Learn about this chronic disease that needs lifelong management, and find out what treatments help you live longer and may even strengthen your heart.
Heart failure — sometimes known as congestive heart failure — occurs when the heart muscle doesn't pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath.
Certain heart conditions, such as narrowed arteries in the heart (coronary artery disease) or high blood pressure, gradually leave the heart too weak or stiff to fill and pump blood properly.
Proper treatment can improve the signs and symptoms of heart failure and may help some people live longer. Lifestyle changes — such as losing weight, exercising, reducing salt (sodium) in your diet and managing stress — can improve your quality of life. However, heart failure can be life-threatening. People with heart failure may have severe symptoms, and some may need a heart transplant or a ventricular assist device (VAD).
One way to prevent heart failure is to prevent and control conditions that can cause it, such as coronary artery disease, high blood pressure, diabetes and obesity.
Heart failure can be ongoing (chronic), or it may start suddenly (acute).
Heart failure signs and symptoms may include:
See your doctor if you think you might be experiencing signs or symptoms of heart failure. Call 911 or emergency medical help if you have any of the following:
Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. Don't try to diagnose yourself.
Emergency room doctors will try to stabilize your condition and determine if your symptoms are due to heart failure or something else.
If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. This may also be the case if you gain 5 pounds (2.3 kilograms) or more within a few days. Contact your doctor promptly.
Heart failure often develops after other conditions have damaged or weakened the heart. However, heart failure can also occur if the heart becomes too stiff.
In heart failure, the main pumping chambers of the heart (the ventricles) may become stiff and not fill properly between beats. In some people, the heart muscle may become damaged and weakened. The ventricles may stretch to the point that the heart can't pump enough blood through the body.
Over time, the heart can no longer keep up with the typical demands placed on it to pump blood to the rest of the body.
Your doctor can determine how well your heart is pumping by measuring how much blood is pumped out with each beat (ejection fraction). Ejection fraction is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is 50% or higher — meaning that more than half of the blood that fills the ventricle is pumped out with each beat.
But heart failure can occur even with a normal ejection fraction. This happens if the heart muscle becomes stiff from conditions such as high blood pressure.
Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, heart failure begins with the left side, specifically the left ventricle — your heart's main pumping chamber.
|Type of heart failure||Description|
|Left-sided heart failure||Fluid may back up in the lungs, causing shortness of breath.|
|Right-sided heart failure||Fluid may back up into the abdomen, legs and feet, causing swelling.|
|Systolic heart failure (also called heart failure with reduced ejection fraction)||The left ventricle can't contract vigorously, indicating a pumping problem.|
|Heart failure with preserved ejection fraction||The left ventricle can't relax or fill fully, indicating a filling problem.|
Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:
Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. The disease results from the buildup of fatty deposits in the arteries, which reduces blood flow and can lead to heart attack.
A heart attack occurs suddenly when a coronary artery becomes completely blocked. Damage to your heart muscle from a heart attack may mean that your heart can no longer pump as well as it should.
Causes of sudden (acute) heart failure also include:
A single risk factor may be enough to cause heart failure, but a combination of factors also increases your risk.
Risk factors for heart failure include:
Complications of heart failure depend on the severity of heart disease, your overall health and other factors such as your age. Possible complications can include:
The key to preventing heart failure is to reduce your risk factors. You can control or eliminate many of the risk factors for heart disease by making healthy lifestyle changes and by taking the medications prescribed by your doctor.
Lifestyle changes you can make to help prevent heart failure include:
To diagnose heart failure, your doctor will take a careful medical history, review your symptoms and perform a physical examination. Your doctor will also check to see if you have risk factors for heart failure, such as high blood pressure, coronary artery disease or diabetes.
Your doctor can listen to your lungs for signs of fluid buildup (lung congestion) and your heart for whooshing sounds (murmurs) that may suggest heart failure. The doctor may examine the veins in your neck and check for fluid buildup in your abdomen and legs.
After the physical exam, your doctor may also order some of these tests:
Stress test. Stress tests measure the health of the heart during activity. You may be asked to walk on a treadmill while attached to an ECG machine, or you may receive an IV drug that stimulates the effect of exercise on the heart.
Sometimes a stress test is done while wearing a mask that measures how well the heart and lungs get oxygen and breathe out carbon dioxide.
Magnetic resonance imaging (MRI). In a cardiac MRI, you lie on a table inside a long, tubelike machine. Radio waves create images of the heart.
A cardiac MRI may be done with a dye (contrast). It's important to tell your doctor about any problems with your kidneys before you receive a cardiac MRI or other MRI because contrast can cause a rare and serious complication in people who have kidney disease.
Results of tests to diagnose heart failure help doctors determine the cause of any signs and symptoms and decide on a treatment plan. To determine the best treatment for heart failure, doctors may classify heart failure using two systems:
New York Heart Association classification
This scale groups heart failure into four categories.
American College of Cardiology/American Heart Association classification
This stage-based classification system uses letters A to D and includes a category for people who are at risk of developing heart failure. Doctors use this classification system to identify risk factors and begin early, more aggressive treatment to help prevent or delay heart failure.
Your doctor often will use both classification systems together to help decide the most appropriate treatment options. Your doctor can help you interpret your score and plan your treatment based on your condition.
Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger.
Doctors sometimes can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, treatment of heart failure involves a balance of the right medications and, sometimes, use of devices that help the heart beat and contract properly.
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one or more medications, including:
Diuretics. Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics, such as furosemide (Lasix), also decrease fluid in your lungs so you can breathe more easily.
