Heart Failure

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

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

Overview

Heart failure develops over time as the heart's pumping action grows weaker. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart.

Right-side heart failure occurs if the heart can't pump enough blood to the lungs to pick up oxygen. Left-side heart failure occurs if 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 the veins in the neck. Right-side and left-side heart failure also may cause shortness of breath and fatigue (tiredness).

The leading causes of heart failure are diseases that damage the heart. Examples include ischemic heart disease, high blood pressure, and diabetes.

Outlook

Heart failure is a very common condition. About 5.7 million people in the United States have heart failure. Both children and adults can have the condition, although the symptoms and treatments differ. The Health Topic focuses on heart failure in adults.

Currently, heart failure has no cure. However, treatments—such as medicines and lifestyle changes—can help people who have the condition live longer and more active lives. Researchers continue to study new ways to treat heart failure and its complications.

• Congestive heart failure.
• Left-side heart failure. This is when the heart can't pump enough oxygen-rich blood to the body.
• Right-side heart failure. This is when the heart can't fill with enough blood.
• Cor pulmonale. This term refers to right-side heart failure caused by high blood pressure in the pulmonary arteries and right ventricle (lower right heart chamber).

Conditions that damage or overwork the heart muscle 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 substances might be released into the blood. These substances have a toxic effect on the heart and blood flow, and they worsen heart failure.

Causes of heart failure include:

• Ischemic heart disease
• Diabetes
• High blood pressure
• Other heart conditions or diseases
• Other factors

Ischemic Heart Disease

Ischemic heart disease is a condition in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.

Plaque narrows the arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow. Ischemic heart disease can lead to chest pain or discomfort called angina, a heart attack, and heart damage.

Diabetes

Diabetes is a disease in which the body’s blood glucose (sugar) level is too high. The body normally breaks down food into glucose and then carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy.

In diabetes, the body doesn’t make enough insulin or doesn’t use its insulin properly. Over time, high blood sugar levels can damage and weaken the heart muscle and the blood vessels around the heart, leading to heart failure.

High Blood Pressure

Blood pressure is the force of blood pushing against the walls of the arteries. If this pressure rises and stays high over time, it can weaken your heart and lead to plaque buildup.

Blood pressure is considered high if it stays at or above 140/90 mmHg over time. (The mmHg is millimeters of mercury—the units used to measure blood pressure.) If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher.

Other Heart Conditions or Diseases

Other conditions and diseases also can lead to heart failure, such as:

• Arrhythmia. Happens when a problem occurs with the rate or rhythm of the heartbeat.
• Cardiomyopathy. Happens when the heart muscle becomes enlarged, thick, or rigid.
• Congenital heart defects. Problems with the heart’s structure are present at birth.
• Heart valve disease. Occurs if one or more of your heart valves doesn’t work properly, which can be present at birth or caused by infection, other heart conditions, and age.

Other Factors

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

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

About 5.7 million people in the United States have heart failure. The number of people who have this condition is growing.

Heart failure is more common in:

• People who are age 65 or older. Aging can weaken the heart muscle. Older people also may have had diseases for many years that led to heart failure. Heart failure is a leading cause of hospital stays among people on Medicare.
• Blacks are more likely to have heart failure than people of other races. They’re also more likely to have symptoms at a younger age, have more hospital visits due to heart failure, and die from heart failure.
• People who are overweight. Excess weight puts strain on the heart. Being overweight also increases your risk of heart disease and type 2 diabetes. These diseases can lead to heart failure.
• People who have had a heart attack. Damage to the heart muscle from a heart attack and can weaken the heart muscle.

Children who have congenital heart defects also can develop heart failure. These defects occur if the heart, heart valves, or blood vessels near the heart don’t form correctly while a baby is in the womb. Congenital heart defects can make the heart work harder. This weakens the heart muscle, which can lead to heart failure. Children don’t have the same symptoms of heart failure or get the same treatments as adults. This Health Topic focuses on heart failure in adults.

You can take steps to prevent heart failure. The sooner you start, the better your chances of preventing or delaying the condition.

For People Who Have Healthy Hearts

If you have a healthy heart, you can take action to prevent heart disease and heart failure. To reduce your risk of heart disease:

• Avoid using illegal drugs.
• Adopt heart-healthy lifestyle habits.

For People Who Are at High Risk for Heart Failure

Even if you’re at high risk for heart failure, you can take steps to reduce your risk. People at high risk include those who have ischemic heart disease, high blood pressure, or diabetes.

