Heart Failure

Table of Contents

Heart failure is when your heart cannot pump enough blood to meet your body’s needs. Heart failure does not mean your heart has stopped or will stop working. It means that your heart is unable to pump blood the way it should. Heart failure can affect one or both sides of the heart.

When the pumping ability of the heart weakens, it can cause: 

  • Blood and fluids to return to the lungs
  • Fluid buildup in the feet, ankles and legs — this is called edema
  • Fatigue and shortness of breath

Common causes of heart failure are coronary artery disease, high blood pressure and diabetes. It is more common to occur in people over 65 years of age, people who are overweight, and people who have had a heart attack. Men have higher rates of heart failure than women.

Your doctor will diagnose heart failure by performing physical and heart tests. Treatment includes diagnosing the cause of your heart failure, prescribing medications, and performing a heart transplant if other treatments have failed.

Overview of Heart Failure

Heart failure develops over time as the heart’s pumping ability weakens. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart.

Right-sided heart failure occurs when the heart cannot pump enough blood to the lungs to take in oxygen. Left-sided heart failure occurs when the heart cannot pump enough oxygen-rich blood around the body. Right-sided heart failure can cause fluid to build up in the feet, ankles, legs, liver, stomach, and blood vessels in the neck. Right and left-sided heart failure can also cause shortness of breath and fatigue.

The primary causes of heart failure are diseases that damage the heart. Examples include coronary heart disease (CHD), high blood pressure, and diabetes.

Heart failure is a very common condition. Children and adults can experience the condition, although the symptoms and treatments differ.

Heart failure is incurable. However, treatment — such as medications and lifestyle changes — can help people with this condition live longer and live a more active life. Researchers continue to study new ways to treat heart failure and its complications.

Causes of Heart Failure

Conditions that damage or overwork the heart muscle can cause heart failure. Over time, the heart weakens. The heart cannot fill with and / or pump blood as well as it should. When the heart is weakened, certain proteins and substances may be released into the blood. These substances have toxic effects on the heart and bloodstream, and they could worsen heart failure.

Causes of heart failure include:

  • Coronary heart disease
  • Diabetes
  • High blood pressure
  • Other heart conditions or diseases
  • Other factors

Coronary Heart Disease

Coronary heart disease is a condition when a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.

Plaque constricts the arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow. Coronary heart disease can cause chest pain or discomfort called angina, heart attack, and heart damage.

Diabetes

Diabetes is a disease in which your body has a high blood sugar level. Normally, the body breaks down food into glucose and then carries it to cells throughout the body. Cells use a hormone called insulin to convert glucose into energy.

In diabetes, your body does not produce enough insulin or does not use its insulin properly. Over time, high blood sugar levels can damage and weaken the heart muscle and blood vessels around the heart, leading to heart failure.

High blood pressure

Blood pressure is the force of blood pushing against the artery walls. If this pressure rises and stays high over time, it can weaken your heart and cause plaque buildup.

Blood pressure is considered high if it stays at or above 140/90 mmHg over time. (MmHg is a millimeter of mercury — a unit used to measure blood pressure.) If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher.

Other Heart Conditions or Diseases

Other conditions and diseases can also cause heart failure, such as:

  • Arrhythmia. This condition occurs when there is a problem with the rate or rhythm of your heartbeat.
  • Cardiomyopathy. This condition occurs when the heart muscle becomes enlarged, thick, or stiff.
  • Congenital or congenital heart defects. This condition occurs when there are problems with the structure of the heart that arise at birth.
  • Heart valve disease. This condition occurs when one or more of the heart valves are not functioning properly, which may be present at birth or caused by infection, other heart conditions, and age.

Other Factors

Other factors can also injure the heart muscle and cause heart failure. Examples include:

  • Alcohol or cocaine abuse and other illegal drug use
  • HIV / AIDS
  • Thyroid disorders (having too much or too little thyroid hormone in the body)
  • Too much vitamin E.
  • Cancer treatments, such as radiation and chemotherapy
  • People who are overweight. Excess weight puts strain on the heart. Being overweight also increases the risk of heart disease and type 2 diabetes. These diseases can lead to heart failure.
  • People who have had a heart attack. Damage to the heart muscle from a heart attack can weaken the heart muscle.

Symptoms of Heart Disease

Risk Factors

Heart failure is more common to affect: 

  • People over 65 years of age. As you age, your heart muscle weakens. Older people may also have had other diseases for years that can cause heart failure. 
  • People who are overweight. Excess weight puts extra strain on your heart. Being overweight also increases the risk of heart disease and type 2 diabetes. These diseases can lead to heart failure.
  • People who have had a heart attack. Damage to the heart muscle from a heart attack can weaken the heart muscle.

