Heart Failure

Heart failure is a serious medical condition that affects millions of people, and prevention is very important. While the name may sound scary, and the condition is very serious, it doesn't mean that a person's death is imminent and they are absolutely doomed. However, it does mean that medical treatment and lifestyle changes are in order. With strict heart-healthy living and medical management, people with heart failure can have many additional years full of life. 

Definition 

Heart failure is a condition in which the heart does not pump as well as it should. This weakness or inefficiency of the heart can be felt in different ways, depending on which parts of the heart are affected. The terms applied to heart failure (congestive, right-sided, systolic dysfunction, etc) describe the type of heart failure and depend on which aspects of the condition are being considered. While there is a lot of common ground and overlap, these terms are important in that people with heart failure may receive different treatments based on the characteristics of their type of heart failure. See Terminology at the end of this article for more. 

There are many different conditions and factors that contribute to the development of heart failure, and it is a condition that can develop gradually over a long period of time, although an event or illness can also cause heart failure to develop rapidly. Sometimes, the damage to the heart that causes it to work less efficiently can be reversed, but in many cases, the damage is irreversible. 

Causes 

There are a number of causes of heart failure, some of which people may not know about until the symptoms of heart failure start to appear. 

Coronary artery disease (CAD) and heart attacks are the most common cause of heart failure.

CAD is so common that it is often simply called “heart disease” and everybody knows what you mean. Other names used to describe the same thing are coronary heart disease, cardiovascular disease (when it involves the coronary arteries that feed the heart), and atherosclerotic heart disease. 

High blood pressure and diabetes are risk factors for coronary artery disease, and they can also contribute to the development of heart failure on their own. 

Other causes of heart failure include the following:

  • Heart valve disease
  • Damage to the heart muscle (cardiomyopathy) 
  • Congenital heart disease
  • Abnormal heart rhythms (arrhythmias)
  • Inflammation of the heart muscle (myocarditis) 

Some chronic diseases and conditions that are associated with other parts of the body can also lead to heart failure, such as: 

  • Kidney failure (renal failure)
  • Emphysema
  • Severe anemia
  • Too much iron in the blood
  • Thyroid disorders
  • Lupus
  • Amyloidosis
  • Sarcoidosis

Alcohol abuse and cocaine can injure the heart muscle, as can HIV/AIDS. Additionally, some cancer chemotherapies have heart toxicity as a side effect and can lead to heart failure. 

This list is not exhaustive, and other factors can lead to heart failure or tip the balance toward heart failure in someone who is just at the cusp. 

Symptoms 

There are many symptoms of heart failure, but most are not specific to heart failure, alone. Heart failure also tends to coexist with other illnesses. If you think you might have heart failure, your doctor should evaluate you. If you have heart failure, you should see a doctor regularly. 

Symptoms of heart failure often relate to not getting enough oxygen where it’s needed and/or too much fluid where it doesn’t belong:

  • Shortness of breath (during activity, or when lying down at night)
  • Fatigue and weakness during exercise
  • Swelling (edema) of the ankles and legs
  • Persistent cough with blood-tinged sputum
  • Dizziness, confusion, fainting
  • Waking up frequently to urinate at night
  • Loss of appetite
  • Weight gain from fluid
  • Swelling in the abdomen or in the lower extremities 

The symptoms of heart failure usually appear gradually, as most of the causes are conditions that worsen over time. However, in some cases, when the cause is sudden, such as a heart attack or infection, the symptoms will also appear much more quickly. 

Treatment 

Heart failure is the leading cause of hospitalization in adults over age 65. Heart failure almost always requires some time in the hospital, not only because it is a serious, life threatening condition, but also because many of the diagnostic tests and the initial treatment require the person to be carefully monitored. After the person's condition has improved, treatment will continue at home, usually for the rest of the person's life. 

