Understanding Heart Failure
- Heart failure is a condition that affects the heart’s ability to pump blood efficiently.
- Symptoms include shortness of breath, weakness, swelling in the legs, ankles and feet and abdominal pain or nausea.
- Treatment for heart failure begins with lifestyle changes and medications. In more advanced cases, surgery or a heart transplant may be needed.
- People can and do live with heart failure. Close self-monitoring and sticking to the doctor's recommended diet, medication and exercise plans are essential to improving quality of life.
Your heart is roughly the size of a fist and sits in the middle of your chest, slightly to the left. It's the muscle at the center of your circulation system, pumping blood around your body as your heart beats. This blood sends oxygen and nutrients to all parts of your body, and carries away unwanted carbon dioxide and waste products.
What Is Heart Failure?
Read MoreWhat Are The Symptoms Of Heart Failure?
If the heart does not pump well, at first you might have no symptoms. But as the condition gets worse, it can cause:- Weakness/tiredness. You may feel lightheaded or dizzy.
- Difficult breathing (dyspnea). This is usually very mild at the beginning. Some patients become less active or need an extra pillow to sleep at night.
- Racing heart/palpitations. Normal hearts beat 60100 times every minute. When your heart beats more than 100 times each minute, that's considered high.
- Lower limb swelling (specifically in the feet and ankles)
- Need to urinate frequently during the night
- Dry, hacking cough
- Nausea
There may be times that your symptoms are mild, or you may not have any symptoms at all. This doesn’t mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe and may come and go. Unfortunately, heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms.
"You could have lightheadedness, you could have fatigue, but a lot of that is based upon the fact that without the necessary oxygen that needs to be in your bloodstream, it’ll compromise your ability to do. The body, the heart works best when it’s enriched with oxygen and nutrients and to deprive the heart of that leads to a compromised lifestyle,” Dr. Philip J. Weintraub, a private cardiologist in New York, tells SurvivorNet.
What Causes Heart Failure?
Several medical conditions can damage the heart muscle over time:
- High blood pressure (hypertension)
- Coronary artery disease: This is when major blood vessels that supply your heart become damaged or diseased (high cholesterol levels, obesity and smoking are major factors that lead to damage these vessels).
- Previous heart attack (myocardial infarction): In the U.S., this is the most common cause that leads to heart failure. The scar tissue from prior damage interferes with the heart muscle’s ability to pump normally.
- Heart issues present at birth (congenital heart disease)
- Diabetes
- Arrhythmia (abnormal heart rhythms, including atrial fibrillation)
- Kidney disease
- Having obesity
- Tobacco and recreational drug use
- Medications: Some types of cancer treatment can lead to heart failure
"There are many different things that can lead to chronic heart failure and some of them can be prevented,” Dr. Dwivedi tells SurvivorNet. "In terms of the lifestyle changes that can prevent heart failure is limiting excessive alcohol intake, quitting smoking or not smoking, leading a healthy lifestyle, which means doing constant, moderate activity, and eating a healthy diet."
How Is Heart Failure Categorized?
There are four stages of heart failure: Stage A, B, C and D.
STAGE A
While performing physical activity is not an issue, patients in Stage A are considered at high risk for developing congestive heart failure. Stage A is considered pre-heart failure. It means you're at high risk of developing heart failure because you have a family history of heart failure, or you have one or more of these medical conditions:
- High blood pressure (hypertension)
- Diabetes
- Coronary artery disease
- Previous heart attack
- Obesity
- History of alcohol abuse
- History of rheumatic fever
- Family history of cardiomyopathy (a disease of the heart muscle that makes it more difficult to pump blood)
STAGE B
Patients in Stage B heart failure have been diagnosed with some sort of structural heart disease like systolic left ventricular dysfunction, but you've never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram that shows an ejection fraction of 40% or less. (Ejection fraction means how much blood is pumped out of your heart each time it beats.) Stage B is considered pre-heart failure.
STAGE C
Patients with a structural heart disease have Stage C heart failure. You currently have or previously had signs and symptoms of the heart failure such as feeling tired, coughing, wheezing, having shortness of breath or swollen limbs. According to the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines, patients in Stage C and D of heart failure should be managed by a “multidisciplinary team that include cardiologists, nurses, and pharmacists who specialize in heart failure as well as dieticians, mental health clinicians, social workers, primary care clinicians, and additional specialists.”
STAGE D
This is the final stage of heart failure. Patients in Stage D are usually unresponsive to treatments and severe symptoms are present after mild activity, or even at rest. According to the ACC and AHA guidelines, this stage is marked by symptoms that interfere with daily life and require frequent hospitalizations. Several terms have been used to describe this group of patients, including "end-stage," "advanced," and "refractory".
Are There Tests For Heart Failure?
Yes. There are several tests for heart failure, and your doctor does not have to order all of them for you. So there’s no need to worry if you’ve only had some of them. You can see the clinical guidelines on heart failure assessment from the American College of Cardiology and the American Heart Association here.