Children who have congenital heart defects can also develop heart failure. This defect occurs when the heart, heart valves, or blood vessels near the heart are not formed properly while the baby is still in the womb. Congenital heart defects can make the heart work harder to pump blood. This weakens the heart muscle, which can lead to heart failure. Children do not have the same symptoms of heart failure or get the same treatment as adults. This article focuses on heart failure in adults.

Signs and Symptoms

The most common signs and symptoms of heart failure are:

  • Shortness of breath or difficulty breathing
  • Fatigue 
  • Swelling of the ankles, feet, legs, abdomen, and veins in the neck

All of these symptoms are a result of fluid buildup in your body. When symptoms start showing, you may feel tired and experience shortness of breath after doing routine physical activities, such as climbing stairs.

When the heart weakens, the symptoms get worse. You may start feeling tired and short of breath after getting dressed or walking across the room. Some people have shallow breaths when lying flat.

Fluid buildup from heart failure also causes weight gain, frequent urination, and a cough that gets worse at night and when you lie down. This cough may be a sign of acute pulmonary edema. This is a condition in which too much fluid builds up in your lungs. This condition requires emergency care.

Prevention of Heart Failure

There are several precautions that you can take to prevent heart failure. The sooner you get started, the better your chances are in preventing or delaying the condition.

For People with Healthy Hearts

If you have a healthy heart, you can take measures to prevent heart disease and heart failure. To reduce your risk of heart disease:

  • Avoid using illegal drugs.
  • Adopt heart-healthy lifestyle habits.

For People At High Risk Of Heart Failure

Even if you are at high risk for heart failure, you can take some preventive measures to reduce your risk. People at high risk include those with coronary heart disease, high blood pressure, or diabetes.

  • Follow all the steps listed above. Talk to your doctor about the right types of physical activity that are safe for you.
  • Treat and control all conditions that can cause heart failure. Take medication according to your doctor’s prescription.
  • Avoid drinking alcohol.
  • See your doctor for continuous care.

For People With Heart Damage but No Signs of Heart Failure 

If you have heart damage but no signs of heart failure, you can still reduce your risk of developing the condition. In addition to the steps above, take your medication as prescribed to reduce your heart’s workload.

Diagnosis of Heart Failure

Your doctor will diagnose heart failure based on your medical and family history, physical examination, and test results. The signs and symptoms of heart failure are also common in other conditions. Therefore, the doctor will:

  • Find out if you have a disease or condition that can cause heart failure, such as coronary heart disease (CHD), high blood pressure, or diabetes
  • Rule out other causes of your symptoms
  • Find any damage to your heart and check your heart’s pumping ability

Early diagnosis and treatment can help people with heart failure live longer, more active lives.

Personal and Family’s Medical History

Your doctor will also ask about your symptoms. He or she needs to identify what signs and symptoms you are experiencing and for how long you have been experiencing them. Your answers will help show whether and how much your symptoms limit your daily routine.

Your doctor will also want to know if anyone in your family has had or currently has a disease or condition that can cause heart failure.

Physical Tests

During the physical test, your doctor will:

  • Listen to your heart to hear any abnormal sounds
  • Listen to your lungs for the sound of extra fluid buildup
  • Look for swelling in your ankles, feet, legs, abdomen, and blood vessels in your neck

Diagnostic Tests

No single test can diagnose heart failure. If you have signs and symptoms of heart failure, your doctor may recommend one or more tests.

Your doctor may also refer you to a cardiologist. Cardiologists are specialist doctors who are able to diagnose and treat heart diseases and conditions.

ECG (Electrocardiogram)

An ECG is a simple, painless test that detects and records the electrical activity of the heart. This test shows how fast your heart is beating and its rhythm (steady or irregular). An ECG also records the strength and timing of electrical signals as they pass through your heart.

An ECG can show if the walls in your heart’s pumping chamber are thicker than normal. Thicker walls can make it more difficult for your heart to pump blood. The ECG can also show signs of a previous or current heart attack.

Chest X-ray

A chest x-ray takes pictures of structures inside your chest, such as your heart, lungs, and blood vessels. This test can show if your heart is enlarged, you have fluid in your lungs, or if you have lung disease.

BNP Blood Test

This test checks the level of a hormone in your blood called BNP. The level of this hormone increases during heart failure.

Echocardiography

Echocardiography (echo) uses sound waves to create a moving picture of your heart. This test shows the size and shape of your heart and how well your heart chambers and valves are working.

Echo can also identify areas of poor blood flow to the heart, areas of the heart muscle that are not contracting normally, and heart muscle damage caused by a lack of blood flow.

Echo may be performed before and after a stress test. The stress echo can show how well blood is flowing through your heart. This test can also show how well the heart is pumping blood whenever it beats.

Doppler ultrasound

Doppler ultrasound uses sound waves to measure the speed and direction of blood flow. This test is often done with echo to give a clearer picture of blood flow to the heart and lungs.

