Things to know about heart failure
- The definition of heart failure is when the heart cannot pump efficiently enough for blood to circulate oxygen-rich blood throughout the body. When the heart becomes weak or when it becomes thickened and stiff, the heart muscle cannot keep up with its workload.
- Signs and symptoms of heart failure include
- shortness of breath,
- fatigue,
- lightheadedness,
- exercise intolerance,
- coughing (or chronic cough),
- wheezing,
- pounding or racing heart,
- excessive tiredness,
- loss of appetite,
- nausea,
- confusion,
- problems thinking,
- swelling in the ankles, and
- rarely, chest pain
- Symptoms are usually worse at night when lying flat.
- Risk factors for heart failure include high blood pressure, prior heart attack, obesity, smoking, alcohol abuse, vitamin deficiencies, sleep apnea, heavy metal toxicity, eating an unhealthy diet (including animal fat and salt), and being sedentary.
- The cause of heart failure is a weakened or thickened cardiac muscle. When risk factors for heart failure are present, there usually is inflammatory stress, which further damages the cardiac muscle, depleting cells of energy and antioxidants.
- There are four stages of heart failure, used to classify the severity of symptoms.
- Heart failure treatment includes lifestyle and diet changes, taking medications, and sometimes implanting devices. A heart transplant may be needed in some cases.
- Medications can help reduce the symptoms of congestive heart failure (CHF) and improve heart muscle function. Commonly prescribed medications for heart failure include beta-blockers, diuretics (water pills), ACE (angiotensin-converting enzyme) inhibitors, and ARBs (angiotensin receptor blockers).
- The prognosis for heart failure is highly variable. If lifestyle changes are not made, medications are not taken, or the underlying causes are not correctable, heart failure can become a progressive and ultimately fatal condition.
- Heart failure can be prevented and reversed by making healthier choices such as addressing stress, being active, eating well, getting enough nutrients, treating sleep apnea, and taking medications as prescribed.
Heart Failure Early Symptoms and Signs
Heart failure occurs when the heart muscle is not able to function in a manner that can sufficiently supply the body with oxygen. Congestive heart failure is the failure of the heart muscle to maintain the circulation, leading to a backup of blood in the veins that causes:
- swelling (particularly in the lower parts of the body);
- shortness of breath is another common symptom of congestive heart failure that occurs due to fluid buildup in the lungs; and
- fatigue and a decreased capacity to exercise are other symptoms that commonly result from heart failure.
Early symptoms and signs may not be apparent, and symptoms may develop only after the condition has progressed over time.
Read more about early symptoms and signs of heart failure »
What is heart failure?
The term heart failure can be frightening, but in reality, it just means that
the heart is not pumping as well as it could be. When the heart muscle is weak,
blood cannot be pumped efficiently enough to get oxygen to all of the cells.
Sometimes the heart becomes dilated and weak. Other times it may be stiff and
thickened. Over time, the heart cannot keep up with its workload. When this
happens, there isn’t enough oxygenated blood reaching the brain and muscles, and
fluid begins to backup in the
lungs and other tissues. The lack of oxygen
causes the main symptoms of heart failure such as fatigue, shortness of breath,
and difficulty completing tasks that require exertion.
What are the different types of heart failure?
The heart has four chambers through which blood pumps. Newly oxygenated blood is pumped from the lungs to the left atrium and left ventricle and out through the aorta to circulate through the rest of the body. After the oxygen has been used, the blood returns through the veins to the right atrium and right ventricle into the lungs to be re-oxygenated.
- Systolic heart failure (left-sided heart failure): When the heart loses strength on the left side (left ventricle) and cannot pump the blood into circulation, it is called systolic heart failure or left-sided heart failure. When this occurs, the heart becomes dilated and weak. The strength of the heart muscle can be measured with an echocardiogram that measures the ejection fraction. An ejection fraction of 70% is normal. The term congestive heart failure, or CHF, refers to the accumulation of fluid in the tissues. Fluid can accumulate in the legs causing swelling (edema), into the lungs causing pulmonary edema, or into the abdomen where it is called ascites. A type of heart failure termed acute decompensated heart failure is an emergency.
- Diastolic heart failure (right-sided heart failure): The second type of heart failure is diastolic heart failure, characterized by the bottom chambers of the heart becoming thicker and stiffer. When this happens, the left ventricle cannot fill with sufficient blood, and not enough blood is pumped into circulation, even if the pumping action is still strong. This is why diastolic heart failure is sometimes referred to as heart failure with preserved ejection fraction (PEF), or right-sided heart failure. If the signs and symptoms of heart failure are present and the ejection fractions is greater than 50%, diastolic heart failure may be considered, especially if an echocardiogram shows the heart muscle is thickening.
