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Heart Failure

What is heart failure?

If you have heart failure, your heart doesn’t pump as strongly as it should. The word “failure” may be frightening, but it doesn’t mean that your heart has stopped working or is about to break down. With treatment and careful attention, many people can manage their condition and still be active and energetic.

Heart failure is common, and the number of patients continues to grow. According to the American Heart Association, an estimated 5.7 million Americans — mostly seniors — have the condition. Another 670,000 cases are diagnosed every year. Heart failure is more common among ethnic groups that are especially susceptible to heart disease, including people of African ancestry.

Most people with heart failure have weakness on the left side of their heart, which is the side that pumps oxygen-rich blood to the body. As the left side loses strength, blood and other fluids can back up into the lungs. If the failure occurs on the right side of the heart, the side that pumps blood to the lungs, fluids build up in the veins, especially in the legs and feet. Some people have weakness on both sides of their heart, which means fluids build up in both their lungs and veins.

What causes heart failure?

Anything that weakens the heart’s ability to fill with blood or pump blood can lead to heart failure. The three most common causes are diseased arteries in the heart (coronary artery disease, or CAD), high blood pressure, and dilated cardiomyopathy (diseased or enlarged heart muscle). Nearly any form of heart disease can lead to heart failure. Other causes include the following:

  • Heart attack
  • Abnormal heartbeats (arrhythmias, such as atrial fibrillation)
  • Diseased heart valves
  • Heart problems from birth
  • Diabetes
  • Treatments for cancer, thyroid disorders, alcohol abuse, HIV/AIDs, and using cocaine and other street drugs can also cause problems leading to heart failure.

What are the symptoms of heart failure?

If your heart is only slightly weaker than it should be, you may not notice any symptoms at all. Some people can go for years without even suspecting that they have a problem. But if the heart loses enough strength, heart failure becomes impossible to ignore. The main symptoms of heart failure are shortness of breath, fatigue, and fluid retention (although you may not have all of these, depending on the cause). Even a short trip up the stairs can leave you gasping. You may also have a cough that gets worse at night. And at bedtime, you may notice that it’s hard to breathe when you lie down flat.

The buildup of fluids can cause swelling in your legs, feet, and ankles. You may also notice that you need to urinate more often than usual, especially at night.

Common symptoms of heart failure then include:

  • Long-lasting fatigue
  • Shortness of breath
  • Fluid buildup in the feet, ankles, and legs
  • Increased urination, especially at night
  • Chest pain
  • Rapid weight gain in one or two days
  • A dry, hacking cough that doesn’t go away

Other symptoms may include nausea, upset stomach or lack of appetite, swollen neck veins, a fast or irregular pulse, confusion and loss of attention or memory, trouble sleeping, dizziness, and cold or clammy skin.

How is heart failure diagnosed?

If you have symptoms of heart failure, your doctor will want to listen to your heart for signs of trouble. A quick listen with a stethoscope can show whether your lungs are filled with fluid. Tests of your blood and urine can also show signs of fluid imbalances. To be really confident, your doctor may order an echocardiogram to determine if you have an enlarged heart and look at how it’s pumping. A chest x-ray may be useful to see whether you have fluid buildup in your lungs, or you may need to have an electrocardiogram (EKG) to track your heartbeats. In certain cases, your doctor may also conduct a radionuclide ventriculography, a test that uses a harmless radioactive substance to track the flow of blood through your body. Your doctor might also ask you to take a stress test to see how your heart handles the stress of exercise.

What can a doctor do to treat heart failure?

Heart failure varies from mild to severe. People with mild heart failure may not require very aggressive therapy — just medicines like ACE inhibitors or ARBs (angiotensin receptor blockers) and beta blockers, as well as a “prescription” for a healthy lifestyle. As your disease progresses, your doctor may also prescribe diuretics and, rarely, digoxin (Lanoxin ), which will help keep your symptoms under control.

Diuretics — drugs that help flush fluids out of your body — are almost always prescribed to decrease the buildup of fluid in the body and to reduce blood pressure. Other types of blood pressure drugs can also give you a double dose of benefits. ACE inhibitors, the cornerstone of heart failure drug therapy, open up your blood vessels, which means your heart won’t have to work so hard to deliver blood. Angiotensin II receptor blockers prevent the chemical angiotensin II from having any effect on the heart and blood vessels. Beta blockers, another type of medicine, work to slow down your heart and can give you increased strength and stamina. If your condition is severe, beta blockers can even help prolong life. Other drugs that your doctor might consider prescribing include digitalis to strengthen your heart, or nitroglycerin to relax your vessels. Sometimes aldesterone antagonists, like spironolactone, are used in more advanced cases of the disease. Other commonly prescribed medications include blood thinners, calcium channel blockers and potassium.

