Heart Failure

What Is Heart Failure?

Heart failure is a condition in which the heart can't pump blood the way it should. In some cases, the heart can't fill with enough blood. In other cases, the heart can't send blood to the rest of the body with enough force. Some people have both problems.

"Heart failure" doesn't mean that your heart has stopped or is about to stop working. However, it's a serious condition that requires medical care.

Overview

Heart failure develops over time as the pumping of the heart grows weaker. It can affect the right side of the heart only or both the left and right sides of the heart. Most cases involve both sides of the heart.

Right-side heart failure occurs when the heart can't pump blood to the lungs, where it picks up oxygen. Left-side heart failure occurs when the heart can't pump enough oxygen-rich blood to the rest of the body.

Right-side heart failure may cause fluid to build up in the feet, ankles, legs, liver, abdomen and, rarely, the veins in the neck. Right-side and left-side heart failure also cause shortness of breath and fatigue (tiredness).

The leading causes of heart failure are diseases that damage the heart. These include coronary artery disease (CAD), high blood pressure and diabetes.

Outlook

Heart failure is a very common condition. About 5 million people in the United States have heart failure, and it results in about 300,000 deaths each year.

Both children and adults can have heart failure, although the symptoms and treatments differ. This article focuses on heart failure in adults.

Taking steps to prevent CAD can help prevent heart failure. These steps include following a heart healthy diet, not smoking, doing physical activity, and losing weight if you're overweight or obese. Working with your doctor to control high blood pressure and diabetes also can help prevent heart failure.

People who have heart failure can live longer and more active lives if it's diagnosed early and they follow their treatment plans. For most, treatment includes medicines and lifestyle measures.

Currently, there's no cure for heart failure. However, researchers are finding and testing new treatments. These treatments offer hope for better ways to delay heart failure and its complications.

Other Names for Heart Failure

• Dropsy
• Left-side or systolic heart failure—When the heart can't pump enough oxygen-rich blood to the body
• Right-side or diastolic heart failure—When the heart can't fill with enough blood

Some people have only right-side heart failure. But all people who have left-side heart failure also have right-side heart failure. Treatments for right-side heart failure alone differ from treatments for both right-side and left-side heart failure. Your doctor will plan your treatment based on your type of heart failure and your unique needs.

What Causes Heart Failure?

Conditions that damage the heart muscle or make it work too hard can cause heart failure. Over time, the heart weakens. It isn't able to fill with and/or pump blood, as well as it should.

As the heart weakens, certain proteins and other substances may be released into the blood. They have a toxic effect on the heart and blood flow, and they cause heart failure to worsen.

The most common causes of heart failure are coronary artery disease (CAD), high blood pressure and diabetes. Treating these problems can prevent or improve heart failure.

Other diseases and conditions that can lead to heart failure are:

• Heart muscle diseases. These diseases may be present at birth or due to injury or infection.
• Heart valve disorders. These problems may be present at birth or due to infections, heart attacks, or damage from heart disease.
• Arrhythmias (ah-RITH-me-ahs) or irregular heartbeats. These heart problems may be present at birth or due to heart disease or heart defects.
• Congenital heart defects. These heart problems are present at birth.

Other factors also can injure the heart muscle and lead to heart failure.

These include:

• Treatments for cancer, such as radiation and chemotherapy
• Thyroid disorders (having either too much or too little thyroid hormone in the body)
• Alcohol abuse
• HIV/AIDS
• Cocaine and other illegal drug use
• Too much vitamin E

Heart damage from obstructive sleep apnea may cause heart failure to worsen. In obstructive sleep apnea, your breathing stops or gets very shallow while you're sleeping. This can deprive the heart of oxygen and increase its workload. Treating this sleep problem may decrease the likelihood of heart failure.

Who Is At Risk for Heart Failure?

About five million people in the United States have heart failure, and it results in about 300,000 deaths each year. The number of people who have heart failure is growing. Each year, another 550,000 people are diagnosed for the first time.

Heart failure is more common in:

• People who are 65 or older. Aging can weaken the heart muscle. Older people also may have had a disease for many years that causes heart failure. Heart failure is the #1 reason for hospital visits in this age group.
• African Americans. African Americans are more likely than people of other races to have heart failure and to suffer from more severe forms of it. They're also more likely than other groups to have symptoms at a younger age, get worse faster, have more hospital visits due to heart failure and die from heart failure.
• People who are overweight or obese. Excess weight puts a greater strain on the heart. It also can lead to Type II Diabetes, which adds to the risk of heart failure.