What are heart failure symptoms and signs?
Symptoms of heart failure include:
- Shortness of breath
- Fatigue
- Lightheadedness
- Exercise intolerance
- Loss of appetite
- Nausea
- Coughing (or chronic
cough) - Wheezing
- Pounding or racing heart
- Excessive tiredness
- Confusion
- Problems thinking
- Swelling in the ankles
- Swelling in the abdomen
- Chest pain
Symptoms are usually worse at night when lying flat. Symptoms are very
similar for systolic and diastolic heart failure. Your doctor may need further
testing to see which type you have.
What are the risk factors for heart failure?
The most common risk factors for heart failure include:
-
Coronary
artery disease - Previous heart attack
- Heart valve problems
- Cardiomyopathy
- Other major risk factors include:
- High blood pressure
- Genetics (congenital heart defects)
- Infections (especially viral
infections) - Obesity
Less well recognized risk factors of heart failure include:
- Sleep apnea
- Nutrient deficiencies
- An unhealthy diet (low in antioxidant vegetables and high in animal
fats) - Stress
- Lack of exercise
All of these also contribute to coronary artery
disease, which is a major risk factor for heart failure.
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What causes heart failure?
The cause of heart failure is a weakened or thickened cardiac muscle. For
example, in chronic high blood pressure (hypertension), the heart must pump
extra forcefully against the additional blood pressure. First it becomes
enlarged and thickened. But over time, the heart weakens, scarring (fibrosis)
develops, and it becomes less efficient at pumping. It can become larger
(dilated) and weak or thickened and stiff. When the risk factors for heart
failure are present, there usually is inflammatory stress, which further damages
the cardiac muscle depleting cells of energy and antioxidants.
What are heart failure stages or classifications?
While doctors define heart failure in stages or classifications, it
represents a progression of heart muscle weakness. Sometimes people refer to
this process as chronic heart failure but technically that term isn’t correct.
The New York Heart Association (NYHA) puts the stages of heart failure into
four classifications:
- Class I: no limitations in activity.
Normal activities can be performed. - Class II: mild limitations and mild
symptoms with activity; no symptoms at rest - Class III: noticeable limitations in
activity; only comfortable at rest - Class IV: symptoms occur at any level
of activity and uncomfortable even resting
The American Heart Association along with the American College of Cardiology
grades heart failure in four stages, and takes into account that heart failure
can be present even before symptoms appear:
- Stage A: No heart failure, but at high
risk due to another medical condition that can lead to heart failure, such as
high blood pressure, diabetes, obesity, or coronary artery disease. - Stage B: The heart has been damaged by
the patient's other medical condition(s) or other factors, but no symptoms
are present yet. - Stage C: The heart is damaged and the patient is experiencing heart failure symptoms.
- Stage D: The patient has severe heart failure
that requires specialized care, despite receiving treatment (end-stage).
How do doctors diagnose heart failure?
- Heart failure can be diagnosed by physical exam, reported symptoms, or chest X-ray.
- An echocardiogram test can identify a low ejection fraction or a thickened, stiff heart muscle.
- Echocardiograms may be used to distinguish between systolic and diastolic types of heart failure.
- Blood tests such as BNP (beta naturetic peptide) suggest heart failure.
- Algorithms and guidelines exist to score and weigh signs and symptoms to help make the diagnosis.
QUESTION
What is heart failure?
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What is the treatment for heart failure?
Heart failure treatment options include making healthier decisions about
lifestyle and diet, taking medications, and sometimes implanting devices. Heart
transplant is sometimes considered for certain individuals.
In acute or decompensated heart failure, the person may need hospitalization or even
intravenous medications to help recover.
What diet and lifestyle management techniques help heart failure?
Many lifestyle and diet factors can improve, or even reverse, congestive heart failure. Cardiac rehabilitation programs can teach people how to make lifestyle changes, as can integrative cardiology clinics. Some of the lifestyle factors that make a difference include:
- Manage stress by doing mind-body practices such as Tai Chi, yoga, Qi Gong, and meditation
- Quit smoking or using tobacco
- Eliminate alcohol
- Eat a healthy Mediterranean, vegetarian, or vegan diet
- Be physically active and become stronger
- Get enough restful sleep
- Manage and treat sleep apnea
- Take dietary supplements including CoQ10, L-carnitine, Crataegus (hawthorne), magnesium, and fish oil
- Avoiding salt and excess fluids
Talk to your doctor before taking any herbs or supplements.