• Follow all of the steps listed above. Talk with your doctor about what types and amounts of physical activity are safe for you.
• Treat and control any conditions that can cause heart failure. Take medicines as your doctor prescribes.
• Avoid drinking alcohol.
• See your doctor for ongoing care.

For People Who Have Heart Damage but No Signs of Heart Failure

If you have heart damage but no signs of heart failure, you can still reduce your risk of developing the condition. In addition to the steps above, take your medicines as prescribed to reduce your heart’s workload.

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 veins in the neck

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

As your 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 acute pulmonary edema (e-DE-ma). This is a condition in which too much fluid builds up in your lungs. The condition requires emergency treatment.

Heart Failure Signs and Symptoms

The image shows the major signs and symptoms of heart failure.

Your doctor will diagnose heart failure based on your medical and family histories, a physical exam, and test results. The signs and symptoms of heart failure also are common in other conditions. Thus, your doctor will take these steps:

• Find out whether you have a disease or condition that can cause heart failure, such as ischemic heart disease, high blood pressure, or diabetes.
• Rule out other causes of your symptoms.
• Find any damage to your heart and check how well your heart pumps blood.

Early diagnosis and treatment can help people who have heart failure live longer, more active lives.

Medical and Family Histories

Your doctor will ask whether you or others in your family have or have had a disease or condition that can cause heart failure.

Your doctor also will ask about your symptoms. He or she will want to know which symptoms you have, when they occur, how long you've had them, and how severe they are. Your answers will help show whether and how much your symptoms limit your daily routine.

Physical Exam

During the physical exam, your doctor will:

• Listen to your heart for sounds that aren't normal
• Listen to your lungs for the sounds of extra fluid buildup
• Look for swelling in your ankles, feet, legs, abdomen, and the veins in your neck

Diagnostic Tests

No single test can diagnose heart failure. If you have signs and symptoms of heart failure, your doctor may recommend one or more tests.

Your doctor also may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.

An EKG may show whether the walls in your heart's pumping chambers are thicker than normal. Thicker walls can make it harder for your heart to pump blood. An EKG also can show signs of a previous or current heart attack.

Chest X Ray

A chest x ray takes pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test can show whether your heart is enlarged, you have fluid in your lungs, or you have lung disease.

BNP Blood Test

This test checks the level of a hormone in your blood called BNP. The level of this hormone rises during heart failure.

Echocardiography

Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves work.

Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and heart muscle damage caused by lack of blood flow.

Echo might be done before and after a stress test (see below). A stress echo can show how well blood is flowing through your heart. The test also can show how well your heart pumps blood when it beats.

Doppler Ultrasound

A Doppler ultrasound uses sound waves to measure the speed and direction of blood flow. This test often is done with echo to give a more complete picture of blood flow to the heart and lungs.

Doctors often use Doppler ultrasound to help diagnose right-side heart failure.

Holter Monitor

A Holter monitor records your heart's electrical activity for a full 24- or 48-hour period, while you go about your normal daily routine.

You wear small patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.

Nuclear Heart Scan

A nuclear heart scan shows how well blood is flowing through your heart and how much blood is reaching your heart muscle.

During a nuclear heart scan, a safe, radioactive substance called a tracer is injected into your bloodstream through a vein. The tracer travels to your heart and releases energy. Special cameras outside of your body detect the energy and use it to create pictures of your heart.

A nuclear heart scan can show where the heart muscle is healthy and where it's damaged.

A positron emission tomography (PET) scan is a type of nuclear heart scan. It shows the level of chemical activity in areas of your heart. This test can help your doctor see whether enough blood is flowing to these areas. A PET scan can show blood flow problems that other tests might not detect.

Cardiac Catheterization

During cardiac catheterization (KATH-eh-ter-ih-ZA-shun), a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. This allows your doctor to look inside your coronary (heart) arteries.

During this procedure, your doctor can check the pressure and blood flow in your heart chambers, collect blood samples, and use x rays to look at your coronary arteries.

Coronary Angiography

Coronary angiography (an-jee-OG-rah-fee) usually is done with cardiac catheterization. A dye that can be seen on x ray is injected into your bloodstream through the tip of the catheter.

The dye allows your doctor to see the flow of blood to your heart muscle. Angiography also shows how well your heart is pumping.

Stress Test

Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast.

You may walk or run on a treadmill or pedal a bicycle. If you can't exercise, you may be given medicine to raise your heart rate.

Heart tests, such as nuclear heart scanning and echo, often are done during stress testing.

Cardiac MRI

Cardiac MRI (magnetic resonance imaging) uses radio waves, magnets, and a computer to create pictures of your heart as it's beating. The test produces both still and moving pictures of your heart and major blood vessels.