Men have a higher rate of heart failure than women. But in actual numbers, more women have the condition. This is because many more women than men live into their seventies and eighties when it's common.

Children with congenital heart defects also can develop heart failure. Children are born with these defects when the heart, heart valves and/or blood vessels near the heart don't form correctly. This can weaken the heart muscle and lead to heart failure.

Children don't have the same symptoms or get the same treatment for heart failure as adults. This article focuses on heart failure in adults.

What Are the Signs and Symptoms of Heart Failure?

The most common signs and symptoms of heart failure are:

• Shortness of breath or trouble breathing
• Fatigue (tiredness)
• Swelling in the ankles, feet, legs, abdomen and, rarely, the veins in your neck

All of these symptoms are due to the buildup of fluid in your body. When symptoms start, you may feel tired and short of breath after routine physical effort—like climbing stairs.

As the heart grows weaker, symptoms get worse. You may begin to feel tired and short of breath after getting dressed or walking across the room. Some people have shortness of breath while lying flat.

Fluid buildup from heart failure also causes weight gain, frequent urination and a cough that's worse at night and when you're lying down. This cough may be a sign of a condition called acute pulmonary (PULL-mun-ary) edema (e-DE-ma). This is when too much fluid is in your lungs. This severe condition requires emergency treatment.

How Is Heart Failure Treated?

Early diagnosis and treatment can help people with heart failure live longer, more active lives. How heart failure is treated will depend on your type and stage of heart failure (how severe it is).

The goals of treatment for all stages of heart failure are to:

• Treat the underlying cause of your heart failure, such as coronary artery disease (CAD), high blood pressure or diabetes
• Reduce your symptoms
• Stop your heart failure from getting worse
• Increase your lifespan and improve your quality of life

For people with any stage of heart failure, treatment will include lifestyle measures, medicines and ongoing care. People who have more severe heart failure also may need medical procedures and surgery.

Lifestyle Measures

You can take simple steps to help yourself feel better and control heart failure. The sooner you start these measures, the better off you're likely to be.

• Follow a Healthy Eating Plan.
• Adopt healthy habits.
• Taking steps to control risk factors for CAD, high blood pressure and diabetes also will help control heart failure.
• Lose weight if you're overweight or obese. Work with your health care team to lose weight safely.
• Do physical activity as your doctor directs to become more fit and stay as active as possible.
• Quit smoking and avoid using illegal drugs. Avoid exposure to secondhand smoke. Smoking and drugs can worsen heart failure and harm your health.
• Get enough rest.

Medicines

Your doctor will base your medicine treatment on the type of heart failure you have, how severe it is and your response to certain medicines. The following are the main medicines for treating heart failure.

• Diuretics (water or fluid pills) help reduce fluid buildup in your lungs and swelling in your feet and ankles.
• ACE inhibitors lower blood pressure and reduce strain on your heart. They also may reduce the risk of a future heart attack.
• Aldosterone antagonists trigger the body to get rid of salt and water through urine, which lowers the volume of blood that the heart must pump.
• Angiotensin receptor blockers relax your blood vessels and lower blood pressure, so the heart doesn't have to work as hard.
• Beta blockers slow your heart rate and lower your blood pressure to decrease the workload on your heart.
• Isosorbide dinitrate/hydralazine hydrochloride helps relax your blood vessels, so your heart doesn't work as hard to pump blood. The Food and Drug Administration approved this medicine for use in African Americans after studies showed it worked well for this group.
• Digoxin makes the heart beat stronger and pump more blood.

Many people with severe heart failure must be treated in the hospital from time to time. In the hospital, you may receive new or special medicines, but you will keep taking your other medicines too. Some people with very severe heart failure are given intravenous (IV) medicines, which are injected into veins in their arms.

Your doctor also will order extra oxygen if you take medicine but still have trouble breathing. The extra oxygen can be given in the hospital and at home.

Ongoing Care

It's important to watch for signs that heart failure is getting worse. Weigh yourself each day. Let your doctor know right away if you have a sudden weight gain or weight loss. Either one can signal a need to adjust your treatment. If your doctor advises you to limit your intake of fluids, carefully watch how much you drink during the day.

