A Matter of The Heart: Understanding heart failure

Mention heart problems and heart attacks would probably be the first to come to our minds. However, another equally lethal heart disease is also highly prevalent in Singaporeheart failure.

About 4.5% of Singaporeans live with the disease, compared to just 1% to 2% in the United States and Europe. This could be attributed to affluence, stress, dietary habits and a sedentary lifestyle.

Episodes like the demise of seemingly fit individuals including professional athletes being linked to heart failure highlight the importance of being more aware about this heart disease.


Heart Failure and Heart Attack – the Differences

While some symptoms of heart failure may be similar to heart attack, it arises from different causes and requires different approaches to treatment and management.

So, what exactly is heart failure and how it different from heart attack?

Heart failure is a chronic condition whereby the heart is unable to pump blood efficiently to meet the body’s needs, resulting in reduced blood and oxygen supply to the rest of the body.

Heart failure symptoms are a manifestation of the failure of function of various organs and include shortness of breath, coughing or wheezing, fatigue, swelling of the feet and (sometimes) abdomen, and reduced effort tolerance. These symptoms vary from person to person.

A heart attack, on the other hand, occurs when there is an imbalance of the supply and demand of blood flow to the heart. This usually occurs when blood vessels supplying blood to the heart muscles are blocked. Symptoms include sudden onset of chest tightness, discomfort of the jaw or left arm, profuse sweating, shortness of breath and sometimes abdominal discomfort.

Unlike heart attacks that happen suddenly, heart failure tends to develop gradually over time though in some cases, it could also start suddenly over days. The muscles of the heart become weaker, impairing its ability to pump blood and oxygen efficiently to the rest of the body. This is different from heart attacks that come about due to blockage of blood vessels of the heart that leads to reduced blood and oxygen supply to the heart muscles. Without oxygen, the heart muscles start to die.


Common Causes of Heart Failure

The top three risk factors linked to heart failure are coronary artery disease, hypertension and diabetes. Let’s take a more in-depth look into some of the common causes:

  • Coronary artery disease – blockages in the blood vessels supplying blood to the heart muscles, leading to reduced oxygen supply and subsequent irreversible damage to the heart muscles
  • High blood pressure (hypertension) – uncontrolled high blood pressure exerts strain on the heart, causing heart muscles to thicken and pumping and relaxation to be impaired
  • Heart valve disorders – conditions such as aortic valve stenosis or mitral valve regurgitation may lead to over straining of the heart and subsequent weakening of heart function
  • Heart muscles disorders (Cardiomyopathy) – a heart muscle disease that can lead to dilated heart chambers and thickened heart muscles, eventually causing heart failure
  • Diabetes mellitus – poorly controlled sugar leading to the weakening of the heart muscles, or more commonly, diabetes; increasing the risk of blockages of the blood vessels and subsequently leading to reduced blood supply to the heart muscles
  • Heart rhythm disorder
  • Infection causing inflammation of heart muscle (myocarditis)
  • Other medical conditions such as thyroid disorder and anaemia

Diagnosing Heart Failure

Diagnosis of heart failure is done through a combination of medical history taking, clinical examination and various diagnostic tests such as:

  • Blood tests – NT proBNP may be elevated in heart failure and some heart enzymes (CKMB, Troponin T) may also be elevated in heart attack causing heart failure
  • Electrocardiogram (ECG) – this records the electrical activity of the heart as some abnormal heart rhythm that may lead to heart failure
  • Echocardiogram – this is an ultrasound scan of the heart which will allow doctors to assess the function, structure and valvular function of the heart
  • Chest X-ray – an assessment of the size of the heart and detection of any fluids in the lungs
  • Cardiac MRI – for providing more detailed function and structure of the heart
  • CT coronary angiogram/ Cardiac catheterisation – an assessment of the coronary arteries to exclude blockages in the coronary arteries

Ways to Keep Heart Failure at Bay

Keeping your heart healthy to prevent heart failure is something you can work on every day. Here are some simple yet effective ways to do so:

  • Regular exercise – engage in moderate intensity physical activity, aiming for 150 minutes per week
  • Healthy diet – follow a balanced diet rich with fruits, vegetables, lean proteins and healthy fats
  • Smoking – quit smoking and vaping
  • Health screening – go for regular health screening, and monitor your sugar, cholesterol and blood pressure regularly

A strong heart is the foundation of a strong life. No one is ever too old or too young to start taking care of it. Take proactive steps to protect your heart today!


Contributed by Dr Leow Khang Leng, Consultant Cardiology, Nobel Heart Centre (Mount Elizabeth) [a member of Healthway Medical Group].

Images: Singapore Heart Foundation, iStock and Envato 

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