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 failure, 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.
About five million Americans are living with heart failure, and between 400,000 and 700,000 new cases are diagnosed every year. Heart failure is serious and can be life-threatening. About 250,000 people die annually of 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 disease, such as high blood pressure, high cholesterol levels, diabetes, smoking, alcohol abuse, inactivity and obesity.
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:
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 to 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. Typically, heart failure begins with the left side specifically the left ventricle, your heart’s main pumping chamber. 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. A weakened heart can’t pump blood efficiently throughout your 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 buildup 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. In fact, all of the behaviors that you probably associate with 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 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 can be present without you even knowing it:
Other diseases such as diabetes, severe anemia, hyperthyroidism, kidney or liver failure, and emphysema also may precipitate 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 the 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:
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.
Doctors sometimes can correct heart failure by treating the underlying cause. 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. However, with treatment, a failing heart can become stronger and signs and symptoms of heart failure can improve.
Doctors usually treat heart failure with medications. Several types of drugs have proved useful in 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 in 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.
The best defense against heart failure is the prevention of heart disease. 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.
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