Heart Failure

What Is a Heart Failure?

A diagnosis of heart failure sounds scary as if your heart could stop at any moment. But the underlying heart conditions that commonly cause heart failures, such as coronary artery disease or high blood pressure, typically develop slowly over many years. The development of heart failure usually means that your heart’s ability to pump blood has weakened, so it can’t circulate enough blood to meet your body’s needs. Shortness of breath, fatigue and leg swelling may result. When fluid builds up, heart failure is called congestive. Sometimes the heart becomes too stiff to fill properly, and that also can lead to heart failure.

Approximately 5 million US citizens are suffering from heart failure, with 400K to 700K new diagnoses occurring annually. Heart failure is a concerning issue and can be potentially fatal if not properly managed. Every year, approximately 250,000 people succumb to heart failure.

Although sometimes there’s no way to reverse damage to your heart, treatments can significantly improve signs and symptoms. You can also make lifestyle changes, such as exercising, reducing salt intake, and losing weight, to help your weakened heart work as efficiently as possible.

Your best defense against heart failure is to prevent or control risk factors that lead to coronary artery diseases, such as high blood pressure, high cholesterol levels, diabetes, smoking, alcohol abuse, inactivity, and obesity.

Signs and Symptoms of Heart Failure

Heart failure typically doesn’t occur suddenly. It develops slowly, over time. It’s usually a chronic, long-term condition. The first and often only symptom may be shortness of breath. Signs and symptoms of heart failure can include:

• Fatigue and weakness
• If you’re feeling out of breath while exercising or when lying down, you may be experiencing (dyspnea).
• Long-term wheezing or coughing accompanied by mucus stained with either pink or white blood.
• Pronounced neck veins
• Swelling (edema) in your legs, ankles, and feet
• Swelling of your abdomen (ascites)
• Rapid weight gain from fluid retention
• Lack of appetite and nausea
• Difficulty concentrating or decreased alertness
• Irregular or rapid heartbeat

Causes of Heart Failure

Your circulatory system includes arteries and veins. Arteries deliver oxygen-rich blood to the organs and tissues of your body. Veins bring oxygen-poor blood back to your heart to be cycled through your heart and lungs and back out to the rest of your body, via your arteries.
Your heart, the center of your circulatory system, consists of four chambers. Throughout your life, your heart beats approximately once a second. In a single day, your heart beats about 100,000 times. Your heart’s two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood.

Blood returning to your heart enters the right upper chamber (right atrium) of your heart. From there, blood empties into the right ventricle underneath. The right ventricle pumps blood into your lungs, where blood is oxygenated. Oxygenated blood from your lungs then returns to your heart, but this time to the left side of the left upper chamber (left atrium). Blood then flows into the left ventricle underneath your heart’s main pumping chamber. With each heartbeat, your left ventricle pumps blood into your body’s largest artery (aorta) and onward to the rest of your body.

Heart failure can involve the left side, right side, or both sides of your heart. Generally, heart failure starts in the left ventricle which is the most important pumping chamber of the heart. Your doctor may refer to your condition as left-sided or left-ventricular heart failure. He or she may define it further as systolic heart failure (when the left ventricle loses its ability to contract vigorously) or diastolic heart failure (when the left ventricle loses its ability to relax or fill fully) or a combination of both. The distinction is important because the drug treatments for each type may be different. Right-sided heart failure can occur independently or be a consequence of left-ventricular heart failure.

Heart failure often occurs because other cardiac conditions have damaged or weakened your heart, forcing it to work harder. An impaired heart leads to reduced blood circulation throughout the body. This causes blood to pool in your legs, feet, and ankles, your kidneys to retain excess water and sodium, and fluid to back up into your lungs, leading to shortness of breath. This build-up of fluid is called congestive heart failure.

Heart failure often results from the stress of a heart attack, high blood pressure, or other forms of heart disease such as valve disorders. All of the behaviors that you probably associate with a heart attack or heart disease such as smoking, being overweight, eating foods high in cholesterol and fat, and not exercising also cause or contribute to heart failure. Sometimes, your heart becomes weakened without explanation, a medical condition known as idiopathic dilated cardiomyopathy.

If you have heart failure, chances are you’ve had one or more of the following conditions, which can damage or weaken your heart. Some of these may be present without any noticeable symptoms:

Other diseases such as diabetes, severe anemia, hyperthyroidism, kidney or liver failure, and emphysema also may precipitate heart failure.

Screening and Diagnosing Heart Failure

In many cases, doctors diagnose heart failure by taking a careful medical history and performing a physical examination. Your doctor will also check for the presence of risk factors such as high blood pressure. Using a stethoscope, your doctor can listen to you breathe and identify the sounds of lung congestion. The stethoscope also picks up abnormal heart sounds that may indicate heart failure.

In addition to a physical exam, your doctor may recommend any of a variety of tests to diagnose heart failure. Your doctor may refer you to a cardiologist a doctor who specializes in the study of the heart and its function for tests such as:

The results of these tests help doctors determine the cause of your signs and symptoms and develop a program to treat your heart. To determine the best course of treatment, doctors classify heart failure using a scale of one to four. Class, I heart failure is the mildest. You can perform everyday activities and not feel winded or fatigued. Class IV is the most severe, in which you’re short of breath even at rest.

Treating Heart Failure

In some cases, doctors can remedy heart failure by tackling the root cause of the problem. For example, controlling a fast heart rhythm may reverse heart failure. But in most cases, once you have heart failure, it’s there to stay. With proper treatment, it is possible to strengthen a failing heart and improve any signs/symptoms of heart failure.

Medications

Doctors usually treat heart failure with medications. Multiple medications have been proven to be beneficial when it comes to the treatment of heart failure. They include:

You’ll probably need two or more medications to treat heart failure. Your doctor may prescribe other heart medications such as nitrates for chest pain, calcium channel blockers to lower blood pressure and improve circulation, or blood-thinning medications to help prevent blood clots along with heart failure medications.

For people with severe congestive heart failure, there’s an intravenous drug called Nesiritide (Natrecor). Nesiritide is a synthetic version of a naturally occurring hormone in the body called brain natriuretic peptide. BNP is secreted at high levels by the heart when it’s overloaded with pressure and its volume is expanded. BNP causes the body to excrete excess fluid, helping to combat the effects of congestive heart failure.

Sometimes symptoms of heart failure become severe enough for you to be hospitalized and monitored for a few days. While in the hospital, you may receive medications that work quickly to help your heart pump better and relieve your symptoms. You may also receive supplemental oxygen through a mask or small tubes placed in your nose. If you have severe heart failure, you may need to use supplemental oxygen long-term.

A study published in November 2004 in The New England Journal of Medicine showed that adding a combination of hydralazine and isosorbide dinitrate (BiDil) to the standard therapy for African Americans with advanced heart failure increased overall survival rates.

How to Prevent Heart Failure

The key to reducing the risk of heart failure is to prevent heart disease from occurring in the first place. You can control or eliminate many of the risk factors for heart disease high blood pressure and coronary artery disease, for example by making lifestyle changes along with the help of any needed medications.