It's also important to get medical care for other related conditions. If you have diabetes and/or high blood pressure, work with your health care team to control your condition(s). Have your blood sugar level and blood pressure checked. Your doctor will tell you how often to come in for tests and how often to take measurements at home.

Medical Procedures and Surgery

As heart failure worsens, lifestyle changes and medicines may no longer control heart failure symptoms. You may need a medical procedure or surgery.

If you have heart damage and severe heart failure symptoms, you may need:

• Cardiac resynchronization therapy. In heart failure, the right and left sides of the heart may no longer contract at the same time. This disrupts the heart's pumping. To correct this problem, doctors may implant a type of pacemaker near your heart. This device helps both sides of the heart contract at the same time, which may decrease heart failure symptoms.
• An implantable cardioverter defibrillator (ICD). Some people with heart failure have very rapid, irregular heartbeats. Without treatment, the problem can cause sudden cardiac arrest. Doctors implant ICDs to solve this problem. ICDs are similar to pacemakers. The device checks your heart rate and corrects heart rhythms that are too fast.

People who have heart failure symptoms at rest despite other treatments may need:

• A mechanical heart pump, such as a left ventricular assist device. This device helps pump blood from the heart to the rest of the body. People may use pumps until they have surgery or as a long-term treatment.
• Heart transplant. When all other treatments fail to control symptoms, some people who have heart failure receive healthy hearts from deceased donors.
• Experimental treatments. Studies are under way to see whether open-heart surgery or angioplasty (a procedure used to unblock heart arteries and improve blood flow) can reduce heart failure symptoms.

Living With Heart Failure

Heart failure can't be cured. You will likely have to take medicine and follow a treatment plan for the rest of your life.

Despite treatment, symptoms may get worse over time. You may not be able to do many of the things that you did before you had heart failure. However, if you take all the steps your doctor recommends, you can stay healthier longer.

Researchers also may find new treatments that can help you in the future.

Follow Your Treatment Plan

Treatment can relieve your symptoms and make daily activities easier. It also can reduce the chance that you'll have to go to the hospital. For these reasons, it's vital that you follow your treatment plan.

• Take all of your medicines as your doctor prescribes. If you have side effects from a medicine, tell your doctor. You should never stop taking medicine without asking your doctor first.
• Make all of the lifestyle changes that your doctor recommends.
• Get advice from your doctor about how active you can/should be. This includes advice on daily activities, work, leisure time, sex and exercise. Your level of activity will depend on the stage of your heart failure (how severe it is). Studies show that aerobic exercise improves heart function; other types of exercise don't.
• Keep all of your medical appointments, including visits to the doctor and appointments to get tests and lab work. Your doctor needs the results of these tests to adjust your medicine doses and help you avoid any harmful side effects.

Take Steps To Prevent Heart Failure From Getting Worse

Certain factors can cause your heart failure to worsen. These include:

• Forgetting to take your medicines
• Not following your diet (such as eating salty foods)
• Drinking alcohol

These factors can lead to a hospital stay. If you have trouble following your diet, talk to your doctor. Your doctor can help arrange for a dietitian to work with you. Avoid drinking alcohol.

People with heart failure often have other serious conditions that require ongoing treatment. If you do, you're likely taking medicines for them, as well as for heart failure. Taking more than one medicine raises the risk of side effects and other problems. Make sure your pharmacist has a complete list of all of the medicines and over-the-counter products that you're taking.

Tell your doctor right away about any problems with your medicines. Also, talk with your doctor before taking any new medicine another doctor prescribes or any new over-the-counter medicines or herbal supplements.

Try to avoid respiratory infections like the flu and pneumonia. Ask your doctor or nurse about getting flu and pneumonia vaccines.

Coping with heart failure and changing your life to decrease symptoms can be hard. You may feel depressed. If so, talk to your doctor. He or she may recommend treatment for depression. This treatment can improve your outlook and help you enjoy life more.

Plan Ahead

Be ready to meet your health needs. Know:

• When to seek help. Talk to your doctor about when to make an office visit or when to get urgent help.
• Phone numbers for your doctor and hospital.
• Directions to the doctor's office or hospital and people who can take you there.
• A list of medicines you're taking.

Source: National Heart Lung and Blood Institute

Please feel free to download and view our booklet on heart surgery information for patients and their families (1.7MB, PDF).

More information is available on the Cardiovascular Center Heart Failure page.