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Does heart failure hurt. Understanding Heart Failure Pain: Symptoms, Causes, and Management

by alexxlab

Does heart failure cause pain. What are the common symptoms of heart failure. How is heart failure diagnosed and treated. Can heart failure be prevented. What lifestyle changes can improve heart failure outcomes. How does heart failure affect quality of life. What are the latest advancements in heart failure treatment.

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The Nature of Pain in Heart Failure

Heart failure is a complex cardiovascular condition that can manifest in various ways, including pain. While not all patients with heart failure experience pain, it is a symptom that deserves attention due to its impact on quality of life and potential prognostic significance.

Pain in heart failure can be attributed to several factors:

  • Reduced blood flow to organs and tissues
  • Fluid buildup causing pressure on surrounding structures
  • Associated conditions like angina or peripheral artery disease
  • Side effects of medications used to treat heart failure

Understanding the relationship between pain and heart failure is crucial for both patients and healthcare providers. It can aid in early detection, improve management strategies, and enhance overall patient care.

Types of Pain Associated with Heart Failure

Patients with heart failure may experience various types of pain, including:

  1. Chest pain (angina)
  2. Abdominal pain
  3. Joint and muscle pain
  4. Headaches
  5. Neuropathic pain

Each type of pain may have different underlying causes and require specific management approaches. Recognizing these distinctions is essential for effective treatment and symptom relief.

Prevalence and Impact of Pain in Heart Failure Patients

Studies have shown that pain is a common complaint among heart failure patients, with prevalence rates varying widely. A systematic review by Godfrey et al. (2006) found that between 23% and 75% of heart failure patients reported experiencing pain.

The impact of pain on heart failure patients is significant:

  • Reduced quality of life
  • Increased psychological distress
  • Limited physical activity and functional capacity
  • Higher healthcare utilization and costs
  • Potential for worse clinical outcomes

Given these consequences, addressing pain in heart failure management is crucial for improving patient outcomes and well-being.

Factors Influencing Pain Perception in Heart Failure

Several factors can influence how heart failure patients perceive and experience pain:

  1. Severity of heart failure
  2. Comorbid conditions (e.g., diabetes, arthritis)
  3. Age and gender
  4. Psychological factors (depression, anxiety)
  5. Cultural and socioeconomic background

Understanding these factors can help healthcare providers tailor pain management strategies to individual patient needs and circumstances.

Diagnostic Approaches for Pain in Heart Failure

Accurately diagnosing the source and nature of pain in heart failure patients is essential for effective management. Diagnostic approaches may include:

  • Comprehensive medical history and physical examination
  • Pain assessment tools and questionnaires
  • Imaging studies (e.g., echocardiogram, chest X-ray)
  • Blood tests to evaluate organ function and biomarkers
  • Electrocardiogram (ECG) to assess heart rhythm and detect ischemia

Healthcare providers must distinguish between pain directly related to heart failure and pain stemming from other conditions or comorbidities. This differentiation is crucial for developing appropriate treatment plans.

Challenges in Pain Assessment for Heart Failure Patients

Assessing pain in heart failure patients can be challenging due to several factors:

  1. Overlapping symptoms with other conditions
  2. Variability in pain perception and reporting
  3. Cognitive impairment in some patients
  4. Comorbidities that may confound pain assessment
  5. Limited validated pain assessment tools specific to heart failure

Overcoming these challenges requires a multidisciplinary approach and ongoing research to develop more precise pain assessment methods for heart failure patients.

Treatment Strategies for Pain in Heart Failure

Managing pain in heart failure patients requires a comprehensive approach that addresses both the underlying cardiac condition and the pain itself. Treatment strategies may include:

  • Optimizing heart failure management
  • Pharmacological interventions for pain relief
  • Non-pharmacological pain management techniques
  • Addressing comorbidities that contribute to pain
  • Psychological support and counseling

The choice of treatment depends on the type and severity of pain, the patient’s overall health status, and potential interactions with heart failure medications.