Because diuretics make your body lose potassium and magnesium, your doctor may also 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.
Aldosterone antagonists. These drugs include spironolactone (Aldactone, Carospir) and eplerenone (Inspra). These are potassium-sparing diuretics that have additional properties that may help people with severe systolic heart failure live longer.
Unlike some other diuretics, spironolactone and eplerenone can raise the level of potassium in your blood to dangerous levels, so talk to your doctor if increased potassium is a concern, and learn if you need to modify your intake of food that's high in potassium.
Your doctor may need to adjust your doses frequently, especially when you've just started a new medication or when your condition is worsening.
You may be admitted to the hospital if you have a flare-up of heart failure symptoms. While in the hospital, you may receive additional medications 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 for a long time.
Surgery or other procedures to implant cardiac devices may be recommended to treat the underlying problem that led to heart failure. Surgery or other procedures for heart failure may include:
Heart valve repair or replacement. If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing the valve. Surgeons can repair the valve by reconnecting valve flaps or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve.
Heart valve repair or replacement may be done as open-heart surgery, a minimally invasive surgery or a heart procedure using flexible tubes called catheters (cardiac catheterization).
Implantable cardioverter-defibrillators (ICDs). An ICD is used to prevent complications of heart failure. It isn't a treatment for heart failure itself. An ICD is a device similar to a pacemaker. It's implanted under the skin in your chest with wires leading through your veins and into your heart.
The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also work as a pacemaker and speed your heart up if it is going too slow.
Ventricular assist devices (VADs). A VAD — also known as a mechanical circulatory support device — is a device that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body. Although a VAD can be placed in one or both ventricles of your heart, it is most frequently implanted in the left ventricle.
Your doctor may recommend a VAD if you're waiting for a heart transplant. Sometimes, a VAD is used as a permanent treatment for people who have heart failure but who aren't good candidates for a heart transplant.
Heart transplant. Some people have such severe heart failure that surgery or medications don't help. These people may need to have their hearts replaced with a healthy donor heart.
A heart transplant isn't the right treatment for everyone. A team of doctors at a transplant center will evaluate you to determine whether the procedure may be safe and beneficial for you.
Your doctor may recommend including palliative care in your treatment plan. Palliative care is specialized medical care that focuses on easing your symptoms and improving your quality of life. Anyone who has a serious or life-threatening illness can benefit from palliative care, either to treat symptoms of the disease, such as pain or shortness of breath, or to ease the side effects of treatment, such as fatigue or nausea.
It's possible that your heart failure may worsen to the point where medications are no longer working and a heart transplant or device isn't an option. If this occurs, you may need hospice care. Hospice care provides a special course of treatment to terminally ill people.
Hospice care allows family and friends — with the aid of nurses, social workers and trained volunteers — to care for and comfort a loved one at home or in hospice residences. Hospice care provides emotional, psychological, social and spiritual support for people who are ill and those closest to them.
Hospice care is available in your own home or in nursing homes and assisted living centers. For people who stay in a hospital, specialists in end-of-life care can provide comfort, compassionate care and dignity.
Although it can be difficult, discussing end-of-life issues with your family and medical team is important. Part of this discussion will likely involve advance care directives — a general term for oral and written instructions you give concerning your medical care should you become unable to speak for yourself.
If you have an ICD, one important consideration to discuss with your family and doctors is whether it should be turned off so that it can't deliver shocks to make your heart continue beating.
Making lifestyle changes can often help relieve signs and symptoms of heart failure and prevent the disease from worsening. These changes may be among the most important and beneficial you can make:
Stop smoking. Smoking damages your blood vessels, raises blood pressure, reduces the amount of oxygen in your blood and makes your heart beat faster.
If you smoke, ask your doctor to recommend a program to help you quit. You can't be considered for a heart transplant if you continue to smoke. Avoid secondhand smoke, too.
Limit salt. Too much salt (sodium) can cause water retention, which makes your heart work harder and causes shortness of breath and swollen legs, ankles and feet.
Ask your doctor if you should follow a no-salt or low-salt diet. Keep in mind that salt is already added to prepared foods, and be careful when using salt substitutes.
Limit alcohol and fluids. Your doctor may recommend that you don't drink alcohol if you have heart failure, since it can interact with your medication, weaken your heart muscle and increase your risk of abnormal heart rhythms.
If you have severe heart failure, your doctor may also suggest that you limit the amount of fluids you drink.
Reduce stress. When you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse, since your heart is already having trouble meeting the body's demands.
Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help keep stress at bay.
Proper heart failure treatment can sometimes improve symptoms and help you live longer. You and your doctor can work together to help make you most comfortable. Pay attention to your body and how you feel, and tell your doctor when you're feeling better or worse. This way, your doctor will know what treatment works best for you.
These steps may help you manage heart failure:
Managing heart failure requires an open communication between you and your doctor. Be honest about whether you're following recommendations concerning your diet, lifestyle and taking medications. Your doctor often can suggest strategies to help you get and stay on track.
If you think you may have heart failure or you are worried about your heart failure risk because of other underlying conditions, make an appointment with your family doctor. If heart failure is found early, your treatment may be easier and more effective.
Because appointments can be brief and there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment and know what to expect from your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For heart failure, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
It's never too early to make healthy lifestyle changes, such as quitting smoking, cutting down on salt and eating healthy foods. These changes can help prevent heart failure from starting or worsening.
October 20th, 2021