Definition
In heart failure, the heart is unable to pump the right amount of blood throughout the body. This causes blood to back up in the veins. Depending on which part of the heart is affected, this can lead to a buildup of excess fluid in the lungs, feet, and elsewhere. Heart failure can worsen with time, which may lead to the use of many treatments. Because of this, doctors are aggressive in treating heart failure to try to prevent it from worsening.
Causes
The leading causes of heart failure are:
- Coronary artery disease
- Heart attack
Other common causes include:
- Problems with the heart’s valves due to:
- Rheumatic heart disease
- Bacterial endocarditis
- Congenital defects
- Calcium deposits from atherosclerosis
- High blood pressure
- Diabetes
Other less common causes include:
- Cardiomyopathy—weakened, damaged heart muscle from various causes
- Certain medicines
- Abnormal heartbeats—arrhythmias
- Hyperthyroidism—overactive thyroid
- Amyloidosis
- Kidney failure and/or liver failure
- Thiamine (vitamin B1) deficiency
Symptoms
Symptoms include:
- Shortness of breath—at first only with activity, then progressing to shortness of breath at rest
- Unexplained weight gain
- Swelling of feet, ankles, or legs
- Need to sleep propped up
- Fatigue, weakness
- Wheezing
- Cough—may be dry and hacking or wet sounding, may have a pink, frothy sputum
- Frequent urination, especially at night
- Abdominal pain
Risk Factors
Factors that increase your chances of getting heart failure include:
- Increased age
- Obesity
- Excess intake of salt and fat
- Excess alcohol intake
- Sex: male
- Race: Black
- Smoking
- Pregnancy
- High fever
- Severe infection
- Chronic lung disease—emphysema
- Chemotherapy
Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done.
Your bodily fluids may be tested. This can be done with:
- Blood tests
- Urine tests
Your heart may be examined. This can be done with:
- Electrocardiogram (ECG)
- Echocardiogram
- Exercise stress test
- Nuclear scanning
- Coronary angiography
Treatment
Treatment of Condition Causing the Symptoms
Heart failure may be caused by another condition. Treating this condition should improve your heart failure or prevent it from getting worse.
Lifestyle Changes
The following lifestyle changes can help treat the symptoms of heart failure and slow down its progression:
- Avoid alcohol.
- If you smoke, quit.
- Lose weight if needed
- Eat a healthy diet. Your diet should be low in fat and high in fiber.
- In some cases, you may need to restrict salt and fluid intake.
- Begin an exercise program with guidance from your doctor. Aerobic training may help improve your level of physical activity and quality of life. You should aim to exercise for 20-30 minutes at least five times each week. You can begin slowly and work your way to this goal. Talk to your doctor before you start an exercise program.
- Weigh yourself every morning. This will allow you to quickly detect if you are retaining fluid. Call your doctor if you gain three or more pounds in one day, five or more pounds in one week, or whatever amount you were told to report. The best time to weigh yourself is before breakfast and after urinating. You should weigh yourself while wearing the same type of clothes, without shoes, and on the same scale. This will help you to know that your weight is accurate.
Medicines
Your doctor will most likely prescribe a combination of medicines, such as:
- Angiotensin-converting enzyme (ACE) inhibitors or their alternatives to widen blood vessels
- Digoxin, also called digitalis, to help your heart pump
- Beta-blockers to slow your heart rate and lower blood pressure
- Diuretics to remove excess fluid in your body
- Nitrates to dilate the blood vessels
You may also be given medications to:
- Thin the blood, such as aspirin, warfarin
- Help manage chest pain, such as nitroglycerin
- Help manage cholesterol levels
- Help control high blood pressure
If heart failure worsens, you may need medical devices to help your heart pump blood properly. If you have heart failure, follow your doctor’s instructions.
Prevention
The best way to prevent heart failure is to reduce your risk of:
- Coronary artery disease
- High blood pressure
- Diabetes
Take these steps to reduce your risk:
- Begin a safe exercise program with the advice of your doctor.
- If you smoke, quit.
- Limit alcohol.
- Lose weight if needed. After you have lost weight, maintain a healthy weight.
- Eat a healthy diet. The DASH diet, in particular, may reduce the risk of high blood pressure and heart failure, particularly in women. The DASH diet is:
- Rich in fruits, vegetables, and low-fat dairy foods
- Low in saturated fat, total fat, and cholesterol
- Eat whole grain breakfast cereal. In addition to the other healthy habits, this may reduce your risk.