Heart Failure

Heart failure, commonly called congestive heart failure, is the heart's inability to pump enough blood throughout the body.  This may develop slowly over many years or heart failure may be sudden.  Regardless of how it happens, the heart loses its ability to pump blood efficiently.

With the blood not circulating well, the body will be lacking in oxygen and nutrients it needs leading to problems like loss of appetite, fatigue and kidney failure. The blood may back up into other areas of the body, causing increased pressure or fluid in the lungs which results in shortness of breath.  Heart failure is usually chronic and is managed with medications and lifestyle changes.

Types of Heart Failure

There are two main categories of heart failure which are systolic and diastolic heart failure.

Systolic heart failure is the most common type of heart failure.  It is caused by the heart not contracting well. The heart can't pump with enough force to push enough blood into the circulation causing fluid to leak into the lungs.

Diastolic heart failure is a different disease which is a result of the heart not relaxing well. It is commonly associated with high blood pressure and a thick heart.  There is usually fluid accumulation, especially in the feet, ankles, and legs. Some patients may have lung congestion. 

Risks of Heart Failure

There are many risk factors that may make you more vulnerable to heart failure. Those risk factors include:

  • age (greater than 60)
  • male (occurrence in males is four to five times greater than that of females)
  • family history (first degree relatives such as father or brother)
  • genetic factors
  • hyperlipidemia (elevated fats in the blood)
  • hypertension (high blood pressure)
  • heart valve disease caused by past rheumatic fever or other infections
  • active infections of the heart valves and/or heart muscle (for example, endocarditis or myocarditis)
  • previous heart attack(s) (myocardial infarction). Scar tissue from prior damage may interfere with the heart muscle's ability to pump normally.
  • coronary artery disease. Narrowing of the arteries that supply blood to the heart muscle.
  • cardiomyopathy or another primary disease of the heart muscle
  • cardiac arrhythmias (irregular heartbeats or dangerous heart rhythms)
  • chronic lung disease and pulmonary embolism
  • certain medications
  • excessive sodium (salt) intake
  • anemia and excessive blood loss
  • smoking
  • diabetes

Symptoms of Heart Failure

Heart failure interferes with the kidney's normal function of eliminating excess sodium and waste products from the body. In congestive heart failure, the body retains more fluid, resulting in swelling of the ankles and legs. Fluid also collects in the lungs, which can cause profound shortness of breath.

The following are the most common symptoms of heart failure. However, everyone may experience heart failure symptoms differently. The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been lost. Symptoms of heart failure may include:

  • shortness of breath during rest, exercise, or lying flat
  • weight gain
  • visible swelling of the legs and ankles (due to a build-up of fluid), and, occasionally, the abdomen
  • fatigue and weakness
  • loss of appetite and nausea
  • persistent cough - often produces mucus or blood-tinged sputum
  • reduced urination

When to contact your doctor or cardiologist:

  • if you have increased cough or phlegm
  • experience sudden weight gain or swelling
  • have weakness
  • acquire other unexplained or new symptoms

Call 911 or go to the emergency room if you:

  • pass out or faint
  • have a fast and/or irregular heart beat
  • experience severe crushing chest pain

Diagnosis of Heart Failure

In addition to a complete medical history and physical examination, the diagnosis of heart failure may include any, or a combination, of a chest x-ray, echocardiogram, electrocardiogram or blood test.

Heart Failure Treatment

Specific treatment for heart failure will be determined by your health care provider based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

The cause of the heart failure will dictate the treatment protocol established. If the heart failure is caused by a valve disorder, then surgery may be performed. If the heart failure is caused by a disease, such as anemia, then the underlying disease will be treated. Although there is no cure for heart failure due to damaged heart muscle, many forms of treatment have been used to treat symptoms very effectively.

The goal of treatment is to improve a person's quality of life by making the appropriate lifestyle changes and implementing drug therapy.

Treatment of heart failure may include:

  • Controlling risk factors:
    • losing weight (if overweight)
    • restricting salt and fat from the diet
    • stop smoking
    • abstaining from alcohol
    • proper rest
    • controlling blood sugar if diabetic
    • controlling blood pressure
    • limiting fluids
  • Medication, such as:
    • Angiotensin converting enzyme (ACE) inhibitors. This medication decreases the pressure inside the blood vessels and reduces the resistance against which the heart pumps.
    • Angiotensin receptor blockers (ARB). This is alternative medication for reducing workload on the heart if ACE inhibitors are not tolerated.
    • Diuretics. These reduce the amount of fluid in the body.
    • Vasodilators. These dilate the blood vessels and reduce workload on the heart.
    • Digitalis. This medication helps the heart beat stronger with a more regular rhythm.
    • Inotropes. These increase the pumping action of the heart muscle.
    • Antiarrhythmic medications. This helps maintain normal heart rhythm and help prevent sudden cardiac death.
    • Beta-blockers. These reduce the heart's tendency to beat faster and reduce workload by blocking specific receptors on heart cells.
    • Aldosterone blockers. Medication that blocks the effects of the hormone aldosterone which causes sodium and water retention.
  • Heart Rhythm strategies:
    • Biventricular pacing/cardiac resynchronization therapy. A type of pacemaker that paces both pumping chambers of the heart simultaneously to coordinate contractions and to improve the heart's function. Some heart failure patients are candidates for this therapy.
    • Implantable cardioverter defibrillator. A device like a pacemaker that senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm.
  • Cardiology interventions:
    • CardioMems heart failure system, implant of a sensor to help with early detection of heart failure symptoms. Patients use a monitoring pillow daily to transmit data collected by the sensor, and these measurements are monitored by clinical teams that can react to pressure variances with medication adjustments or other recommendations before a heart failure hospitalization occurs.
  • Heart Surgery: 
    • Valve replacement
    • Ventricular assist devices (VADs). These are mechanical devices used to take over the pumping function for one or both heart's ventricles, or pumping chambers. A VAD may be necessary when heart failure progresses to the point that medications and other treatments are no longer effective.
    • Heart transplantation