Electrocardiogram (EKG)
This test measures the electrical activity traveling through your heart. It can show whether you have an abnormal heartbeat or have had a heart attack in the past.
Generic blood tests
Blood tests to check kidney and thyroid gland health, cholesterol levels and red blood cell count (to check if you have anemia) are useful to determine the cause of your heart failure and also to determine if you are experiencing any complications because of it.
Brain natriuretic peptide (BNP) or “N-terminal pro-BNP” (NT-proBNP)
These are also blood tests. Your heart releases these substances when heart failure develops.
Chest X-ray
A simple chest X-ray shows the size of your heart and if there is fluid in the lungs.
Echocardiogram (also called an “echo”)
This test is very similar to an ultrasound test. It uses sound waves to create a picture of your heart as it beats. It's one of the most important exams to evaluate your overall heart condition. An echo can show what your ejection fraction (EF) is.
Stress test
Your heart gets “stressed” when you walk on a treadmill or take medications that increase its pumping. This test helps doctors see if the heart is getting enough blood when it is under stress. If you cannot walk or run, you might instead get a medicine to stress your heart.
Cardiac catheterization (also called “cardiac cath” or coronary angiography)
This is a more invasive test, a thin tube will be inserted into a blood vessel in your neck, leg, or arm and it will be moved up to your heart. This measures whether you have clogged heart arteries.
Cardiac MRI or CT-scan
These scans can help your doctor understand the status of the arteries that supply blood to your heart. It can also determine the size and the shape of your heart.
How Is Heart Failure Treated?
Education plays a crucial role. Controlling risk factors is a key part of controlling the condition. It's very important that you:
- Quit smoking
- Exercise regularly
- Loose weight
- Discontinue alcohol or drug use
- Treat high blood pressure, which also means controlling the amount of sodium (salt) in your diet
- Treat lipid disorders (including high cholesterol)
- Control your blood sugar (if you are diabetic)
As heart failure gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. Since you can't move backward through the heart failure stages, the goal of treatment is to keep you from moving forward through the stages. Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle behaviors are part of every treatment plan. Some medications have been shown to prolong life in heart failure patients:
Angiotensin converting enzyme (ACE) inhibitors: ACE inhibitors decrease the pressure inside the blood vessels and reduce the resistance against which the heart pumps.
Angiotensin receptor blockers (ARBs): This is an alternative medication for reducing the workload on the heart if ACE inhibitors are not tolerated. An ACE inhibitor or ARB blocker are the most recommended drugs to treat heart failure, but not both.
Beta blockers: This medication reduces the heart’s tendency to beat faster and reduces its workload by blocking specific receptors on heart cells.
Aldosterone blockers: These drugs block the effects of the hormone aldosterone, which causes sodium and water retention.
Angiotensin receptor-neprilysin inhibitors (ARNIs): This is a relatively new class of medication that for some people has been shown to be a better option than ACE inhibitors or ARB blockers.
Loop diuretics: These diuretics cause the kidneys to pass out more fluid which leads to less fluid in the bloodstream, and can ultimately help with symptoms of heart failure.
Medications for heart failure need to be taken every day as directed. They can reduce the chances that you will need to go to the hospital, have a heart attack, or die. They can also reduce or eliminate your symptoms.
Other Treatment Options
If you have late-stage disease (Stage D), you should discuss the possibility of the following treatments with your doctor:
Heart transplant
You may need a heart transplant if your heart is failing, and other treatments are not effective. A heart transplant is surgery to remove the diseased heart from you and replace it with a healthy one from an organ donor. You will need to take medicine to prevent or treat rejection for the rest of your life, and these drugs have side effects such as repeated infections.
Ventricular assist devices
These are also called "bridge to transplant" therapies. For some people, a left ventricular assist device or a total artificial heart can help maintain or improve your overall health while you wait for a donor heart.
Continuous infusion of intravenous inotropic drugs
Inotropic agents are medicines that change the force of your heart’s contractions. Some patients with end-stage heart failure are placed on continuous infusions of cardiac inotropes in an attempt to improve symptoms and avoid additional hospitalizations. They can be used for longer periods to support patients as a bridge to a more definite treatment, such as a heart transplant, or as part of a palliative care regimen.
Surgery options
Heart failure may be caused by a number of underlying conditions, such as coronary artery disease or arrhythmias. If blocked arteries are damaging your heart, a coronary artery bypass graft (CABG) can improve blood flow and prevent future damage. A percutaneous coronary intervention (PCI) may also be performed first to restore blood flow to blocked arteries or veins.
Cardiac Rehab
This may consist of physical rehab as well as education about necessary lifestyle changes and emotional support. It has been shown to improve symptom management.
End-of-life (palliative or hospice) care
Palliative care is a specialized medical care for people facing a serious illness like late-stage heart failure. The goal is to improve quality of life for both you and your family. Hospice can be offered in a patient's home or a care facility. Unlike other medical care, hospice focuses on treating symptoms, such as respiratory distress and pain, rather than trying to cure the illness itself.
Learn more about SurvivorNet's rigorous medical review process.