Doctors often use Doppler ultrasound to diagnose right-sided heart failure.

Holter Monitor

The Holter monitor records your heart’s electrical activity over a full 24 or 48 hour period while you go about your normal daily routine.

You will wear small patches called electrodes on your chest. The cable connects the patch to a small, portable recorder. The recorder can be clamped to your belt, stored in your pocket, or hung around your neck.

Nuclear Heart Scan

A nuclear heart scan shows how well blood is flowing through your heart and how much blood is reaching your heart muscle.

During a nuclear heart scan, a safe radioactive substance called a tracer is injected into your bloodstream via a vein. The tracker travels to your heart and releases energy. A special external camera detects the energy and uses it to create an image of your heart. Nuclear heart scan can show where the healthy and the damaged heart muscles are.

Positron emission tomography (PET) scan is a type of nuclear heart scan. This test shows the level of chemical activity in your liver area. This test can help the doctor see if enough blood is flowing to this area. PET scans can show blood flow problems that other tests may not detect.

Cardiac Catheterization

In cardiac catheterization, a long, thin, flexible tube called a catheter is inserted into a blood vessel in your arm, groin (upper thigh), or neck and continues into your heart. This allows the doctor to look inside your coronary (heart) arteries.

During this procedure, your doctor can check blood pressure and flow in the chambers of your heart, collect blood samples, and use X-rays to view your coronary arteries.

Coronary Angiography

Coronary angiography is usually performed with cardiac catheterization. A dye that can be seen on an x-ray is injected into your bloodstream through the tip of the catheter.

The dye will help your doctor see blood flow to your heart muscle. Angiography also shows your heart’s pumping ability.

Stress Test

Some heart problems are easier to diagnose when your heart is working hard and beating fast. During a stress test, you will be asked to exercise to make your heart work harder and beat faster.

You can walk or run on the treadmill or pedal a bicycle. If you are unable to exercise, you may be given medication to increase your heart rate.

Heart tests, such as nuclear heart scans and echo, are often done during a stress test.

Cardiac MRI

MRI (magnetic resonance imaging) of the heart uses radio waves, magnets, and a computer to create pictures of your heart as it beats. This test produces still and moving images of the heart and major blood vessels.

A cardiac MRI can show if parts of your heart are damaged. Doctors have also used MRI in research to find early signs of heart failure, even before symptoms appear.

Thyroid Function Test

Thyroid function tests show how well your thyroid gland is working. These tests include blood tests, imaging tests, and tests to stimulate the thyroid. Having too much or too little thyroid hormone in the blood can lead to heart failure.

Treatment for Heart Failure

Early diagnosis and treatment can help people with heart failure live longer, more active lives. Treatment for heart failure depends on the type and severity of heart failure.

 The objectives of treatment for all stages of heart failure include:

  • Treating the underlying cause of the condition, such as coronary heart disease, high blood pressure, or diabetes
  • Relieving symptoms
  • Stopping heart failure from getting worse
  • Increasing your life span and improving your quality of life

Treatment usually includes lifestyle changes, medications, and continous care. If you have severe heart failure, you may also require medical procedures or surgery.

Lifestyle Changes For Better Heart Health

Your doctor may recommend heart-healthy lifestyle changes if you have heart failure. Heart-healthy lifestyle changes include:

  • Implement heart-healthy diet
  • Maintain a healthy body weight
  • Engage in regular physical activity
  • Quit smoking

Medications

Your doctor will prescribe medication based on the type of heart failure you have, how severe it is, and your body’s reaction to certain medications. The following medicines are commonly used to treat heart failure:

  • ACE inhibitors lower blood pressure and reduce pressure on the heart. They can also reduce the risk of future heart attacks.
  • Aldosterone antagonists trigger the body to get rid of excess sodium through the urine. This decreases the volume of blood that the heart has to pump.
  • Angiotensin receptor blockers relax blood vessels and lower blood pressure to reduce your heart’s workload.
  • Beta blockers slow down your heart rate and lower your blood pressure to reduce the workload of your heart.
  • Digoxin makes the heart beat stronger and pump more blood.
  • Diuretics (water pills) help reduce fluid buildup in your lungs and swelling in your feet and ankles.
  • Isosorbide dinitrate / hydralazine hydrochloride helps relax blood vessels so your heart does not work hard to pump blood. Research shows that this medication can reduce the risk of death in black people. More research is required to be conducted to find out whether this medicine would benefit other racial groups.

Take all medicines regularly, according to your doctor’s prescription. Do not increase or lower the dose unless your doctor tells you to. You still need to maintain a heart-healthy lifestyle, even if you are taking medication to treat your heart failure.

Continuous Care

You should pay attention if the signs of heart failure are getting worse. For example, gaining weight might mean that there is a fluid buildup in your body. Ask your doctor how often you should check your weight and when to report weight changes.

