Heart Failure

Heart failure occurs when your heart has weakened or become too stiff to pump enough blood to meet your body’s needs. Because your heart does not pump blood as well as it should when you have heart failure, fluid tends to build up in the lungs and other parts of the body. Heart failure usually develops slowly over time.

The most common symptoms of heart failure include:

• Shortness of breath, including when lying down
• Swelling of the feet and legs
• Fatigue

Other symptoms may include:

• Weight gain from fluid buildup
• Swollen abdomen, nausea, and loss of appetite
• Confusion or inability to think clearly
• Cough, usually dry or wheezing
• Inability to sleep unless propped up
• Frequent urination, especially at night
• Decreased exercise tolerance

To diagnose heart failure, your doctor will ask about your symptoms and medical history; examine your heart, lungs, abdomen, and legs; and conduct tests to help confirm diagnosis. Diagnostic tests may include:

• Chest X-ray
• Electrocardiogram (EKG or ECG)
• Echocardiogram
• Ejection fraction
• Stress test
• Coronary catheterization

Heart failure is often the result of another condition that has damaged your heart. Eventually, your heart just can’t keep up with your body’s demand for blood. Risk factors and conditions that may lead to heart failure include:

• Advancing age
• High blood pressure
• Coronary artery disease
• Heart attack
• Arrhythmia
• Diabetes
• Sleep apnea
• Congenital heart defects
• Excessive alcohol use
• Illicit drug use
• Obesity
• Chronic lung disease
• Certain types of chemotherapy
• Heart valve disease or damaged heart valves
• Thyroid disease
• Kidney disease
• Cardiomyopathy (damaged heart muscle)
• Myocarditis (inflammation of the heart muscle)
• Certain medications
• Certain viral infections

Heart failure is often classified as:

• Systolic, which occurs when the heart enlarges, loses the ability to contract properly, and can’t pump enough blood to the body. This is the more common type of heart failure.
• Diastolic, which occurs when the heart muscle is thick and stiff. As a result, the heart cannot relax and fill properly with blood.

Heart failure is usually a chronic condition that requires management for life, and can improve with proper management. Sometimes, this means treating an underlying condition that has caused heart failure.

If you are diagnosed with heart failure, you will likely need to make a number of changes to your lifestyle, including:

• Quitting smoking
• Limiting or avoiding alcohol
• Monitoring your weight, and losing weight if you are overweight
• Reducing stress and getting enough sleep
• Eating a low-salt, heart-healthy diet
• Drinking less than two liters of fluid daily
• Exercising with guidance from your doctor

Heart failure is typically treated with a number of medications, including:

• Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs)
• Beta-blockers
• Diuretics, to remove excess fluid and salt from the body.
• Digitalis, to help improve the heart’s pumping ability.

If you have heart failure, you may be helped by an implantable device. In some cases, such devices are used to address an underlying problem; other devices actually help the heart pump.

• An implantable cardioverter-defibrillator (ICD) detects life-threatening abnormal heart rhythms (arrhythmias) and corrects them by delivering a jolt of electricity.
• Cardiac Resynchronization Therapy (CRT) involves implanting a biventricular pacemaker to send timed electrical impulses to the heart’s lower chambers (the ventricles), helping them to pump in a synchronized manner.
• A Left Ventricular Assist Device (LVAD) is a mechanical pump, implanted in your chest or abdomen, that temporarily assists your heart’s pumping. The pump may take over the function of either or both ventricles of your heart. LVADs are used for patients awaiting heart transplants and have also become a long-term treatment option.

Three types of surgery can help improve symptoms of heart failure:

• Coronary artery bypass surgery (CABG), open-heart surgery, which bypasses the blocked artery
• Heart valve surgery, to repair defective or diseased heart valves
• Heart transplantation, for the most serious heart failure cases, when there are no other treatment options