Pharmacological Approaches to Pain Management

When considering pharmacological interventions for pain in heart failure patients, healthcare providers must carefully weigh the benefits against potential risks. Common pain medications include:

  1. Acetaminophen (paracetamol)
  2. Non-steroidal anti-inflammatory drugs (NSAIDs) – used with caution
  3. Opioids – for severe pain, under close monitoring
  4. Topical analgesics
  5. Adjuvant medications (e.g., antidepressants, anticonvulsants for neuropathic pain)

The choice of medication should be individualized based on the patient’s specific needs, comorbidities, and potential drug interactions.

Non-Pharmacological Pain Management Techniques

Non-pharmacological approaches play a crucial role in managing pain for heart failure patients, offering benefits without the potential side effects of medications. These techniques include:

  • Physical therapy and exercise programs
  • Cognitive-behavioral therapy
  • Relaxation techniques and meditation
  • Acupuncture and acupressure
  • Heat or cold therapy

Incorporating these non-pharmacological methods into a comprehensive pain management plan can enhance overall effectiveness and improve patient outcomes.

The Role of Exercise in Pain Management

Exercise is particularly important for heart failure patients, offering benefits for both cardiac function and pain management:

  1. Improved cardiovascular health
  2. Enhanced muscle strength and flexibility
  3. Reduced inflammation
  4. Improved mood and reduced stress
  5. Better sleep quality

However, exercise programs must be carefully designed and supervised to ensure safety and effectiveness for heart failure patients.

Psychological Aspects of Pain in Heart Failure

The psychological impact of pain in heart failure patients is significant and can influence overall health outcomes. Key psychological aspects include:

  • Depression and anxiety
  • Fear and uncertainty about the future
  • Social isolation
  • Reduced self-efficacy
  • Impact on relationships and daily activities

Addressing these psychological aspects is crucial for comprehensive pain management and improving quality of life for heart failure patients.

Strategies for Psychological Support

Providing psychological support for heart failure patients experiencing pain may involve:

  1. Cognitive-behavioral therapy
  2. Support groups
  3. Mindfulness-based stress reduction
  4. Patient education programs
  5. Family and caregiver involvement

These strategies can help patients develop coping mechanisms, improve their understanding of their condition, and enhance their overall well-being.

The Future of Pain Management in Heart Failure

As research in heart failure and pain management continues to evolve, several promising areas are emerging:

  • Personalized medicine approaches
  • Novel pharmacological agents with fewer side effects
  • Advanced interventional techniques
  • Improved pain assessment tools specific to heart failure
  • Integration of technology in pain management (e.g., wearable devices, telemedicine)

These advancements hold the potential to significantly improve pain management outcomes for heart failure patients in the future.

Emerging Research Directions

Current research in pain management for heart failure patients is focusing on several key areas:

  1. Understanding the mechanisms of pain in heart failure
  2. Developing targeted therapies for specific types of pain
  3. Investigating the role of genetics in pain perception and response to treatment
  4. Exploring the potential of regenerative medicine in addressing pain
  5. Evaluating the long-term impact of various pain management strategies on heart failure outcomes

These research directions promise to enhance our understanding of pain in heart failure and lead to more effective management strategies.

Integrated Care Models for Pain Management in Heart Failure

Effective pain management in heart failure requires a multidisciplinary approach that integrates various aspects of care. Integrated care models may include:

  • Collaboration between cardiologists, pain specialists, and primary care providers
  • Regular pain assessments as part of routine heart failure follow-ups
  • Incorporation of palliative care principles in heart failure management
  • Patient-centered care planning that addresses individual needs and preferences
  • Seamless communication between healthcare providers across different settings

These integrated models aim to provide comprehensive, coordinated care that addresses both the cardiac and pain-related aspects of heart failure.

Benefits of Integrated Care Approaches

Implementing integrated care models for pain management in heart failure can offer several benefits:

  1. Improved symptom control and quality of life
  2. Reduced healthcare utilization and costs
  3. Enhanced patient satisfaction with care
  4. Better adherence to treatment plans
  5. Potential for improved clinical outcomes

By addressing pain comprehensively within the context of heart failure management, integrated care models have the potential to significantly improve patient outcomes and experiences.

