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 does not mean the heart stops. Rather, it means the heart fails to pump as well as it should. Heart failure generally results from some other underlying condition.

What You Need to Know

  • Cardiomyopathy, a name for any disease of the heart muscle, is one condition that often leads to heart failure.
  • Symptoms of heart failure include shortness of breath, swelling in the legs and feet, and abdominal pain or nausea.
  • Diagnosis includes 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 you are taking, including over-the-counter remedies.

What are the symptoms of heart failure?

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

  • shortness of breath during rest or 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

Broadly speaking, some people will develop symptoms because they can’t get blood to the body (fatigue and weakness, shortness of breath with activity), and some will develop symptoms because blood and fluid become congested prior to reaching the heart (shortness of breath lying down, weight gain, persistent cough, abdominal congestion, nausea, abdominal pain, poor appetite, leg swelling). Some may have symptoms from both groups. And yet some may not have any symptoms at all.

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 those of other conditions or medical problems. Always consult your health care provider for a diagnosis.

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.

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 overall 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 (ARBs): This is an alternative medication for reducing the workload on the heart if ACE inhibitors are not tolerated. An ACE inhibitor or ARB blocker will often be recommended, but not both.

      • 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.

      • angiotensin receptor- neprilysin inhibitors (ARNIs) : This is a relatively new class of medication that for some people has been shown to be a better alternative than ACE inhibitors or ARB blockers.

    • 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.

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

      • anti-arrhythmia medications: These help maintain normal heart rhythm and help prevent sudden cardiac death. However, some anti-arrhythmics may actually cause heart failure.

  • Implanted devices that help the heart function more effectively

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

    • implantable cardioverter defibrillator (ICD) : A device similar to a pacemaker, it 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) : This mechanical device 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.

    • heart transplantation : For select patients, replacing the heart with a donated heart is a last resort for those who do not improve despite all other treatments.

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