It is important for you to get medical treatment for other related conditions. If you have diabetes or high blood pressure, work with your healthcare provider to manage these conditions. You are recommended to have your blood sugar levels and blood pressure checked. Ask your doctor when you should have the test and how often to take blood pressure measurements at home.

Try to avoid respiratory infections like colds and pneumonia. Ask your doctor how you can get the flu and pneumonia vaccines.

Many people who have severe heart failure may require to be hospitalized. Your doctor may recommend oxygen therapy, which can be provided in a hospital or at home.

Medical and Surgical Procedures

As heart failure worsens, lifestyle changes and medications may no longer control your symptoms. You may need a medical or surgical procedure (surgery).

In heart failure, the right and left sides of the heart may no longer contract at the same time. This interferes with the heart’s ability to pump. To resolve this problem, your doctor may place a cardiac resynchronization therapy device (a type of pacemaker) near your heart. This device helps both sides of your heart contract at the same time – which can relieve symptoms of heart failure.

Some people who have heart failure experience rapid and irregular heartbeats. Without treatment, this heartbeat can lead to sudden cardiac arrest. Your doctor may place an implantable cardioverter defibrillator (ICD) near your heart to solve this problem. The ICD checks your heart rate and uses electrical pulses to correct irregular heart rhythms.

People who experience severe symptoms of heart failure while resting, despite other treatments, may require: 

  • A mechanical heart pump, such as a left ventricular assist device. This tool helps pump blood from the heart to the rest of the body. You can use a heart pump until you have surgery or as a long-term treatment.
  • Heart transplant. A heart transplant is a surgery in which a diseased heart is replaced with a healthy heart from a recently deceased donor. Heart transplants are performed as a life-saving measure for end-stage heart failure when less significant medical and surgical treatments have failed.

Home Care for Patients Diagnosed with Heart Failure 

Heart failure is incurable. You may have to take medication and follow a life-long treatment plan.

Even with treatment, the symptoms can get worse over time. You may not be able to perform regular activities you used to engage in before you had heart failure. However, if you follow all the steps your doctor recommends, you will stay healthy for longer.

Researchers may also find new treatments that can help you in the future.

Follow Your Treatment Plan

Treatment can relieve your symptoms and facilitate the resumption of your daily activities. It can also reduce the chances of you having to go to the hospital. Thus, it is important that you follow your treatment plan.

  • Take your medicines as prescribed by your doctor. Inform your doctor the moment you experience side effects from medication. He or she may adjust the dose or type of medication you take to relieve side effects.
  • Implement the lifestyle changes as recommended by your doctor.
  • Ask your doctor for advice on how active you should be. This includes advice on daily activities, work, leisure, sex and sports. Your activity level depends on the stage of your heart failure (how severe it is).
  • Keep the results from all your medical appointments, including doctor visits and appointments for tests and laboratory work. Your doctor will need the results of these tests to adjust your medication dose and help you avoid dangerous side effects.

Steps in Preventing Worsening Heart Failure Condition

Certain actions can worsen your heart failure, such as:

  • Forgetting to take your medicines
  • Not sticking to your diet (for example, eating salty foods)
  • Drinking alcoholic beverages

These actions can put you in the hospital. If you have trouble sticking to your diet, talk to your doctor. He or she can help arrange a dietitian to work with you. You should avoid drinking alcoholic beverages.

People who have heart failure often have other serious conditions that require ongoing treatment. If you have other serious conditions, you may be taking medications for those serious conditions as well as for heart failure. Taking more than one medicine carries a risk of side effects and other problems. Make sure your doctor and pharmacist has a complete list of all the medications and over-the-counter products that you should consume.

Tell your doctor right away if you have any problems with your medicines. Consult your doctor before taking any new medications prescribed by another doctor or any new over-the-counter medicines or herbal supplements.

Try to avoid respiratory infections like colds and pneumonia. Ask your doctor or nurse on how to get flu and pneumonia vaccines.

Future Plans

If you have heart failure, it is important to know:

  • When to seek help. Ask your doctor when to make a visit to his or her practice or get emergency care.
  • Phone numbers of your doctor and hospital.
  • Directions to your doctor’s office and hospital and list of people who can take you there.
  • List of medicines that you are taking.

Emotional Issues and Support

Living with heart failure can cause fear, anxiety, depression, and stress. Share your feelings with the healthcare provider of your choice. Talking to a professional counselor may also help. If you are very depressed, your doctor may recommend medications or other treatments that can improve your quality of life.

Participating in a support group can help you adjust to living with heart failure. You can see how other people who have the same symptoms cope with the condition. Ask your doctor about local support groups or check with your regional health center.

Support from your close family and friends can also help relieve stress and anxiety. Let your loved ones know how you feel and ask them what they can do to help you.

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