What Is It?
Heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for blood. Contrary to its name, heart failure does not mean the heart has failed completely. Heart failure is also called congestive heart failure.
The inefficient pumping associated with heart failure causes a backup of blood in the veins leading to the heart. It causes the kidneys to retain fluid. As a result, the body's tissues swell.
The swelling most commonly affects the legs. But it also can occur in other tissues and organs. When it occurs in the lungs, it causes breathing difficulty.
Heart failure often is the end stage of another form of heart disease. Its many causes include:
Hyperthyroidism, diabetes and prolonged lung disease also increase the risk of heart failure.
In some people with heart failure, the heart muscle becomes weaker. It cannot pump as well. In other people, the heart muscle becomes stiff. As a result, the heart cannot fill with enough blood between heartbeats.
The first symptom of heart failure often is fatigue. As the condition worsens, shortness of breath and wheezing occur during exertion. Eventually, shortness of breath and wheezing occur when you are resting.
As fluid accumulates in the lungs, people with heart failure may begin to sleep propped up with pillows. This makes breathing easier. There also can be a chronic cough due to fluid accumulation in the lungs.
Fluid also can collect in the legs and ankles, causing swelling. In people who are less active, collected fluid can accumulate in the middle of the body. Some people urinate several times during the night as the kidneys drain off some of this excess fluid. As the body accumulates more and more fluid, the person may experience significant weight gain.
Heart failure usually affects both sides of the heart. But in some people it affects only one side. When heart failure affects mainly the left side of the heart, the symptoms are more likely to involve breathing difficulties. When mainly the right side is affected, the main symptoms may be leg swelling and abdominal swelling.
Your doctor will review your medical history and ask for details about your symptoms. For example, he or she may ask:
During your physical examination, your doctor will:
You also will have diagnostic tests. An electrocardiogram and chest X-ray, will check for enlargement of the heart and fluid in the lungs.
Other diagnostic tests may be needed to find the cause of your heart failure. For example, an echocardiogram may be done to look for heart valve abnormalities, signs of heart attack, or other cardiac abnormalities.
The echocardiogram is particularly important. It can determine whether the heart muscles have weakened or become stiff. Treatment can differ depending on the type of heart failure.
Heart failure often is a lifelong condition.
However, if the cause is treatable, heart failure can go away.
To avoid heart failure, you must prevent the various forms of heart disease that lead to it.
To prevent heart disease:
Some types of heart failure cannot be prevented.
The treatment of heart failure focuses on:
To accomplish these goals, your doctor will advise a low-salt diet and medication.
Medications may include:
Sometimes, anticoagulants (blood thinners) also are prescribed to prevent blood clots. These are particularly important if the patient requires a long period of bed rest.
Your doctor also will address the underlying cause of your heart failure. Heart failure related to coronary artery disease may require additional medications, angioplasty or surgery. When heart failure is caused by a poorly functioning heart valve, your doctor may advise surgical repair and valve replacement.
For some heart failure patients, losing weight or avoiding alcohol can dramatically improve symptoms. Your doctor will tell you how much exercise is appropriate. Balancing physical activity with rest is important in more advanced stages of heart failure.
Eventually medications and self-treatment may no longer be helpful. At this point, a heart transplant may be considered. This treatment option is limited by a shortage of donor hearts. It usually is reserved for patients younger than 65.
When to Call a Professional
Call your doctor if you have any of the following symptoms, particularly if you already have been diagnosed with heart disease:
The outlook depends on:
When heart failure develops suddenly and has a treatable cause, people sometimes can regain normal heart function after treatment.
With appropriate treatment, even people who develop heart failure as a result of long-standing heart disease often can enjoy many years of productive life.
American Heart Association (AHA)
7272 Greenville Ave.
Dallas, TX 75231
National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105