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What medications treat heart failure?
Medications help reduce the symptoms of congestive heart failure (CHF) and
can actually improve heart muscle function. There are several main classes of
medications that are used for treating a weak heart muscle. Your physician will
choose medications based on your symptoms and whether your heart needs to be
strengthened or relaxed. The types of medications commonly prescribed for heart
failure include:
- Beta-blockers: carvedilol (Coreg),
bisoprolol (Zebeta), metoprolol (Lopressor, Toprol), nebivolol (Bystolic),
acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), carteolol
(Cartrol), esmolol (Brevibloc), penbutolol (Levatol), nadolol (Corgard),
pindolol (Visken), propranolol (Inderal, InnoPran), timolol (Blocadren),
labetalol (Trandate, Normodyne) - Diuretics (water pills):
Thiazide diuretics:
hydrochlorothiazide (Microzide,
Hydrodiuril), chlorothiazide (Diuril),
metolazone (Mykrox,
Zaroxolyn, Diulo),
methyclothiazide (Enduron),
indapamide (Lozol), chlorothalidone (Hygrotron) - Loop diuretics: furosemide (Lasix), bumetanide (Bumex),
torasemide (Demadex), ethacrynate (Edecrin) - Potassium sparing diuretics: spironolactone (Aldactone),
triamterene (Dyrenium), eplerenone (Inspra), amiloride hydrochloride - ACE (angiotensin converting enzyme)
inhibitors: lisinopril (Prinivil, Zestril), benazepril (Lotensin), and captopril
(Capoten), enalapril/enalaprilat (Vasotec oral and injectable), fosinopril
(Monopril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril),
ramipril (Altace), trandolapril (Mavik) - ARBs (angiotensin receptor blockers):
candesartan (Atacand), irbesartan (Avapro), olmesartan (Benicar), losartan
(Cozaar), valsartan (Diovan), telmisartan (Micardis), eprosartan (Teveten)
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What procedures or surgery treats heart failure?
In severe heart failure, devices can help the heart pump better. Left
Ventricular Assist Devices (LVAD) are implanted mechanical pumps that are most
commonly used when people are waiting for heart transplants.
When medications and lifestyle haven’t stopped the progression of heart
failure, surgical transplantation of a donor heart can be lifesaving.
Other
surgical procedures can sometimes be performed earlier to address the risk factors
and causes of heart disease such as coronary artery bypass, percutaneous
coronary intervention, or angioplasty
to open the blockages of coronary atherosclerosis.
Which specialties of doctors treat heart failure?
You may initially see your primary care provider (PCP) such as a family
practitioner or internist, and in a sudden or severe situation you may be seen
by an emergency medicine specialist in a hospital’s emergency department.
You will be referred to a cardiologist, a specialist in disorders of the
heart. You also may see some sub-specialties of cardiology, including a cardiac electrophysiologist, who specializes in electrical and heart rhythm problems, or
a cardiothoracic surgeon if surgery is needed.
What are the potential complications of heart failure?
The complications of heart failure include severe fatigue and weakness,
inability to complete activities of daily living, kidney damage, and progressive
heart failure that could ultimately require heart transplant.
What is the prognosis and life expectancy for a person with heart failure?
The course of heart failure is highly variable. People who address their risk
factors and make lifestyle changes may never progress. However, if changes are
not made, if medications are not taken, or if the underlying causes are not
correctable, heart failure can become a progressive and eventually fatal
condition. This means that the heart muscle will continue to get weaker and have
more difficulty keeping up with the workload. Fortunately, many
treatment options exist for heart failure.
Is it possible to prevent heart failure?
- The best way to prevent heart failure is to never have a heart attack, but if you do, there still are treatments. The Lyon Heart study demonstrated that a Mediterranean diet can prevent heart failure among people who have had a heart attack.
- Following other healthy lifestyle recommendations such as not smoking, not abusing alcohol, eating a plant-based diet, eating a diet that is antioxidant rich, eating an anti-inflammatory diet such as a Mediterranean diet, and being physically active every day may also help prevent heart failure.
- Treating early signs of heart failure and risk factors such as high blood pressure, being overweight or obese, and hardening of the arteries (atherosclerosis) are also strategies to prevent congestive heart failure.
- Stress raises blood pressure, worsens diabetes, and causes coronary artery disease. Learning stress resiliency techniques such as Transcendental Meditation, Yoga, or meditation can reduce the risk of many types of cardiovascular disease.
