An Overview of Complications and Comorbidities of Heart Failure

Heart failure (HF) is a complex clinical syndrome that occurs when the heart cannot pump blood properly. It is generally well understood. However, the presence of comorbidities, other underlying medical conditions, can make the treatment and management of heart failure more difficult.¹

Heart failure is a chronic progressive condition. With effective treatment, people can slow the progression of their heart failure and live longer, with a better quality of life.² By monitoring your symptoms with your healthcare team, you can reduce the chances of developing more serious complications of heart failure.²

Complications of heart failure

When the heart is damaged or weak and has to work too hard it can lead to symptoms and a decreased quality of life. Lifestyle factors including smoking, obesity, a high-fat diet, and physical inactivity can also make heart failure worse.³

Complications can be life-threatening so it is important to identify them early.⁴ Common complications include:

• Cardiac arrhythmias- Heart rhythm problems from either the top chambers (atria) or bottom chambers (ventricles) can cause worsening of heart failure and other complications. Atrial fibrillation (AFIB) can cause palpitations, fainting, and lead to strokes. Ventricular tachycardia or ventricular fibrillation can cause palpitations, fainting or even sudden death.^4,5 An irregular or fast heartbeat can negatively affect the heart’s ability to pump sufficient blood to nourish the body.³
• Anemia- Develops when there is a decrease in the oxygen-carrying hemoglobin in red blood cells. It can cause weakness and fatigue and result in a faster heart rate.⁴
• Stroke- If the brain is deprived of oxygen when blood volume is low (low blood pressure) or cut off (clot) you can experience a stroke. This can result in a loss of motor function, ability to communicate ability and even death.⁴
• Heart valve problems- If there are mechanical issues with your heart valves it can affect the heart's pumping ability. It can trigger arrhythmias, make HF worse, and may require surgery to repair.^4,5

Lifestyle factors such as smoking, being overweight, eating a high-fat diet, and physical inactivity can also contribute to complications of heart failure.³

Comorbidities of heart failure

Comorbidity is the presence of more than one specific medical condition in an individual. Medical management of multiple diseases, present at the same time, has implications for clinical care. There is a new term, multimorbidity, which refers to “the co-occurrence of multiple chronic or acute diseases and medical conditions within one person.” Often there is a known, underlying condition that developed first. The order in which comorbidities appear may have critical clinical implications for treatment protocols and prognosis, the projected outcome of the treatment.¹

Comorbidities that can make heart failure worse can develop in any part of the body.

• Pulmonary complications can develop due to congestion, excess fluid that backs up into the lungs. This can compromise breathing and limit the amount of oxygen available to the rest of the body.³
• Organ failure may develop when vital organs do not get enough blood supply. Decreased cardiac pumping ability can result in an array of medical problems including neurological deficits, kidney failure, and gastrointestinal disorders.²
• Kidney damage can develop when blood flow to the kidneys is reduced. Damage to blood vessels can prevent the kidneys from filtering extra fluid and waste from the body.⁵
• Liver damage can occur when fluid buildup places excess pressure on the liver. This can cause scarring, which interferes with liver function.⁵
• Diabetes increases the risk of heart failure because hypertension and atherosclerosis are often present due to elevated lipid levels in the blood.^2,3,5
• Obesity causes the heart to work harder than normal. It can contribute to sleep apnea and cardiomyopathy, a disease of the heart muscle.³
• Sleep apnea is a sleep disorder caused by pauses in your breathing. Disrupted sleep can cause daytime fatigue and be a risk factor for multiple medical problems including high blood pressure, exacerbations in heart failure, diabetes, and stroke.³
• Hyperthyroidism is a condition caused by an overactive thyroid gland. This means the thyroid produces too much of a hormone called thyroxine. This can accelerate your metabolism, resulting in weight loss and a rapid or irregular heartbeat.³

Any of these complications and comorbidities in a person with HF can lead to increasing disability or death. Being aware of changes in your symptoms can assist your doctor to more easily and effectively control your condition before it progresses to a critical level.²