If your heart is damaged, surgery may be necessary to relieve your heart failure. Depending on your situation, that could mean something as simple as a pacemaker or as dramatic as a heart transplant. A pacemaker is an electronic, battery-powered device implanted under the skin. If your heart drops below a certain rate set by your doctor, it sends a series of impulses to “kickstart” your heart back into a more normal rhythm.

A surgeon may be able to give your heart new strength by repairing or replacing a valve, or by replacing clogged vessels (coronary artery bypass surgery).

If you need a heart transplant, it means replacing a diseased or damaged heart with a healthy organ. You’ll most likely be placed on a donor list to receive a new heart. If you’re placed on a waiting list, your doctor may recommend surgery to implant a left-ventricle assist device (LVAD). Called a “bridge to transplantation,” it is often recommended for those hospitalized because of end-stage heart failure who have to wait for a new heart.

Your doctor will also want to treat any problems that might be further weakening your heart. For example, if you have high blood pressure, bringing your numbers down will be a top priority.

What can I do about heart failure?

Your doctor will do his part to manage your condition, but the most important work is up to you. The steps you take at home can be more effective than any pill.

You’ll have to be careful about what you eat and drink. You’ll want to avoid highly salty foods (including canned soups or many frozen dinners) that can make your body retain water. You should be especially serious about cutting back on salt if you notice swelling in your feet, ankles, or belly.

Your doctor may also suggest you cut back on liquids. You may have to limit yourself to a little more than 8 cups of liquid (about 66 ounces) each day. Even if your doctor doesn’t set a limit, you’ll want to go easy on liquids if you notice any sudden swelling.

A healthy lifestyle can help protect your heart. If you smoke, it’s time to quit. If you are overweight, consider shedding a few pounds. Depending on your condition and your medications, your doctor might recommend that you avoid alcohol completely or limit yourself to just one drink a day.

Also, regular exercise can strengthen your heart. For people with heart failure, the American Heart Association suggests gradually working up to 30 minutes of exercise a day, or whatever your doctor recommends. At the same time, you’ll have to be careful not to overdo it. Your doctor can help you find an exercise routine that’s right for you.

Finally, you’ll have to pay close attention to your body. Weigh yourself every morning before breakfast, but after a trip to the bathroom. Call your doctor if you gain more than three pounds in a day or five pounds in a week (without overeating). You should also call your doctor if you have any sudden swelling or breathlessness.

References

American Heart Association. Heart failure. http://www.americanheart.org/presenter.jhtml?identifier=1486

Texas Heart Institute. Congestive Heart Failure. July 2006. http://www.texasheartinstitute.org/HIC/Topics/Cond/CHF.cfm

American Heart Association. In heart failure, beta-blockers boost survival advantage for women. http://www.americanheart.org/presenter.jhtml?identifier=3001182

Cleveland Clinic. Monitoring your weight and fluid intake. http://www.clevelandclinic.org/health/health-info/docs/1800/1831.asp

Cleveland Clinic. Heart failure treatment. http://www.clevelandclinic.org/heartcenter/pub/guide/disease/heartfailure/hftreatement.htm

Cleveland Clinic. Cardiac resynchronization therapy. http://www.clevelandclinic.org/heartcenter/pub/guide/tests/procedures/biventricular_pm.htm

Cleveland Clinic. Surgical procedures to treat heart failure. http://www.clevelandclinic.org/heartcenter/pub/guide/disease/heartfailure/hf_surgery.htm

American Academy of Family Physicians. Heart failure: How to stay well and out of the hospital. September 2005. http://familydoctor.org/x2234.xml

National Heart Lung and Blood Institute. What is heart failure? http://www.nhlbi.nih.gov/health/dci/Diseases/Hf/HF_WhatIs.html

American Heart Association, Heart failure, Lifestyle and Exercise

Ghali, Jalal, K., Pina, Stephen S. et al, Metroprolol CR/XL in Female Patients with Heart Failure: Analysis of the Experience in Metoprolol Extended- Release Randomized Intervention Trial in Heart Failure (MERIT-HF), 2002:105; 1585-91.

American Heart Association. Medications commonly used to treat heart failure.

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