Patient Education and Self-Management Strategies

Empowering heart failure patients with knowledge and skills to manage their pain is crucial for long-term success. Patient education and self-management strategies may include:

  • Understanding the relationship between heart failure and pain
  • Recognizing warning signs that require medical attention
  • Proper use of prescribed medications and non-pharmacological techniques
  • Lifestyle modifications to reduce pain and improve heart health
  • Stress management and coping skills

These strategies can help patients take an active role in their pain management and overall heart failure care.

Tools for Patient Self-Management

Various tools and resources can support patient self-management of pain in heart failure:

  1. Pain diaries and tracking apps
  2. Educational materials tailored to heart failure patients
  3. Online support communities and forums
  4. Telehealth consultations for ongoing support
  5. Wearable devices for monitoring symptoms and activity levels

These tools can enhance patients’ ability to monitor their symptoms, communicate effectively with healthcare providers, and make informed decisions about their care.

The Role of Palliative Care in Managing Pain in Advanced Heart Failure

Palliative care plays a crucial role in managing pain and other symptoms in advanced heart failure. Key aspects of palliative care in this context include:

  • Comprehensive symptom management, including pain relief
  • Emotional and psychological support for patients and families
  • Advance care planning and discussions about goals of care
  • Coordination of care across different healthcare settings
  • Support for caregivers and family members

Integrating palliative care principles into heart failure management can significantly improve quality of life and symptom control for patients with advanced disease.

Timing of Palliative Care Integration

Determining the appropriate timing for integrating palliative care in heart failure management is important:

  1. Early integration can provide better symptom control and quality of life
  2. Palliative care can be provided alongside curative or life-prolonging treatments
  3. Regular reassessment of palliative care needs is important as the disease progresses
  4. Palliative care can help with transitions of care and decision-making
  5. End-of-life care is an important component of palliative care in advanced heart failure

Early and ongoing integration of palliative care can provide comprehensive support throughout the course of heart failure, including effective pain management.

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Dealing with Chest Pain and Heart Failure




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ESC Guidelines for Heart Failure – what patients need to know


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Pain due to heart problems is usually felt in the chest, although it can be located anywhere between the upper abdomen (upper trunk) and throat, including the arms and shoulders. It can be experienced as discomfort, pressure, gas, or a burning or aching feeling.

Chest pain should ALWAYS be treated as serious as it could indicate a worsening of your heart failure, angina or a heart attack. You should sit or lie down immediately and rest.

If you experience chest discomfort or pain that lasts for more than 15 minutes or is not relieved by rest or glyceryl trinitrate (GTN/nitroglycerin) (if you have been prescribed this by your doctor), then you should call for emergency help immediately.


ESC Guidelines for Heart Failure

What patients need to know

This guide for patients from the European Society of Cardiology aims to provide an overview of the latest evidence-based recommendations for the diagnosis and treatment of heart failure.

In particular, it should help patients to understand the:

  • main types of heart failure
  • medicines used to treat heart failure
  • devices that may be appropriate
  • importance of rehabilitation
  • management by a multidisciplinary team
  • importance of self-care in managing your own condition


Learn more





Download the Guidelines

AN ANIMATED JOURNEY THROUGH HEART FAILURE

A series of 9 simple, captivating animations explaining heart failure and its treatment.

These narrated animations explain how a healthy heart works, what happens to it in heart failure and how various treatments work to improve your health.



How the normal heart works



What goes wrong in heart failure



How the heart and body compensate in heart failure



How heart failure causes fluid accumulation



How a heart attack can cause heart failure



How abnormal heart valves can cause heart failure



How vasodilators work in heart failure



How diuretics work in heart failure



How medical devices work in heart failure

PATIENT AND CAREGIVERS VIDEOS

In this section you can watch, listen or read interviews with other people with heart failure and their caregivers.




