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.

Due to the fact the blood is not circulating well, the body will be lacking oxygen and nutrients it needs leading to problems like shortness of breath, fatigue, swelling in the feet and legs, a distended abdomen and possibly 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 a chronic disease however it can be managed with medications, low sodium diets 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. The left ventricle is unable to contract normally and is unable to pump enough blood into circulation. This happens because the ventricle has gotten larger and is unable to pump with the force needed to supply the rest of the body with the oxygenated blood it needs. 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 where the left ventricle stiffens and bulks up as a result, the heart is not relaxing between beats and cannot fill completely. It is commonly associated with high blood pressure.  There is usually fluid accumulation, especially in the feet, ankles, legs and abdomen. Symptoms of diastolic and systolic heart failure are similar and the type of heart failure can be best diagnosed with a 2 D echo cardiogram 

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)
  • 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:

  • develop increased shortness of breath
  • if you gain two to three pounds in 24 hours or 5 pounds in 1 week
  • feel fatigued or weakness
  • have swelling in feet, ankles, legs or bloating in your abdomen
  • if you have increased cough or phlegm 
  • cannot sleep through the night, wake frequently, increased shortness of breath 
  • acquire other unexplained or new symptoms 

Call 911 or go to the emergency room if you:

  • Develop severe chest pain
  • Have increased shortness of breath even at rest
  • Feel like you are going to pass out or faint
  • Develop a fast or irregular heart rate

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.