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How to diagnose heart failure in cases of obesity

Diagnosing heart failure is quite a “clinical challenge” in patients suffering from obesity, since their main symptom, which is exercise intolerance, is usually attributed to obesity itself rather than heart failure.

The challenge of diagnosing heart failure in obese patients

Electrocardiogram on a woman, one of the tests to detect heart failure. EFE/Sáshenka Gutiérrez

The Spanish Society of Cardiology (SEC) and the Spanish Society of Endocrinology and Nutrition (SEEN) have come together to improve the approach to heart failure in people with obesity, which on March 4 marks the World Day.

Obesity is a highly prevalent disease, epidemic if possible, with a multifactorial cause and in some cases extremely complex as it is the cause of many complications, among which cardiovascular ones are distinguished, such as heart failure.

The main difficulty centers on the intolerance to effortmain symptom of heart failure but which is also a consequence of obesity itself.

For an early diagnosis

The SEC and the SEEN have drawn up a consensus document, “Detection and management of heart failure in the obese patient”which includes a series of tips to ensure a better and earlier diagnosis in cases of heart failure in people with obesity.

Thus, it is distinguished:

  • What evidence should be requested from the inquiry of endocrinology in front symptoms and signs of suspicion heart failure
  • The global approach to risk factors.
  • What an initial treatment it is necessary to follow in these cases.
  • Referral and coordination with cardiology to guarantee the best patient care.

In short, one is proposed multidisciplinary treatment of obesity to avoid the possible difficulties arising from its symptomatology, which is somewhat generic.

the doctor Raquel Campuzano, one of the authors of the document and former president of the Association of Vascular Risk and Cardiac Rehabilitation of the SEC talks about the complications presented by obesity in this context.

“The diagnosis of heart failure in these cases, especially in the initial stages, constitutes a real clinical challenge because obese patients often have other comorbidities that make the diagnosis even more complex,” the expert points out.

Therefore, this proposal is nothing more than a new tool that the endocrinologist has for rrecognize, address, treat and refer to the patient, guaranteeing better care and, therefore, a better prognosis. Because early treatment will always be an advantage in these cases.

What is heart failure?

The heart failure (HF) it occurs when the heart is not able to pump enough blood to the body. Its symptoms include:

  • dyspneathat is, the lack of air due to cardiac cause.
  • Difficulty exercising or usual physical activities.

The evolution of these symptoms and signs is a key element to arrive at the diagnosis, although it must be done explorations complementary to confirm it.

Doctor Vicente Arrarte, member of the SEC and also author of the initiativeassures that in addition to intolerance to effort, there is a very characteristic symptomatology when talking about heart failure, such as bendopnea (dyspnea when tying shoes) or la orthopnea (dyspnea more obvious when getting into bed).

Risk factors

Dr. Campuzano lists the main risk factors that increase the likelihood of heart failure in obese patients:

  • Over the age of 65.
  • Presence of arterial hypertension.
  • diabetes mellitus
  • Chronic kidney disease.
  • History of ischemic heart disease.
  • Atrial fibrillation.
obesity-heart failure-older
Over the age of 65 is a risk factor for heart failure. EFE/Kiyoshi Ota

Tools for detection

Regarding the diagnostic tools used in these cases, they differ:

  • electrocardiogram: has an excellent predictive value to rule out heart failure.
  • Measurement of plasma biomarkers.
  • Echocardiography and other imaging techniques.

The problem of obesity in numbers

Given the prevalence of obesity, the risk of heart failure is an important factor to consider.

And it is that according to National Institute of Statisticsthe incidence of obesity has doubled in the last 20 yearscalculating that one 17% of Spaniards are obese. A number that is expected to continue to grow in the coming years.

Regarding the relationship between obesity and cardiovascular problems, some studies show that the risk of heart failure is increased by 5% in men and 7% in the case of women for each point of increase in body mass index.

For this reason, from SEC and SEEN, it advocates for multidisciplinarity and the importance of continuous improvement of medical care.

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