Patient in exercise training




Patient with an ICD




An LVAD as a bridge to transplantation




Adjusting lifestyle and staying optimistic




Living with heart failure devices




Challenges in making the diagnosis




Living with an LVAD

VISIT OUR FACEBOOK PAGE

and share your own views and experiences with other patients, families and caregivers.


https://www.facebook.com/heartfailurematters

heartfailurematters.org is a European Society of Cardiology website

The heartfailurematters.org website was developed under the direction of the Heart Failure Association of the European Society of Cardiology (ESC). The ESC is a world leader in the discovery and dissemination of best practices in cardiovascular medicine. Our members and decision-makers are healthcare professionals who volunteer their time and expertise to represent professionals in the field of cardiology in Europe and beyond.




Heart failure: causes, signs and symptoms

Today, heart failure has become epidemic. Every year the number of people suffering from this disease is growing all over the world. Heart failure develops as a complication of various diseases of the cardiovascular system.

In Russia, at least 8 million people suffer from heart failure. This disease is common among people of mature and old age: it mainly develops after 60 years of age

What is heart failure?

Heart failure is a condition based on a malfunction of the heart, a decrease in its “pumping” function, as a result of which the blood supply to tissues and organs is disturbed, they experience a lack of oxygen and nutrients. This failure occurs due to the fact that the heart literally runs out of strength: they are no longer enough to push blood into the vascular bed, the contractility of the myocardium decreases. To cope with this task, the heart goes into “emergency mode” – by increasing the pressure in the chambers (in the left and right ventricles and atria) of the heart itself.


Heart failure is chronic or acute.

The latter is an emergency condition requiring immediate medical intervention (an ambulance call is required). But, fortunately, acute heart failure develops less frequently.

A chronic disease may not manifest itself for a long time and develop gradually. Periods of exacerbations are replaced by a temporary lull. So a person can live for many years.

Causes of heart failure

Heart failure most often develops against the background of arterial hypertension and coronary heart disease . Also, the cause of its development can be:

  • 1

    diabetes mellitus

  • 2

    heart valve defects

  • 3

    obesity

  • 4

    cardiomyopathy

  • 5

    diseases of the pericardium and endocardium (outer and inner membranes of the heart)

  • 6

    congenital heart defects

  • 7

    excessive alcohol consumption, smoking

  • 8

    malnutrition, deficiency of vitamins and microelements

Heart failure increases the risk of hypokalemia (low potassium levels), often due to the use of diuretic drugs. Potassium preparations (Panangin) help prevent the development of cardiac glycoside toxicity (bradycardia, arrhythmia, weakness, dizziness, nausea, vomiting, abdominal pain, etc. ), which develops under conditions of hypokalemia, improve the tolerability of therapy with this group of drugs.

Signs and symptoms of heart failure

The insidiousness of this disease is that in the initial stages it is difficult to recognize. Common signs such as swelling, shortness of breath and fatigue are not taken seriously by many. In addition, other health problems give a similar picture. Therefore, an accurate diagnosis is possible only with a thorough history taking. Usually, determining the degree of heart failure, i.e. how far the disease has gone, and the verdict is made after taking an anamnesis and evaluating the following data. The more positive answers the doctor receives, the more likely the patient has heart failure:

  • 1

    dyspnoea when lying down, standing or sitting

  • 2

    weight gain

  • 3

    complaints about feeling of interruptions in the work of the heart

  • 4

    jugular vein swelling

  • 5

    Discomfort while lying in bed (lifting pillows, falling asleep sitting up, nocturnal choking)

  • 6

    edema

  • 7

    rales in lungs

  • 8

    heaviness, feeling of fullness in the right hypochondrium as a result of liver enlargement

  • 9

    increase in systolic blood pressure

  • 10

    heart gallop rhythm

Cardiologists stand up for public awareness: the more attentively a person treats himself during a period of ailment, the higher the chance to help him in the early stages of the disease.

Heart failure – causes, symptoms, signs, diagnosis, treatment, prevention

Classification

Causes

Symptoms

Diagnosis

Treatment

Heart failure is a clinical condition in which the activity of the heart is disrupted and it is not able to provide the body’s need for oxygen in accordance with its need.

