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:
Coronary artery disease is the most common form of heart disease. Over time, arteries that supply blood to your heart muscle can become narrowed from a buildup of fatty deposits (atherosclerosis). Blood moves more slowly through narrowed arteries. As a result, some areas of your heart muscle may be chronically deprived of oxygen-rich blood. These areas may become weak from the lack of oxygen and pump less vigorously. Sometimes this results in a heart attack with the death of the heart muscle, but in many cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well.
Blood pressure is the force of blood pumped by your heart through your blood vessels. When blood pressure is elevated, the heart has to strain more than normal to pump the blood around your body. Over time, the heart muscle may enlarge and become thicker to compensate for the extra work it must perform. Eventually, your heart muscle may either become too stiff or too weak to effectively pump blood forward.
Heart failure can be a complication of a heart attack. A heart attack occurs when a blood clot forms in a narrowed coronary artery, blocking blood flow to a portion of your heart muscle and damaging it. The damaged portion of your heart can no longer pump as well as it should. The rest of your heart tries to make up for the loss, but may be unable to or may become weakened by the extra workload.
The four valves of your heart keep blood flowing in the proper direction through the heart. A malfunctioning valve puts an extra load on your heart so it has to work harder to ensure proper blood circulation. Over time this extra work can weaken your heart.
This is damage to the heart muscle. Some of the many causes of cardiomyopathy include infections, alcohol abuse, and the toxic effect of drugs such as cocaine and some drugs used for chemotherapy. In addition, systemic diseases such as lupus that may affect the body as a whole also can damage the heart muscle. In many cases, a specific cause can’t be determined. This condition is termed idiopathic dilated cardiomyopathy. In some cases, cardiomyopathy may be inherited.
If your heart and its chambers don’t form correctly, the healthy parts of your heart have to work harder to compensate. Genetic defects contribute to the risk of certain types of heart disease, which in turn may lead to heart failure.
An irregular heartbeat can cause your heart to speed up. This creates extra work for your heart. Over time, this extra work can weaken your heart muscle, producing heart failure. A heartbeat that’s too slow also may prevent your heart from adequately circulating blood and lead to heart failure.
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:
X-rays are a valuable tool that can give your doctor an insight into your lung and heart health. In heart failure, your heart may appear enlarged and fluid accumulation may be visible in your lungs. The doctor might use an X-ray to identify other potential causes for your symptoms, in addition to heart failure.
This test records the electrical activity of your heart through electrodes attached to your skin. Electrical signals that arise in the brain are recorded as waves and displayed on a monitor or printed out on paper. This test is useful for diagnosing anomalies in the heart’s rhythm and any damage that may have been caused due to a heart attack, which can ultimately lead to congestive heart failure.
An echocardiogram uses sound waves to produce a video image of your heart. This image can help doctors determine the capacity at which your heart is pumping. The percentage of blood pumped out of your heart’s main pumping chamber (the left ventricle) with each heartbeat is referred to as the ejection fraction. This percentage can be measured by an echocardiogram or other imaging techniques. In a healthy heart, the ejection fraction is about 60 percent. In someone with systolic heart failure, it’s usually 40 percent or less. An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure, in which the pumping function is normal but the heart is stiff.
In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at your groin or arm and guided through your main artery, the aorta, into your coronary arteries. During the procedure, a special dye is injected through a catheter and this enables the X-ray to highlight and reveal the arteries supplying your heart. This test helps doctors identify narrowed arteries in your heart (coronary artery disease) that can be a cause of heart failure. The test also helps doctors determine the strength of the left ventricle the heart’s main pumping chamber and the health of the heart valves.
Tests such as radionuclide ventriculography (RNV) or multiple gated acquisitions (MUGA) scanning allow your doctor to see how much blood your heart pumps with each beat. The tests are done using a small amount of dye injected into your veins. A specialized camera can detect any radioactive material that passes through your heart, allowing for accurate diagnosis and monitoring.
Your doctor may take a sample of your blood to check for indicators of other diseases that affect the heart. In addition, your doctor may order a blood test that specifically checks for heart failure. The test checks for levels of a hormone called brain natriuretic peptide (BNP). Your heart secretes BNP at high levels when it’s overworked. A large amount of BNP in your blood may indicate heart failure.
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.
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:
These drugs the mainstay treatment for congestive heart failure help people with congestive heart failure live longer and feel better. Examples include enalapril (
Vasotec), lisinopril (
Prinivil,
Zestril), and captopril (
Capoten). ACE inhibitors lower blood pressure and decrease your heart’s workload. They also blunt some of the effects of hormones that promote salt and water retention. Because ACE inhibitors lower blood pressure, you could feel weak or dizzy shortly after taking them. Your doctor may recommend that you take them just before bedtime so that you’ll be lying down soon after taking the drug. ACE inhibitors also cause an irritating cough in some people. Sometimes it may be best to put up with the cough, if you can, to gain the medication’s benefits. It is essential to consult with a doctor before making any decisions regarding this. Switching to another ACE inhibitor may relieve the problem.
Losartan (
Cozaar) and Valsartan (
Diovan), have similar beneficial effects to ACE inhibitors, yet do not cause a long-term cough. They may be an alternative for people who can’t tolerate ACE inhibitors.
Diuretics, commonly known as water pills, work by increasing the frequency of urination and help to reduce the amount of fluid that gets accumulated in the body. Commonly prescribed diuretics for congestive heart failure include bumetanide (
Bumex) and furosemide (
Lasix, Fumide). The medications can help to reduce excess fluid in the lungs, thus enabling easier breathing. Because diuretics make your body lose potassium and magnesium, your doctor may prescribe supplements of these minerals. If you’re taking a diuretic, your doctor will likely monitor levels of potassium and magnesium in your blood through regular blood tests.
This potassium-sparing diuretic may improve survival for people with severe congestive heart failure. Unlike some other diuretics, spironolactone can raise potassium levels in your blood. Therefore, if you’re taking this drug, your doctor will want to check the potassium level in your blood periodically. Occasionally, spironolactone can also cause breast swelling and tenderness.
Often known as digitalis, this drug has the capability to strengthen the contractions of your heart muscles. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves your ability to live with the condition.
This type of medication slows heartbeat rate and decreases the pressure of blood in the circulatory system. These medicines can help reduce the chances of developing heart arrhythmia, making them a sensible choice for preventive care. Beta-blockers may reduce signs and symptoms of congestive heart failure and improve heart function.
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.
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