Hjartabilun

Hjartabilun (heart failure) is a chronic condition in which the heart is unable to pump enough blood to meet the body's needs, or can do so only with elevated filling pressures. It is a syndrome that can result from many heart and systemic diseases.

HF can be classified by the left ventricle's pumping function: heart failure with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). In HFrEF, the heart's pumping strength is reduced; in HFpEF, the ventricle is stiff and fills poorly. Both forms cause similar symptoms and disease burden.

Common causes include coronary artery disease and prior myocardial infarction, long-standing high blood pressure, cardiomyopathy, valvular disease, and arrhythmias. Risk is increased by diabetes, obesity, kidney disease, lung disease, and age.

Symptoms typically include shortness of breath, fatigue, and reduced exercise tolerance. Other signs are leg or abdominal swelling, orthopnea, nocturnal cough, rapid heartbeat, and fluid retention. Symptoms may worsen during illness or with increased salt intake.

Diagnosis involves history, physical examination, and tests such as echocardiography, ECG, chest X-ray, and measurement of natriuretic peptides (BNP or NT-proBNP). Classification by left-ventricular EF and clinical stage guides management.

Management aims to relieve symptoms, slow progression, and prevent hospitalization. It includes lifestyle measures (sodium restriction, fluid management, exercise) and medications such as ACE inhibitors or ARBs or ARNI, beta-blockers, diuretics, and mineralocorticoid receptor antagonists. SGLT2 inhibitors are increasingly used; device therapies (ICD, CRT) and valve or revascularization procedures are considered for selected patients.

Prognosis varies with underlying disease and treatment adherence. Heart failure imposes substantial morbidity and health-system burden due to hospitalizations, but outcomes improve with evidence-based therapy and risk-factor control.