Heart Failure

Heart Failure is a condition where the heart becomes so weak that it has trouble pumping a normal amount of blood. When the heart can't keep up with the volume of blood returning from the body, the blood backs up in the pulmonary veins (the blood vessels that carry blood from the lung to the heart). Fluid pools in the lungs and interferes with normal breathing. The build up of fluid is the reason for the term “congestive” heart failure. It also accounts for the telltale symptoms so common in heart failure patients: shortness of breath and fatigue. Sometimes fluid builds up in other parts of the body, with the most apparent symptom being swelling (edema) of the legs. To make matters worse, when kidneys (the body's clearinghouse) do not receive enough blood, they produce certain hormones that can cause excess fluid and water retention. This increase in fluid makes the situation worse, requiring the heart to handle an even greater volume of fluid and leading to more swelling (edema.)

For Basic Facts on Heart Failure click here.

Signs and Symptoms

Many people do not have symptoms, or do not recognize them as serious, especially in the early stages of heart failure. As heart failure progresses, the following symptoms may begin to appear:

Shortness of breath (dyspnea)
Patients may experience breathlessness during exercise or other activity and even when resting or lying down. The sense that one “cannot breathe” may come on suddenly and can waken people from sleep. Some people with heart failure must prop themselves up with extra pillows to breathe more easily. Patients complain they wake up feeling exhausted or anxious, even after many hours of sleep. Tiredness, fatigue and a general “lack of energy” As heart failure becomes more severe, the heart can no longer pump enough blood to meet all the body’s needs. People with heart failure often feel tired all the time, and have difficulty performing ordinary activities such as walking, climbing stairs or carrying groceries.

Chronic cough or wheezing
The build-up of fluid in the lungs causes the lungs to work harder. Patients may have a persistent cough or wheezing (a whistling sound in the lungs, or labored breathing). Sometimes, people with heart failure cough up phlegm, a thick, mucous-like substance that may be tinged with blood.

Rapid or irregular heart beat
The heart may speed up to compensate for its failing ability to pump blood normally. Patients may feel a fluttering in the heart (palpitations), or a heartbeat that seems irregular or out of rhythm. The sensation often is described as a “pounding” or “racing” sensation in the chest.

Lack of appetite or nausea
People may complain of being “sick to their stomach” or have the feeling of being “full,” even when they have not eaten for a long time. Their abdomen may become swollen or distended.

HEART FAILURE AND ARRHYTHMIAS: THE LINK
Damaged or stretched heart muscle, as is seen in heart failure, often impairs the electrical system that controls the normal, steady rhythm of the heartbeat. Damaged heart muscle may cause a heartbeat that is too slow (bradycardia), too fast (tachycardia) or irregular. Abnormal heart rhythms (arrhythmias) are common in heart failure patients.

Mental confusion or impaired thinking
Abnormal levels of certain substances in the blood, such as sodium, or reduced blood flow to the brain can cause memory loss or disorientation. The person with heart failure may not notice these changes. A family member or caregiver may be the first to recognize mental impairment in the patient with heart failure.

Fluid retention, swelling
Swelling (edema), especially in the legs, feet and ankles or in the abdomen, can signal water retention characteristic of heart failure. Unexplained weight gain is another sign.

Causes, Risk Factors and Prevention

Regular physical examinations are important, especially for those at high risk for heart failure. Early diagnosis and treatment can stop or reverse the progression of heart failure. Living a “heart healthy” lifestyle that includes regular exercise, a healthy diet low in sodium (salt) and not smoking also is important. The most common risk factors that lead to heart failure include:

• Damage from a prior heart attack (myocardial infarction) or coronary artery disease (clogged blood vessels)
• High blood pressure
• Diseases of the heart muscle or valves
• Diabetes

Diagnosis and Treatment

Treatments, or a combination of treatments, are selected based on the type, cause and severity of heart failure. Treatment may include:

• Lifestyle changes
• Medications
• Treatment of underlying causes, such as coronary artery disease, heart valve disease, high blood pressure and arrhythmias.
• Surgery to reduce or control structural changes in the heart or, in some patients with the most severe form of heart failure, heart transplant may be an option.
• Implanted devices can control arrhythmias (abnormal heart rhythms) that may result from heart failure. Devices include pacemakers to treat a too-slow heart rate and implantable cardioverter defibrillators (ICDs) to stop a too-rapid heart rate that could be life threatening.
• Cardiac resynchronization therapy (CRT) is a technique in which a special type of pacemaker is implanted to coordinate, or synchronize, muscle contractions in the ventricles. This can improve the heart's pumping ability in certain groups of patients.