Over the past 48 hours, we’ve looked at the differences between heart failure and a heart attack. Whilst a heart attack can later result in heart failure (and heart failure can result in a heart attack), the important distinction is that heart failure is generally a chronic condition. This is not to say that heart failure cannot present acutely, but it is unlikely to be an immediate cause of death; rather, if left untreated or unsuccessfully treated, the individual may undergo numerous acute heart failure events of increasing severity (see acuteheartfailure.com/HDAC.html for more information).

Whilst the underlying causes of course develop over time (particularly in the case of coronary artery disease), a heart attack (myocardial infarction) is, by definition, an acute event. Nowadays, many individuals survive a heart attack, or even multiple events, thanks to options such as revascularisation. Revascularisation can restore bloodflow to the occluded vessels rapidly enough to prevent, or at least mitigate, lasting damage.

Such individuals are at a longer term risk of developing heart failure. Risk factors for heart failure, according to the European Society of Cardiology (2016) include:

– History of coronary artery disease (previous heart attack, revascularisation)
– History of arterial hypertension
– Exposure to cardiotoxic drugs or radiation
– Use of diuretics
– Dyspnoea (can be monitored by sleep studies using a high quality pulse oximeter).

A study by Masip et al. (2012) showed that oxygen saturation <93% by pulse oximetry had 90% specificity and 65% sensitivity for heart failure. Results of pulse oximetry also had important prognostic implications.

References

Masip, J, Gayà M, Páez J, Betbesé A, Vecilla F, Manresa R, Ruíz P. Pulse oximetry in the diagnosis of acute heart failure. Rev Esp Cardiol (Engl Ed). 2012 Oct;65(10):879-84.

Ponikowski, P.,  Voors, A., Anker, S. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 2129-2200.