Heart Failure

The words “heart failure” sound alarming, but they do not mean that your heart has suddenly stopped working. Instead, heart failure means that your heart is not pumping as well as it should to deliver oxygen-rich blood to your body’s cells.

Heart failure usually develops slowly. You may go for years without symptoms, and then symptoms may begin to occur and get worse with time. This slow onset and progression of heart failure is caused by your heart’s own efforts to deal with its gradual weakening. Your heart tries to make up for this weakening by enlarging and by forcing itself to pump faster to move more blood through your body.

Who is at risk for developing heart failure, and what are its causes?

According to the American Heart Association, people 40 and older have a 1 in 5 chance of developing heart failure in their lifetime. More than 6 million people in the United States—mostly older adults—already have heart failure, and the number of people with heart failure keeps rising. About 870,000 people develop heart failure each year. This is because people are living longer and surviving heart attacks and other medical conditions that put them at risk for heart failure. People who have other types of heart and vessel disease are also at risk for heart failure.

Risk factors for heart failure include

• Previous heart attacks
• Coronary artery disease
• High blood pressure (hypertension)
• Irregular heartbeat (arrhythmia)
• Heart valve disease (especially of the aortic and mitral valves)
• Cardiomyopathy (disease of the heart muscle)
• Congenital heart defects (defects you are born with)
• Alcohol and drug abuse
• Hemochromatosis (a dangerous iron build-up in the body)

What are the symptoms?

Symptoms can help doctors find out which side of your heart is not working properly.

If the left side of your heart is not working properly (left-sided heart failure), blood and fluid back up into your lungs. You will feel short of breath, be very tired, and have a cough (especially at night). In some cases, patients may begin to cough up pinkish, blood-tinged sputum.

If the right side of your heart is not working properly (right-sided heart failure), the slowed blood flow causes a buildup of fluid in your veins. Your feet, legs, and ankles will begin to swell. This swelling is called edema. Sometimes edema spreads to the lungs, liver, and stomach. Because of the fluid buildup, you may need to go to the bathroom more often, especially at night. Fluid buildup is also hard on your kidneys. It affects their ability to dispose of salt (sodium) and water, which can lead to kidney failure. Once the heart failure is treated, the kidneys’ function usually improves.

Congestive heart failure (CHF) happens when the heart’s weak pumping action causes a buildup of fluid called congestion in your lungs and other body tissues. Sometimes, you may hear the terms “heart failure” and “CHF” used interchangeably, but CHF is actually a specific type of heart failure.

As heart failure progresses, your heart becomes weaker and symptoms begin. In addition to those listed above, here are some other symptoms of heart failure:

• You have trouble breathing or lying flat because you feel short of breath.
• You feel tired, weak, and are unable to exercise or perform physical activities.
• You have weight gain from excess fluid.
• You feel chest pain.
• You do not feel like eating, or you feel like you have indigestion.
• Your neck veins are swollen.
• Your skin is cold and sweaty.
• Your pulse is fast or irregular.
• You feel restless, confused, and find that your attention span and memory are not as good as they were.

How is heart failure diagnosed?

Most doctors can make a tentative diagnosis of heart failure from the presence of edema and shortness of breath.

• With a stethoscope, a doctor can listen to your chest for the crackling sounds of fluid in the lungs, the distinct sound of faulty valves (heart murmur), or the presence of a very quick heartbeat. By tapping on your chest, doctors can find out if fluid has built up in your chest.
• A chest x-ray can show if your heart is enlarged and if you have fluid in and around your lungs.
• Electrocardiography (ECG or EKG) can be used to check for an irregular heartbeat (arrhythmia) and stress on the heart. It can also show your doctor if you have had a heart attack.
• Echocardiography can be used to see valve function, heart wall motion, and overall heart size. One measurement that is usually taken at this time is your heart’s left ventricular ejection fraction, or LVEF. During the heartbeat’s two-part pumping action, the heart contracts and relaxes. When the heart contracts, it pumps (or ejects) blood out of the ventricles. When the heart relaxes, the ventricles fill up with blood. No matter how strongly your heart contracts, it never ejects all of the blood out of its ventricles. The LVEF refers to the percentage of blood that is pumped out of the left ventricle with each heartbeat. The LVEF for a healthy heart is between 55% and 70%. The LVEF may be lower if your heart has been damaged. Echocardiography is also used to see if there is decreased heart wall motion (called hypokinesia or hypokinesis).

Other imaging techniques, such as magnetic resonance imaging (MRI), nuclear ventriculography and angiography, can provide a firm diagnosis and show doctors how diseased your heart is.

How is heart failure treated?

Many therapies can help to ease the workload of your heart. Treatment may include lifestyle changes, medicines, percutaneous coronary interventions (also called transcatheter interventions), and surgery.

Lifestyle Changes

• If you smoke, quit.
• Learn to control high blood pressure, cholesterol levels, and diabetes.
• Eat a sensible diet that is low in calories, saturated fat, and salt.
• Limit how much alcohol you drink.
• Limit the amount of liquids you drink.
• Weigh yourself daily to watch for fluid buildup.
• Start an aerobic exercise program that has been approved by your doctor.
• Get tested for obstructive sleep apnea (OSA), if you think you may have it. For heart failure patients, OSA can make their condition worse because of the stress it places on the heart during sleep.

Medicines

Studies show that medicines also help improve your heart function and make it easier for you to exercise or do physical activity. The following medicines are often given to patients with heart failure:

• Diuretics, which help rid your body of extra fluid.
• Inotropics, such as digitalis, which strengthen your heart’s ability to pump.
• Vasodilators, such as nitroglycerin, which open up narrowed vessels.
• Calcium channel blockers, which keep vessels open and lower blood pressure.
• Beta-blockers, which have been shown to help increase your ability to exercise and improve your symptoms over time.
• ACE inhibitors, which keep vessels open and lower blood pressure.
• Angiotensin II receptor blockers, which keep vessels open and lower blood pressure.

Percutaneous Coronary Interventions

• Angioplasty is a procedure that is used to open arteries narrowed by fatty plaque buildup.
• Stenting is used along with balloon angioplasty. It involves placing a mesh-like metal device into an artery at a site narrowed by plaque. The stent keeps the vessel open and stops the artery from collapsing.
• Inotropic drug therapy can increase your heart’s ability to beat. This medicine is given through a small catheter placed directly in an artery.

Surgical Procedures

• Heart valve repair or replacement
• Pacemaker insertion
• Correction of congenital heart defects
• Coronary artery bypass surgery
• Mechanical assist devices
• Heart transplantation

The best way to prevent heart failure is to practice healthy lifestyle habits that reduce your chances of developing a heart problem. It is also important to find out if you have any risk factors that contribute to heart failure, such as high blood pressure or coronary artery disease. Many patients with heart failure can be successfully treated so they can continue to live full and productive lives.