Heart Failure

What is Heart Failure

Heart failure is a condition in which the heart has trouble pumping blood because it has become weak or stiff. This means that the heart does not pump blood efficiently for the body to work well.

For some people with heart failure, fluid may back up into the lungs and there may be swelling (edema) in the lower legs. Heart failure is usually a long-term (chronic) condition. It is important for you to take good care of yourself and follow the treatment plan from your health care provider.

5 Interesting Facts of Heart Failure

1. Clinical syndrome characterized by structural or functional impairment of ventricular filling or ejection of blood, resulting in insufficient perfusion to meet metabolic demand
2. Severe mitral regurgitation causes symptomatic heart failure; however, heart failure may be caused by other conditions such as hypertension, coronary artery disease, and cardiomyopathy
3. Similar manifestations include edema, dyspnea, and fatigue
4. Diagnosis is based on history, physical examination, natriuretic peptide levels, chest radiography, and echocardiographic findings
5. Additional investigations (eg, coronary angiography) may be necessary to determine underlying cause

What are the causes?

Heart Failure is caused by some health problems, including:

• High blood pressure (hypertension). Hypertension causes the heart muscle to work harder than normal. High blood pressure eventually causes the heart to become stiff and weak.
• Coronary artery disease (CAD). CAD is the buildup of cholesterol and fat (plaques) in the arteries of the heart.
• Heart attack (myocardial infarction). Injured tissue, which is caused by the heart attack, does not contract as well and the heart’s ability to pump blood is weakened.
• Abnormal heart valves. When the heart valves do not open and close properly, the heart muscle must pump harder to keep the blood flowing.
• Heart muscle disease (cardiomyopathy or myocarditis). Heart muscle disease is damage to the heart muscle from a variety of causes, such as drug or alcohol abuse, infections, or unknown causes. These can increase the risk of heart failure.
• Lung disease. When the lungs do not work properly, the heart must work harder.

What increases the risk?

Risk of heart failure increases as a person ages. This condition is also more likely to develop in people who:

• Are overweight.
• Are male.
• Smoke or chew tobacco.
• Abuse alcohol or illegal drugs.
• Have taken medicines that can damage the heart, such as chemotherapy drugs.
• Have diabetes.
  • High blood sugar (glucose) is associated with high fat (lipid) levels in the blood.
  • Diabetes can also damage tiny blood vessels that carry nutrients to the heart muscle.
• Have abnormal heart rhythms.
• Have thyroid problems.
• Have low blood counts (anemia).

What are the symptoms?

Symptoms of Heart Failure include:

• Shortness of breath with activity, such as when climbing stairs.
• Persistent cough.
• Swelling of the feet, ankles, legs, or abdomen.
• Unexplained weight gain.
• Difficulty breathing when lying flat (orthopnea).
• Waking from sleep because of the need to sit up and get more air.
• Rapid heartbeat.
• Fatigue and loss of energy.
• Feeling light-headed, dizzy, or close to fainting.
• Loss of appetite.
• Nausea.
• Increased urination during the night (nocturia).
• Confusion.

How is this diagnosed?

This condition is diagnosed based on:

• Medical history, symptoms, and a physical exam.
• Diagnostic tests, which may include:
  • Echocardiogram.
  • Electrocardiogram (ECG).
  • Chest X-ray.
  • Blood tests.
  • Exercise stress test.
  • Radionuclide scans.
  • Cardiac catheterization and angiogram.

How is this treated?

Treatment for this condition is aimed at managing the symptoms of heart failure. Medicines, behavioral changes, or other treatments may be necessary to treat heart failure.

Medicines

These may include:

• Angiotensin-converting enzyme (ACE) inhibitors. This type of medicine blocks the effects of a blood protein called angiotensin-converting enzyme. ACE inhibitors relax (dilate) the blood vessels and help to lower blood pressure.
• Angiotensin receptor blockers (ARBs). This type of medicine blocks the actions of a blood protein called angiotensin. ARBs dilate the blood vessels and help to lower blood pressure.
• Water pills (diuretics). Diuretics cause the kidneys to remove salt and water from the blood. The extra fluid is removed through urination, leaving a lower volume of blood that the heart has to pump.
• Beta blockers. These improve heart muscle strength and they prevent the heart from beating too quickly.
• Digoxin. This increases the force of the heartbeat.

Healthy behavior changes

These may include:

• Reaching and maintaining a healthy weight.
• Stopping smoking or chewing tobacco.
• Eating heart-healthy foods.
• Limiting or avoiding alcohol.
• Stopping use of street drugs (illegal drugs).
• Physical activity.

