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(A-Z listing includes diseases, conditions, tests and procedures)

Heart Failure

What is heart failure?

Heart failure is a condition in which the heart can’t pump enough oxygenated blood to meet the body’s needs. The heart keeps pumping, but not as efficiently as a healthy heart. Heart failure is the result of some other underlying condition.

Heart failure does not mean the heart stops. Rather, it means the heart fails to pump as well as it should.

What You Need to Know About Heart Failure

  • Cardiomyopathy, a name for any disease of the heart muscle, is one condition that often leads to heart failure.

  • Symptoms include shortness of breath, swelling in the legs and feet and abdominal pain or nausea.

  • Diagnosis will include tests for the existence of heart failure, followed by tests to evaluate the cause of the heart failure.

  • Treatment for heart failure begins with lifestyle changes and medications. In more advanced cases, surgery may be needed.

  • People can and do live with heart failure. Close self-monitoring and sticking to the doctor’s recommended diet, medication and exercise plans are essential to improving quality of life.

What causes heart failure?

Heart failure may result from any or all of the following:

A number of medications and supplements may worsen heart failure or interfere with heart failure medicines. Be sure to tell your physician about all medications and supplements, including over-the-counter remedies.

What are the symptoms of heart failure?

The following are the most common symptoms of heart failure. However, each individual may experience symptoms differently. Symptoms may include:

  • Shortness of breath during rest, exercise, or while lying flat

  • Weight gain

  • Visible swelling of the legs, ankles and sometimes the abdomen, due to a buildup of fluid

  • Fatigue and weakness

  • Nausea, abdominal pain, loss of appetite

  • Persistent cough that can cause blood-tinged sputum

The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been affected.

Symptoms of heart failure may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.

More Information About Heart Failure from Johns Hopkins Medicine

Diagnosed with heart failure? Three Questions to Ask Your Doctor

  1. Is my heart failure genetic? If heart failure is in your genes, it may be in your family. Family members should be screened for heart failure or for your particular heart failure gene.
  2. Which medications should I avoid? Certain common medications can make heart failure worse. Ask your doctor which medications may affect your type of heart failure.
  3. What caused my heart failure? Heart failure can have many causes, which are usually underlying conditions that need to be addressed separately. Treating those conditions may help you slow the progression of heart failure.

How is heart failure diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for heart failure may include some combination of the following:

  • Chest X-ray: A process that produces pictures of internal tissues, bones and organs

  • Echocardiogram (also called echo): An ultrasound of the heart

  • Electrocardiogram (ECG or EKG):Wires taped to various parts of your body to create a graph of your heart’s electrical rhythm

  • BNP testing: B-type natriuretic peptide (BNP) is a hormone released from the ventricles in response to increased wall tension (stress) that occurs with heart failure. BNP levels rise as wall stress increases. BNP levels are useful in the rapid evaluation of heart failure. In general, the higher the BNP levels, the worse the heart failure.

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Heart disease remains the number one killer nationwide. To help prevent heart disease or catch symptoms early, adults over 50 should have a full cardiovascular assessment. A coronary calcium scan can show just how at risk you are for a heart attack or other heart issues before other signs and symptoms occur. This is particularly useful for those with a family history of heart disease or other significant risk factors.

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How is heart failure treated?

The goal of heart failure treatment is to improve quality of life by addressing the underlying causes, reducing symptoms and managing health. Education plays a crucial role. Patients and their families who learn to recognize and respond to small changes, such as swelling or weight gain, can help slow the progression of heart failure.

Treatments include:

  • Treating underlying conditions

  • Controlling risk factors

    • Quitting smoking

    • Losing weight (if overweight) and increasing moderate exercise

    • Switching to a heart-healthy diet

    • Avoiding alcohol

    • Getting proper rest

    • Controlling blood sugar (if diabetic)

    • Controlling blood pressure — which also means controlling the amount of sodium (salt) in your diet

    • Limiting fluids

  • Medications

    • These medications have been shown to prolong life in heart failure patients:

      • Angiotensin converting enzyme (ACE) inhibitors: This medication decreases the pressure inside the blood vessels and reduces the resistance against which the heart pumps.

      • Angiotensin receptor blockers (ARB): This is an alternative medication for reducing the workload on the heart if ACE inhibitors are not tolerated.

      • Beta-blockers: These reduce the heart's tendency to beat faster and reduce its workload by blocking specific receptors on heart cells.

      • Aldosterone blockers: This medication blocks the effects of the hormone aldosterone, which causes sodium and water retention.

    • These medications have been shown to reduce symptoms:

      • Diuretics: These reduce the amount of fluid in the body.

      • Vasodilators: These dilate the blood vessels and reduce workload on the heart.

      • Digitalis: This medication helps the heart beat stronger with a more regular rhythm.

      • Antiarrhythmia medications: These help maintain normal heart rhythm and help prevent sudden cardiac death. However, some antiarrhythmics may actually cause heart failure.

  • Implanted devices that help the heart function more effectively

    • Biventricular pacing/cardiac resynchronization therapy: A new type of pacemaker that paces both sides of the left ventricle simultaneously to coordinate contractions and to improve the heart's function. Some heart failure patients are candidates for this therapy.

    • Implantable cardioverter defibrillator (ICD): A device similar to a pacemaker that senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm.

    • Ventricular assist device (VAD): A mechanical device that takes over the pumping function for one or both of the heart's ventricles, or pumping chambers. A VAD may be necessary when heart failure progresses to the point that medications and other treatments are no longer effective.

  • Left ventricular restoration: For certain patients, surgical reshaping of an abnormally oversized left ventricle — the chamber of the heart that often malfunctions in heart failure — can help the heart beat much more effectively. Learn more about left ventricular restoration being performed at Johns Hopkins.

  • Heart transplantation: Replacing the heart with a donor organ is a last resort for patients who do not improve despite all other treatments.

Reviewed by Dr. Edward Kasper from the Division of Cardiology.

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