Heart failure (HF) is a sign of decompensation of other diseases: both acute and chronic.

Classification

There are a number of classifications based on organic damage to various parts of the heart, clinical examination data, and the degree of impairment of the patient’s quality of life.

Downstream heart failure is:

  • acute;
  • chronic.

Based on the physical examination of the patient, the following classes are distinguished on the Killip scale:

  • I – without signs of heart failure;
  • II – with mild signs of heart failure, few wheezing in the lungs;
  • III – with more pronounced signs of heart failure, a lot of wheezing in the lungs;
  • IV – with signs of cardiogenic shock, systolic pressure not higher than 90 mm. rt. Art.

According to the New York Society of Cardiology, the following functional classes (FC according to NYHA) are distinguished:

  • I FC – normal physical activity is not impaired, severe weakness, shortness of breath, palpitations do not occur after exercise;
  • II FC – physical activity is moderately limited, habitual physical activity leads to fatigue, weakness, shortness of breath, palpitations, but absent at rest;
  • III FC – physical activity is significantly limited, symptoms occur with less physical exertion than the patient is used to, there are no symptoms at rest;
  • IV FC – in peace and with any type of physical activity, symptoms of the disease appear.

Variants of heart failure, taking into account data on the contractility of the left heart (left ventricular ejection fraction – LVEF):

  • with low LVEF – below 40%;
  • with an intermediate LVEF – from 40% to 49%;
  • with preserved LVEF – from 50% and above.

Stages of chronic heart failure according to Vasilenko-Strazhesko:

  • I – symptoms appear during exercise, absent at rest, there are changes in the work of the left ventricle;
  • II – there are signs of congestion in the large and / or small circles of blood circulation, remaining at rest;
  • III – a pronounced decrease in tissue oxygenation, congestion in the body with impaired hemodynamics, with dysfunction of the liver, lungs, kidneys (treatment is practically ineffective against the background of exhaustion of the body).

The risk of death in women and men with signs of heart failure is equally high, regardless of the functional class. This is due to the fact that the disease is unstable.

Causes

Older people are more likely to suffer from heart failure due to development and decompensation:

  • coronary heart disease;
  • hypertension;
  • acute myocardial infarction;
  • cardiomyopathy;
  • arrhythmias;
  • diabetes mellitus;
  • chronic obstructive pulmonary disease;
  • myocarditis.

Factors that adversely affect the body, increasing the possibility of developing the disease:

  • tobacco smoking and alcohol consumption in hepatotoxic doses;
  • overweight and obesity;
  • metabolic changes;
  • dyslipidemia;
  • endocrine dysfunction;
  • reduced physical activity;
  • stress.

As the cause of the development of heart failure, genetic predisposition, anomalies in the development of the heart and blood vessels are of great importance.

Symptoms

In the early stages, the disease can be asymptomatic, while changes in the body can be detected during examinations, tests with physical activity.

At various stages of the disease, the following signs can be detected:

  1. Dyspnea, shortness of breath. In the later stages of heart failure, shortness of breath occurs even when eating.
  2. Cough as a sign of congestion in the pulmonary circulation. With inefficient work of the left ventricle, the hydrostatic pressure in the lungs increases, the liquid part of the blood sweats into the lumen of the alveoli. Cough often occurs after sleep.
  3. Edema. A sign of congestion in the systemic circulation (dysfunction to a greater extent of the right ventricle). Ascending edema begins in the legs. They can manifest as ascites (sweating of the liquid part of the blood into the peritoneal cavity), enlargement of the liver, spleen, hydrothorax (sweating of the liquid part of the blood into the pleural cavity), anasarca (swelling of the whole body). During the examination, the swollen tissues are soft, after pressing on the skin of the lower leg, a dimple remains, on the hips and back there is a symptom of “orange peel”.
  4. Palpitations, increased heart rate (manifestation of the compensatory capabilities of the heart, aimed at increasing the minute volume of blood).
  5. Weakness, fatigue, sleep disturbance, decreased exercise tolerance. The result of chronic hypoxia and microcirculation disorders.
  6. Inability to sleep without a high pillow (manifestation of congestive heart failure in the pulmonary circulation).

