Heart failure or congestive heart failure is a cardiac condition wherein the heart is unable to pump enough oxygen-rich blood to all body tissues and organs because of stiffness of heart muscles or it becoming too weak. As organs and tissues are not able to receive blood and other nutrients, eventually their functioning gets affected.

Heart failure can’t be understood as the stopping of a heartbeat rather it is just a condition where the heart is not able to work normally as it should. [1, 2]

What causes Heart Failure?

There are several factors contributing to heart failure, including:

• Hypertension- Due to high blood pressure, extra strain can be put on the heart and if not controlled by medications, the patient can get heart failure.
• Arrhythmias- These are abnormal cardiac rhythms such as atrial fibrillation wherein the patient has a persistent fast heart rate that impairs the contraction strength of the heart and causes less efficient pumping of the heart.
• Coronary Artery Disease- It is a medical condition where the arteries that supply blood to the heart get clogged usually because of the deposits of bad cholesterol.
• Cardiomyopathy- It refers to the inherited or acquired conditions that affect the heart muscles leading to failure of heart function.
• Congenital Heart Disease- It refers to all birth defects that impair the normal working of the heart.
• Heart Valve Disease- It is a condition where the heart valves either get damaged or have a defect that increases the volume and strain on the heart, hence weakening it and leading to its failure.
• Toxicity- Certain chemotherapy drugs and excess intake of alcohol can be toxic for heart muscle cells and result in their non-functioning or malfunctioning.
• Metabolic Disorders- There are some endocrine causes of heart failure including diabetes and hyperthyroidism with an overactive thyroid.
• Others- Obesity and behaviors like having a diet rich in cholesterol and sodium, a sedentary lifestyle, and smoking. [1]

Stages of Heart Failure

According to the degree of symptoms or functional limits, there are 4 stages of heart failure named as Stage A, Stage B, Stage C, and Stage D.

Stage A

The patients having stage A heart failure are the ones considered to be at high risk of developing heart failure. This means they neither have heart failure nor its symptoms. It can be because of factors including:

• Family history
• Heart attack
• Coronary Artery Disease
• Hypertension
• Diabetes
• Obesity
• Metabolic syndrome
• Earlier records of having rheumatic fever
• Past history of drinking too much alcohol
• History of intake of drugs that can damage the heart muscles like cancer medications.

Stage B

The patients falling under this stage have asymptomatic or silent heart failure. They have been diagnosed via echocardiogram (echo) for some structural changes in the heart such as systolic left ventricular dysfunction which is strongly associated with developing heart failure. People with stage B heart failure usually show an ejection factor (EF) of 40 percent or less on echo.

Stage C

When the patients experiencing structural changes in the hearts start to exhibit symptoms of heart failure, they are considered to be Stage C heart failure patients. Such patients either currently have signs and symptoms of heart failure or previously had them. The most common symptoms that the patients can expect to see include:

• Nausea
• Fatigue or extreme tiredness
• Weakness
• Dizziness
• Lightheadedness
• Coughing and wheezing
• Increased urge to urinate at night
• Inability to exercise
• Shortness of breath or breathing problems
• Difficulty in concentrating
• Rapid or irregular heartbeat even when the body is at rest
• Weight gain
• Swollen ankles, feet, lower legs, and even abdomen (edema).

Stage D

Patients are considered to be in stage D heart failure when their heart failure symptoms fail to respond to treatments and require aggressive medical therapy. It is the advanced or final stage of heart failure. The patients are likely to show extreme cases of symptoms as mentioned in stage C heart failure at rest or on mild/minimal exertion. [1, 2. 3]

The Treatment Plan For Each Stage Of Heart Failure

Heart failure can be treated based on the stage at which heart failure is determined by the doctor.

Stage A Treatment

As it is a pre-heart failure stage, the primary treatment plan includes preventive measures such as:

• Smoking cessation
• No alcohol abuse or usage of recreational drugs
• Treatment for high cholesterol with drugs
• Doing regular cardio exercises, being active and fit
• Treatment for hypertension through intake of a low sodium diet, lifestyle modification, and certain medications to control high blood pressure
• Taking medications to treat underlying health issues like diabetes.

