Heart Failure

What is heart failure?

The heart is a muscle that pumps oxygen-rich blood to all parts of the body. When you have heart failure, the heart is not able to pump as well as it should. Blood and fluid may back up into the lungs (congestive heart failure), and some parts of the body don’t get enough oxygen-rich blood to work normally. These problems lead to the symptoms of heart failure.

What causes heart failure?

Heart failure may result from:

• Heart valve disease caused by past rheumatic fever or other infections

• High blood pressure (hypertension)

• Active infections of the heart valves or heart muscle (for example, endocarditis or myocarditis)

• Previous heart attack(s) (myocardial infarction)

• Coronary artery disease

• Cardiomyopathy or another primary disease of the heart muscle

• Congenital heart disease or defects (present at birth)

• Cardiac arrhythmias (irregular heartbeats)

• Chronic lung disease and pulmonary embolism

• Certain medicines

• Excessive sodium (salt) intake

• Anemia and excessive blood loss

• Complications of diabetes

• Alcohol abuse

• Certain viral infections

How does heart failure affect the body?

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 shortness of breath. The changing fluid dynamics of the body in heart failure can also affect the kidneys and the liver.

What are the symptoms of heart failure?

These are the most common symptoms of heart failure:

• Shortness of breath during rest, exercise, or while lying flat

• Weight gain

• Visible swelling of the legs and ankles (due to a buildup of fluid), and, occasionally, swelling of the abdomen

• Fatigue and weakness

• Loss of appetite, nausea, and abdominal pain

• Persistent cough that can cause blood-tinged sputum

The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been compromised.

The symptoms of heart failure may look like other conditions or medical problems. Always talk to your healthcare provider for a diagnosis.

How is heart failure diagnosed?

Your doctor will do a complete medical history and physical exam. Other tests may include:

• Chest X-ray. This test uses electromagnetic energy beams to make images of internal tissues, bones, and organs onto film. This test shows the size and shape of your heart. Fluid in the lungs will also show up on X-ray.

• Echocardiogram (also called echo). This noninvasive test uses sound waves to evaluate the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. This shows how well the heart pumps. It also shows the thickness of the heart walls, and if the heart is enlarged. It is one of the most useful tests because it shows a great deal of information about the heart's function and helps guide treatment decisions.

• Electrocardiogram (ECG). This test records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and can sometimes detect heart muscle damage.

• BNP testing. B-type natriuretic peptide (BNP) is a hormone released from the ventricles that occurs with heart failure. BNP levels are useful in the rapid evaluation of heart failure. In general, the higher the BNP levels, the worse the heart failure. BNP is measured from a blood sample.

Treatment for heart failure

The cause of the heart failure will guide the treatment plan. If the heart failure is caused by a valve disorder, then surgery may be done to fix the valve. 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.

Treatment of heart failure may include the following.

Controlling risk factors

These include:

• Quitting smoking

• Losing weight (if overweight) and increasing moderate exercise

• Restrict salt and fat from the diet

• Avoiding alcohol

• Proper rest

• Controlling blood sugar if diabetic

• Controlling blood pressure

• Limiting fluids

Medicine

Medicines include:

• Angiotensin converting enzyme (ACE) inhibitors. This medicine decreases the pressure inside the blood vessels and reduces the resistance against which the heart pumps. These also help remodel the heart, which can promote better pumping ability.

• Angiotensin receptor blockers (ARB). This is an alternative medicine to reduce workload on the heart if you can't tolerate ACE inhibitors. Some people develop a cough and need to discontinue ACE inhibitors. It helps to relax blood vessels, reduce stress on the heart, and helps your body get rid of salt and fluid.

• Angiotensin receptor-neprilysin inhibitors (ARNIs). This new medicine combines an ARB and a neprilysin inhibitor. It helps relax blood vessels, reduce stress on the heart, and helps your body get rid of salt and fluid.

• Sinus node I-f channel blocker. This is a newer medicine that may be used to reduce heart rate, which puts less stress on the heart.

• Diuretics. These reduce the amount of fluid in the body and are among the most important medicines in helping control fluid buildup in the body.

• Vasodilators. These widen (dilate) the blood vessels and reduce workload on the heart.

• Digitalis. This medicine helps the heart beat stronger with a more regular rhythm. 

• Antiarrhythmics. These help maintain normal heart rhythm and help prevent sudden cardiac death.

• Beta-blockers. These reduce the heart's tendency to beat faster and reduce workload by blocking specific receptors on heart cells. They can also promote better pumping over time.

• Aldosterone blockers. This medicine blocks the effects of the hormone aldosterone which causes sodium and water retention.

• Statins. These medicines lowers the amount of bad cholesterol in your blood. While not used to treat heart failure, your doctor may prescribe a statin if you have high cholesterol or have had a past heart attack and are at risk for heart failure.

Other treatments

• Biventricular pacing/cardiac resynchronization therapy. A type of pacemaker that paces both pumping chambers of the heart at the same time to coordinate contractions and to improve the heart's function. Some people with heart failure are candidates for this therapy.

• Implantable cardioverter defibrillator. A device similar to a pacemaker that senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm. This can be a life saving device.

• Heart transplant. This is replacing the diseased heart with a healthy one from a donor.

• Ventricular assist devices (VADs). These are mechanical devices used to take over the pumping function for one or both of the heart's ventricles, or pumping chambers. A VAD may be needed when heart failure progresses to the point that medicines and other treatments no longer help.