Symptoms of heart failure depend not only on the stage of the disease itself, but also on the presence of concomitant pathology of the body.

Diagnostics

Given the severity of the development of the pathological process, diagnosis and care for heart failure begins when transported by ambulance to a medical facility (for example, with the development of acute myocardial infarction). Examination of a patient with a chronic form of the disease is carried out in an outpatient clinic or in a hospital setting.

Statistical data indicate that people in half of the cases seek medical help already with pronounced symptoms of the disease, structural and functional changes in other organs.

Examination may include:

  1. Collection of complaints and anamnesis (medical and life histories). The doctor carefully listens to the patient’s complaints and details them, specifies the duration of the disease, the severity of symptoms, medication, the presence of concomitant diseases, disability.
  2. Physical examination. The disease is characterized by such signs as: swelling of the cervical veins, hepatojugular reflux (when pressing on the abdomen at the site of the projection of the liver, the jugular veins swell on the neck), an increase in the boundaries of the heart, displacement of the apex beat (determined by percussion), a gallop rhythm when listening to the heart .
  3. A laboratory study includes a complete blood count, a general urinalysis, blood glucose, a biochemical blood test (ALT, AST, bilirubin, alkaline phosphatase, urea, uric acid, creatinine, total protein, albumin, ferritin), electrolytes in the blood (calcium, potassium, sodium), lipidogram, coagulogram, NUP (natriuretic peptide), thyroid hormones.
  4. Instrumental study: 12-lead ECG, Holter ECG monitoring, ultrasound of the heart, chest X-ray, Doppler – EchoCG with a study of pressure in the pulmonary artery, indicators of diastolic function of the left ventricle, myocardial biopsy, radionuclide ventriculography, coronary ventriculography.
  5. Consulting by specialists of a narrow profile.

A complete examination plan is drawn up by the attending physician individually for each patient, taking into account the stage of the disease, his current condition, and the equipment of the medical institution.

Treatment

Therapy is aimed at eliminating or reducing the severity of the symptoms of the disease, reducing congestion, preventing complications and further decompensation of the underlying and concomitant diseases, and improving the quality of human life.

Comprehensive treatment is carried out, which includes methods of non-drug and drug therapy.

The physician prepares a pharmacotherapy plan, which may include:

  1. ACE inhibitors (Enalapril, Lisinopril, Perindopril). They affect the level of blood aldosterone, the increase of which is pathogenetically significant in the development of hypertension, heart failure.
  2. Aldosterone receptor antagonists (Valsartan, Losartan).
  3. Aldosterone antagonists (spironolactone).
  4. Beta-blockers (Bisoprolol, Metoprolol, Carvedilol, Nebivolol). They have a protective effect on the myocardium, slowing down its remodeling.
  5. Diuretics (Furosemide, Torasemide). Reduce tissue swelling.
  6. Cardiac glycosides (Digoxin, Strofantin, Lanatoside C, lily of the valley preparations). Improve the contractility of the heart.
  7. Means of sympathomimetic action for parenteral use (Dopamine, Dobutamine). They are used in the later stages of the disease, in a hospital and under the strict supervision of a physician.
  8. Anticoagulants, antiplatelet agents, nitrates, antiarrhythmic drugs – according to indications.

The regimen, doses of drugs for the treatment of heart failure periodically change depending on the course and signs of the disease, the severity of complaints.

The treatment plan may include surgical therapy to restore blood circulation in the myocardium.

Non-pharmacological treatment is an important component of therapy, both in the treatment of the current condition and in the prevention of progression of heart failure.

It includes:

  • giving up bad habits;
  • normalization of body weight;
  • compliance with the rules of rational nutrition;
  • avoidance of physical overwork, stressful situations;
  • physical activity, prevention of hypodynamia.

Treatment is long and requires considerable effort and patience from the patient.

The author of the article:

Ivanova Natalya Vladimirovna

therapist

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