Stage B Treatment

The usual treatment plan would include all the treatments/ preventive measures listed in stage A treatment along with the medications used to treat heart failure such as:

• Angiotensin-Converting Enzyme Inhibitor (ACE-I)
• Angiotensin II receptor blockers (ARB), also called angiotensin-2 receptor antagonists
• Beta-blockers also called beta-adrenergic blocking agents- for patients who had a heart attack and their ejection factor is 40% or less
• Aldosterone antagonists- for patients who had a heart attack or have diabetes and ejection factor of 30% or less
• SGLT2 inhibitor medication
• Other medications based on the presence of other health issues in the patients such as blood thinners (anticoagulants), statins (cholesterol-lowering drugs), and dig-oxin

For those having coronary artery disease, valve disease, or a heart attack, possible surgeries or interventions are provided for their treatment.

Stage C Treatment

The treatment plan includes the treatments listed for stage A and Stage B heart failure patients along with other treatments as listed below:

• Angiotensin-receptor neprilysin inhibitors (ARNIs)
• Prescribed diuretics (water pills)- if symptoms persist
• Channel blockers
• Possible fluid restriction
• Medications to bring the fast heart rate back to normal i.e. 70 beats/min
• Hydralazine and isosorbide dinitrate combination-specifically meant for African-Americans having moderate to severe heart failure symptoms when other treatments are not able to provide relief
• Assess fluid retention by keeping track of body weight
• Placement of biventricular pacemaker- a possible cardiac resynchronization therapy
• Possible implantable cardiac defibrillator therapy.

Stage D Treatment

The usual treatment plan includes treatments of the other three stages of heart failure along with evaluation for more advanced treatment options, such as:

• Left ventricular assist devices
• Heart surgery
• Heart transplantation
• Valve replacement surgery
• Percutaneous coronary intervention or angioplasty
• Continuous infusion of intravenous inotropic drugs
• Hospice or palliative care or research therapies. [1, 2]

References

1. https://www.topdoctors.co.uk/ medical-articles/understanding-4-stages-heart-failure
2. https://www.emedicinehealth.com/ what_are_the_4_stages_of_congestive _heart_failure/article_em.htm
3. https://www.midgaheart.com/blog/ advanced-cardiology-what-are-the-4-stages-of-congestive-heart-failure/

The human heart is a blood-pumping organ that helps in the circulation of oxygen-rich blood throughout the body. The pumping action of the heart which lasts for about a second is called a heartbeat. It happens in two parts. Firstly, when the upper two chambers of the heart get filled with blood, an electrical signal is transmitted that causes the heart to contract and push blood to the lower two heart chambers. In the second contraction of the heart, the blood is pushed to the lungs where it gets mixed with oxygen and then circulated all over the body. All this occurs automatically without the person being aware of his/her heartbeats. So, what does skipping a heartbeat means, and what causes it? Let’s find out. [1]

What are Heart Palpitations?

A heart palpitation is an unexpected or unexplained racing or pounding of the heart, or a feeling just like skipping a heartbeat. It is a kind of arrhythmia- an abnormal heart rhythm. The heart beats out of rhythm only when it fires signals from the wrong place at the wrong time.

Heart palpitations are sensations that are felt when the heart is beating either too slow, too fast, or irregularly. Most people experience heart palpitations once-in-a-blue-moon while others face a lot many in a day, sometimes so strong that they might confuse it with a heart attack. [2.3]

The Symptoms of Heart Palpitations

Heart palpitations are felt by most people as momentarily pounding, murmuring, flip-flopping, or racing of heart; extra or skipped heartbeat; a forceful or fluttering beat. These are felt in the chest or neck. The skipped beat is probably experienced by people as an early heartbeat. It happens when the heart contracts much before the ventricles get time to fill with blood. As a result, the body receives no or very little blood and that heart contraction is not at all felt as a beat. The next beat comes up as a forceful one as more volume of blood is then pushed out.

