In some patients, heart failure is caused by a specific treatable problem, or this problem contributes significantly to its development. In such cases, therapy that targets the specific disorder may help. In some cases, the damage to the heart is even reversible.
Ischemic heart disease:
If heart failure is caused by insufficient blood supply to the heart muscle due to narrowing of the coronary arteries, it is possible to restore blood flow to some extent. Procedures can be performed either on a planned basis or acutely in the event of a myocardial infarction. There are basically two options – surgery involving opening the chest and sewing in connectors that bypass the narrowing (coronary bypass), or intervention, in which the doctor uses special instruments (catheters) to reach the heart via the vessels in the wrist or groin and repair the problem from the inside. The vascular system is visualized by injecting a substance that can be seen using real-time X-ray imaging. If there is a noticeable failure to fill a certain area of the heart due to narrowing, this area is treated by expanding a balloon and inserting a stent, a metal tube-shaped reinforcement. The choice between interventional and surgical methods is usually made by a multidisciplinary team at centers that perform both procedures. Interventions are usually performed on patients with fewer narrowings, but specific anatomical conditions are also decisive. Interventional examinations and possible repair of narrowed areas are also performed on all patients after cardiac arrest.
Valve disease:
For the heart to function effectively as a pump, blood must flow in only one direction. This is achieved by a system of valves. Valve disorders are divided into two basic types – stenosis and regurgitation. The first type involves narrowing, which slows down the flow through the valve, while the second type involves leakage, where blood does not flow in one direction but flows back. Depending on the specific disorder, the valves can be repaired either through open surgery or through a small incision in the groin.
If alcohol is the cause of the problem:
Heart failure can be caused by long-term alcohol consumption. In such cases, it is necessary to stop drinking completely. If this is successful, many patients will be completely cured or at least experience a significant improvement in their heart problems.
When the heart pumps too fast (and irregularly):
Arrhythmias (irregular rhythms) can cause heart failure, but they can also result from it. An irregular rhythm reduces the efficiency of blood ejection, and in the case of rapid arrhythmias (usually atrial fibrillation), the heart becomes overloaded, similar to when striated muscles become tired during exercise. Treatment is based on medication and electrocardioversion (a kind of restart of the heart using an electric current, performed under anesthesia). However, in some patients, arrhythmias keep coming back, so an interventional procedure called radiofrequency ablation is needed. In this minimally invasive procedure, doctors use long wires (called catheters) that are inserted through a vein in the groin and threaded up to the heart to find and burn the spot.
And when it is too slow:
In slow arrhythmias, whether regular or irregular, the main problem is low cardiac output. This results in fatigue, dizziness, or loss of consciousness. The solution is to implant a pacemaker, usually under the skin in the subclavian region. Electrodes (thin wires) lead from the device body and are inserted through the blood vessels into the heart. Through these electrodes, the device stimulates the heart and determines its rhythm according to specific needs.
A personal defibrillator that is always ready:
Some patients with reduced heart function are at risk of developing malignant arrhythmias. These are rhythm disorders in which the heart is beating but is not pumping any blood, leading to cardiac arrest. These conditions require immediate treatment, otherwise death will occur. The only sufficiently rapid option is to administer an electric shock using a defibrillator or AED, which, however, are not always available and must be remembered and known how to use. In patients at increased risk of malignant arrhythmia, a device known as an implantable cardioverter-defibrillator (ICD) is therefore inserted preventively into the subcutaneous tissue in the subclavian area. The insertion procedure is practically the same as for a pacemaker, but the function is different. The defibrillator detects any malignant arrhythmia and delivers an electric shock directly to the heart, which cancels it out and restores heart function.
Cardiac resynchronization therapy:
For the heart to function effectively, its individual chambers (atria and ventricles) must work in harmony and their contractions must be properly timed. Conversely, when the heart chambers are out of sync, a condition known as dyssynchrony, the heart’s pumping efficiency decreases. In such cases, resynchronization therapy may be introduced. The resynchronization device looks similar to a pacemaker; it is a small box implanted in the subclavian area, from which electrodes emerge. However, the electrodes stimulate multiple sites simultaneously to restore the synchronization of cardiac activity. Some devices can combine cardiac resynchronization therapy with a defibrillator function in cases of malignant arrhythmia.