A cardiac MRI can show whether parts of your heart are damaged. Doctors also have used MRI in research studies to find early signs of heart failure, even before symptoms appear.

Thyroid Function Tests

Thyroid function tests show how well your thyroid gland is working. These tests include blood tests, imaging tests, and tests to stimulate the thyroid. Having too much or too little thyroid hormone in the blood can lead to heart failure.

Early diagnosis and treatment can help people who have heart failure live longer, more active lives. Treatment for heart failure depends on the type and severity of the heart failure.

The goals of treatment for all stages of heart failure include:

• Treating the condition’s underlying cause, such as ischemic heart disease, high blood pressure, or diabetes
• Reducing symptoms
• Stopping the heart failure from getting worse
• Increasing your lifespan and improving your quality of life

Treatments usually include heart-healthy lifestyle changes, medicines, and ongoing care. If you have severe heart failure, you also may need medical procedures or surgery.

 Heart-Healthy Lifestyle Changes

Your doctor may recommend heart-healthy lifestyle changes if you have heart failure. Heart-healthy lifestyle changes include:

• Heart-healthy eating
• Aiming for a healthy weight
• Physical activity
• Quitting smoking

 Medicines

Your doctor will prescribe medicines based on the type of heart failure you have, how severe it is, and your response to certain medicines. The following medicines are commonly used to treat heart failure: 

• 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 remove excess sodium through urine. This lowers the volume of blood that the heart must pump.
• Angiotensin receptor blockers relax your blood vessels and lower blood pressure to decrease your heart’s workload.
• Beta blockers slow your heart rate and lower your blood pressure to decrease your heart’s workload.
• Digoxin makes the heart beat stronger and pump more blood.
• Diuretics (fluid pills) help reduce fluid buildup in your lungs and swelling in your feet and ankles.
• Isosorbide dinitrate/hydralazine hydrochloride helps relax your blood vessels so your heart doesn’t work as hard to pump blood. Studies have shown that this medicine can reduce the risk of death in blacks. More studies are needed to find out whether this medicine will benefit other racial groups. 

Take all medicines regularly, as your doctor prescribes. Don’t change the amount of your medicine or skip a dose unless your doctor tells you to. You should still follow a heart healthy lifestyle, even if you take medicines to treat your heart failure.

 Ongoing Care

You should watch for signs that heart failure is getting worse. For example, weight gain may mean that fluids are building up in your body. Ask your doctor how often you should check your weight and when to report weight changes.

Getting medical care for other related conditions is important. If you have diabetes or high blood pressure, work with your health care team to control these conditions. Have your blood sugar level and blood pressure checked. Talk with your doctor about when you should have tests and how often to take measurements at home.

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

Many people who have severe heart failure may need treatment in a hospital from time to time. Your doctor may recommend oxygen therapy, which can be given in a hospital or at home.

 Medical Procedures and Surgery

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

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, your doctor might implant a cardiac resynchronization therapy device (a type of pacemaker) near your heart. This device helps both sides of your heart contract at the same time, which can decrease heart failure symptoms.

Some people who have heart failure have very rapid, irregular heartbeats. Without treatment, these heartbeats can cause sudden cardiac arrest. Your doctor might implant an implantable cardioverter defibrillator (ICD) near your heart to solve this problem. An ICD checks your heart rate and uses electrical pulses to correct irregular heart rhythms.

People who have severe 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. You may use a heart pump until you have surgery or as a long-term treatment.
• Heart transplant. A heart transplant is an operation in which a person’s diseased heart is replaced with a healthy heart from a deceased donor. Heart transplants are done as a life-saving measure for end-stage heart failure when medical treatment and less drastic surgery have failed.

Currently, heart failure has no cure. You'll 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 might 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. Thus, it's important that you follow your treatment plan.

• Take your medicines as your doctor prescribes. If you have side effects from any of your medicines, tell your doctor. He or she might adjust the dose or type of medicine you take to relieve side effects.
• Make all of the lifestyle changes that your doctor recommends.
• Get advice from your doctor about how active you can and 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).
• 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 harmful side effects.

Take Steps To Prevent Heart Failure From Getting Worse

Certain actions can worsen your heart failure, such as:

• Forgetting to take your medicines
• Not following your diet (for example, eating salty foods)
• Drinking alcohol

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

People who have heart failure often have other serious conditions that require ongoing treatment. If you have other serious conditions, 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 doctors and your pharmacist have 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 prescribed by another doctor 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.

Plan Ahead

If you have heart failure, it's important to know:

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

Emotional Issues and Support

Living with heart failure may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.

Joining a patient support group may help you adjust to living with heart failure. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.

Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.