Other than these common symptoms, some people do experience serious symptoms. Talk to a heart specialist, if experiencing any of the following symptoms alongside heart palpitations:

• Fainting
• Light-headedness
• Dizziness
• Frequent or prolonged heart palpitations or when these worsen over time instead of getting improved
• Chest pains like angina or tightness
• Unusual sweating
• Confusion
• Troubled breathing or shortness of breath

In extreme cases of heart palpitations, people can have a sudden cardiac arrest. [3]

Causes of Irregular Heartbeat-Heart palpitations:

Heart palpitations can occur occasionally out of the blue and all of a sudden disappear too. Some people can notice them while they are drifting off to sleep while others may feel them when they are standing up after bending over. Heart palpitations can be linked with certain events, activities, emotions, or even advancing age. The skipping of a heartbeat can be an outcome of several factors, including:

1. Emotional or Psychological Triggers: Anxiety, stress, or a panic attack can lead to heart palpitations.

2. Lifestyle Triggers: Dehydration, excess consumption of alcohol, chocolate, or caffeine; strenuous exercise, and insufficient sleep all can result in Heart palpitations. A heart can even skip a beat of a person who is a smoker or an illegal drug abuser- like cocaine or maybe taking stimulants such as Sudafed.

3. Arrhythmias: These are the changes in the normal pattern of electrical impulses from the heart, resulting in irregular heartbeats. Some of them are harmless while others are life-threatening and require immediate medical attention. There are different kinds of arrhythmias such as: 

• Tachycardia- Heart rate is faster than normal.
• Bradycardia- A slow heart rate.
• Ventricular tachycardia- A potentially serious cardiac condition wherein the heart rhythm is regularly fast and sometimes associated with blackouts or dizziness.
• Supraventricular tachycardia: A rapid heartbeat that leads to dizziness.
• Atrial fibrillation: It can result in irregular, fast heart rate and also increase the likeliness of stroke.

4. Heart Conditions: Some heart palpitations can be an indication of heart problems. The examples are-

• Heart failure- This occurs when there is no effective pumping of blood through the heart and the heart chambers get dilated.
• Congenital heart disease- It is the heart abnormality that a person has from birth.
• Mitral valve prolapses- It is a condition wherein the valve between the upper and lower heart chambers does not close properly resulting in inefficient blood flow through the heart.
• Hypertrophic cardiomyopathy- It is a heart condition wherein the heart muscles and its walls get enlarged.

5. Certain Medications: The medications that can trigger harmless heart palpitations include:

• Antihistamines
• Antidepressants
• Asthma medications
• Hypertension medications
• Antibiotics
• Antifungals

6. Hormonal Changes: Women can experience heart palpitations during their menstrual periods, pregnancy, or menopause because of hormonal fluctuations. An overactive thyroid can even result in heart palpitations.

7. Other Medical Conditions: The medical issues that can result in heart palpitations includes:

• Low blood pressure
• Anemia
• Abnormalities in electrolytes
• Thyroid storm
• Low blood sugar level-Hypoglycemia
• Fever
• Low potassium. [1,2]

How to Stop Heart Fluttering?

The treatment of a heart skipping a beat depends upon its cause. If one experiences unexplained heart palpitations all of a sudden, then the following things must be done at first:

• Stop smoking tobacco
• Drink adequate amount of water
• Stop drinking alcohol or limit its intake
• Eat food regularly to ensure blood sugars are at level
• Consult the concerned heart doctor to ensure that the current intake of medications and supplements are not causing heart palpitations
• Go for a heart-healthy diet that contains whole grains, a range of fruits and vegetables, fish and seafood, nuts, legumes, and seeds
• Be physically active

If the triggers of skipped heartbeats are anxiety or stress, the patient can try meditation, exercise, relaxation response, tai chi, yoga, or any other stress-busting activity. It may be a good idea to talk to a therapist

Medical Treatment Options Include:

• A pacemaker- to regulate the heartbeat
• Medications to reduce cholesterol, blood sugar levels, and hypertension
• Mild electrical shock- to allow the heart to return to its normal rhythm
• A cardiac defibrillator- an implantable device that monitors and corrects an irregular heart rhythm
• Cardiac surgery- to remove a portion of the heart that is not functioning properly as expected. [1,2]

References:

1. https://www.medicalnewstoday.com/articles/321793#what-is-a-heart-palpitation
2. https://www.health.harvard.edu/heart-disease/skipping-a-beat–the-surprise-of-palpitations
3. https://www.hopkinsmedicine.org/health/conditions-and-diseases/palpitations