The specific treatment regimen your doctor recommends depends on the severity and type of heart failure. It may be important for you and your doctor to know your ejection fraction, or EF. This number can help determine the best treatment initially and help measure the success of your treatment, once initiated. Often regimens address the root causes of heart failure and include medications to help reduce the fluid in the body and to help the heart in its job. 

Treating the causes

  • Control hypertension                            
  • Quit smoking                                       
  • Treat cholesterol (lipid disorders)          
  • Get regular exercise                              
  • Avoid alcohol and illicit drugs               
  • ACE inhibitor or ARB, if appropriate      

Treating the symptoms and helping your heart function

  • Continue with the items listed above
  • Diuretics (water pills)
  • ACE inhibitor or ARB
  • Digoxin (Lanoxin)
  • Beta-blockers
  • Aldosterone antagonists 

In addition to medications, there are a number of medical procedures that can help with heart failure, depending upon the severity. The implantation of an automated cardioverter-defibrillator (AICD), mechanical circulatory support and heart transplants are all options for those who have more severe cases of heart failure.

There are several lifestyle changes that most people with heart failure are also asked to make including dietary changes, restrictions on activities, and they will be required to weigh themselves daily as well as monitor their blood pressure. Any sudden weight gain or spike in blood pressure can signify a serious problem that needs further attention. 

Long-term Outlook

The long-term prognosis for someone with heart failure can vary greatly. If the problems are found early, the prognosis is good. With the right combination of diet and medication, many people with heart failure go on to live long lives. If the problem is severe, or if treatment isn't adhered to, the condition is deadly. 

Statistically, 1 in 5 will die within one year of diagnosis due to complications from heart failure, and that adds up to more than 280,000 deaths per year, but it doesn't have to be that way. Aggressive treatment and lifestyle changes can give a person their life back, instead of taking it away. 

Terminology

Left-sided heart failure: Recall that the left side of the heart takes oxygen-rich blood from the lungs and pumps it out to the brain, the kidneys, and the whole body. When the left side of the heart does a poor job getting oxygen-rich blood to the brain, for example, people can feel fatigued, dizzy, and confused. The left ventricle has to be strong enough to do the hard work of pumping pressurized blood, but it cannot be too stiff, or it will not fill up properly. When the left ventricle is too weak in squeezing or contracting, this is called systolic dysfunction. When the left ventricle can’t relax properly, and systolic or squeezing function is normal, it can’t fill up properly. This is called diastolic dysfunction. When the left ventricle is affected, the left side of the heart has to work extra hard just to pump the same amount of blood. Left-sided heart failure can also cause right-sided heart failure. 

Right-sided Heart Failure: Now remember that the right side of the heart takes the tired old blood from the veins and delivers it to the lungs to be fully oxygenated. When the right side of the pump is not doing what it should, blood can back up in the veins, causing excess fluid in the body. The fluid causes swelling under the skin called peripheral edema. This can be foot and ankle swelling if you are standing up or in the small of the back area (sacral edema) if you are mostly lying down. 

Congestive heart failure: Congestion refers to blood backing up where it doesn’t belong instead of being pumped along. Sites of congestion may include the liver, abdomen, lower extremities and lungs.


Sources:

  1. Mant J, Al-Mohammad A, Swain S, Laramee P. Guideline Development Group. Management of chronic heart failure in adults: synopsis of the National Institute For Health and clinical excellence guideline. Ann Intern Med. 2011;155(4):252-9. http://www.ncbi.nlm.nih.gov/pubmed/21844551.
  2. MedlinePlus. Heart Failure. http://www.nlm.nih.gov/medlineplus/heartfailure.html. Accessed May 9, 2013.
  3. PubMed Health. Heart failure - overview. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001211/. Accessed May 9, 2013.
  4. United States Centers for Disease Control and Prevention. Division for Heart Disease and Stroke Prevention. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm. Accessed May 9, 2013.

Medically Reviewed by Tom Iarocci, MS, MD

Last Updated May 20, 2013

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