In such cases, some evidence suggests that the reasons for this may include less aggressive approach to treatment for the initial heart conditions.

Ethnicity

African-Americans are at higher risk for heart failure than Caucasians, and studies have reported that they tend to do much worse. In a 2003 study, however, in which Caucasians and African-Americans had comparable treatment, African-Americans actually had lower 1-year mortality rates (with slightly higher rates of rehospitalizations). Still, more studies are needed to determine if there are actual biologic differences in specific patients. Some evidence, for example, suggests that African-Americans are more often likely than Caucasians to develop diastolic heart failure (a failure of the heart muscle to relax normally), which is often a precursor to systolic heart failure (impaired ability to pump blood). Caucasians tend to develop systolic heart failure first. In one study comparing Caucasian and African-Americans who only had diastolic heart failure, African-Americans had a 30% higher mortality rate.

Family History and Genetics

A family history of early heart failure caused by cardiomyopathies (diseases that damage the heart muscle) may predispose people to the disease. Researchers are also looking for changes in specific genes that might regulate systems involved in heart failure and so increase susceptibility in certain populations.

Chronic Alcohol Abuse

Chronic alcohol abuse can damage the heart muscles, can cause hypertension, and may prove to be one cause of idiopathic dilated cardiomyopathy. Moderate alcohol consumption, on the other hand (generally defined as two drinks a day for men and one for women), may protect against heart failure. Non-drinkers, though, are not advised to begin drinking.

Medical Conditions that Increase the Risk for Heart Failure

Emphysema
Emphysema is a lung disease involving damage to the air sacs (alveoli).There is progressive destruction of alveoli and the surrounding tissue that supports them. As the disease gets worse, large air cysts take the place of normal lung tissue. Air is trapped in the lungs.

Medications Associated with Heart Failure

Thiamin (a vitamin B) deficiency can lead to reversible cardiomyopathy. Long-term use of anabolic steroids (male hormones used to build muscle mass) increases the risk for heart failure. The drug itraconazole (Sporanox), taken orally for skin, nail, or other fungal infections, has been linked to heart failure in a small number of cases.


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