Other treatments

These may include:

• Surgery to open blocked coronary arteries or repair damaged heart valves.
• Placement of a biventricular pacemaker to improve heart muscle function (cardiac resynchronization therapy). This device paces both the right ventricle and left ventricle.
• Placement of a device to treat serious abnormal heart rhythms (implantable cardioverter defibrillator, or ICD).
• Placement of a device to improve the pumping ability of the heart (left ventricular assist device, or LVAD).
• Heart transplant. This can cure heart failure, and it is considered for certain patients who do not improve with other therapies.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider. Medicines are important in reducing the workload of your heart, slowing the progression of heart failure, and improving your symptoms.
  • Do not stop taking your medicine unless your health care provider told you to do that.
  • Do not skip any dose of medicine.
  • Refill your prescriptions before you run out of medicine. You need your medicines every day.

Eating and drinking

• Eat heart-healthy foods. Talk with a dietitian to make an eating plan that is right for you.
  • Choose foods that contain no trans fat and are low in saturated fat and cholesterol. Healthy choices include fresh or frozen fruits and vegetables, fish, lean meats, legumes, fat-free or low-fat dairy products, and whole-grain or high-fiber foods.
  • Limit salt (sodium) if directed by your health care provider. Sodium restriction may reduce symptoms of heart failure. Ask a dietitian to recommend heart-healthy seasonings.
  • Use healthy cooking methods instead of frying. Healthy methods include roasting, grilling, broiling, baking, poaching, steaming, and stir-frying.
• Limit your fluid intake if directed by your health care provider. Fluid restriction may reduce symptoms of heart failure.

Lifestyle

• Stop smoking or using chewing tobacco. Nicotine and tobacco can damage your heart and your blood vessels. Do not use nicotine gum or patches before talking to your health care provider.
• Limit alcohol intake to no more than 1 drink per day for non-pregnant women and 2 drinks per day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
  • Drinking more than that is harmful to your heart. Tell your health care provider if you drink alcohol several times a week.
  • Talk with your health care provider about whether any level of alcohol use is safe for you.
  • If your heart has already been damaged by alcohol or you have severe heart failure, drinking alcohol should be stopped completely.
• Stop use of illegal drugs.
• Lose weight if directed by your health care provider. Weight loss may reduce symptoms of heart failure.
• Do moderate physical activity if directed by your health care provider. People who are elderly and people with severe heart failure should consult with a health care provider for physical activity recommendations.

Monitor important information

• Weigh yourself every day. Keeping track of your weight daily helps you to notice excess fluid sooner.
  • Weigh yourself every morning after you urinate and before you eat breakfast.
  • Wear the same amount of clothing each time you weigh yourself.
  • Record your daily weight. Provide your health care provider with your weight record.
• Monitor and record your blood pressure as told by your health care provider.
• Check your pulse as told by your health care provider.

Dealing with extreme temperatures

• If the weather is extremely hot:
  • Avoid vigorous physical activity.
  • Use air conditioning or fans or seek a cooler location.
  • Avoid caffeine and alcohol.
  • Wear loose-fitting, lightweight, and light-colored clothing.
• If the weather is extremely cold:
  • Avoid vigorous physical activity.
  • Layer your clothes.
  • Wear mittens or gloves, a hat, and a scarf when you go outside.
  • Avoid alcohol.

General instructions

• Manage other health conditions such as hypertension, diabetes, thyroid disease, or abnormal heart rhythms as told by your health care provider.
• Learn to manage stress. If you need help to do this, ask your health care provider.
• Plan rest periods when fatigued.
• Get ongoing education and support as needed.
• Participate in or seek rehabilitation as needed to maintain or improve independence and quality of life.
• Stay up to date with immunizations. Keeping current on pneumococcal and influenza immunizations is especially important to prevent respiratory infections.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a rapid weight gain.
• You have increasing shortness of breath that is unusual for you.
• You are unable to participate in your usual physical activities.
• You tire easily.
• You cough more than normal, especially with physical activity.
• You have any swelling or more swelling in areas such as your hands, feet, ankles, or abdomen.
• You are unable to sleep because it is hard to breathe.
• You feel like your heart is beating quickly (palpitations).
• You become dizzy or light-headed when you stand up.

Get help right away if:

• You have difficulty breathing.
• You notice or your family notices a change in your awareness, such as having trouble staying awake or having difficulty with concentration.
• You have pain or discomfort in your chest.
• You have an episode of fainting (syncope).