About Heart Failure (HF)

Heart failure (HF) is a chronic condition that occurs when the heart muscle does not pump as much blood as the body needs. The body tries to compensate by holding on to sodium and water. This increases the amount of blood in the bloodstream. The result of increased blood in the bloodstream triggers the heart to beat faster and the heart muscle gets bigger to compensate.

As a result, the heart cannot pump enough oxygen and nutrients to meet the body’s needs. The chambers of the heart respond by stretching to hold more blood to pump through the body or by becoming more stiff and thickened. The kidneys respond, causing the body to retain fluid (water) and sodium, which causes swelling in the arms, legs, ankles, feet, lungs or other organs. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath.

Heart failure is a serious condition, and usually there is no cure. But many people with heart failure lead full, enjoyable lives when the condition is managed with medications and healthy lifestyle changes.

Symptoms

Heart failure symptoms may be mild or severe. They can be consistent or infrequent, as they are related to the changes that occur in the heart and body, which is dependent on how weak the heart is. The most common symptoms of heart failure are:

Shortness of breath
Persistent coughing or wheezing
Fluid or water retention (swelling or weight gain)
Tiredness, weakness and fatigue
Confusion, impaired thinking
Decrease in appetite

Risk Factors

Heart failure is caused by one or a combination of risk factors, including:

Coronary artery disease
Heart attack
High blood pressure
Abnormal heart valves
Heart muscle damage from alcohol/drug abuse, infections
Congenital heart disease
Severe lung disease
Severe anemia
Hyperthyroidism
Abnormal heart rhythm

The following risk factors may also attribute to heart failure:

Smoking
High blood cholesterol
Diabetes
Obesity
Lack of physical activity

Diagnosis

Early diagnosis and treatment may slow the progression of heart failure. When presented with symptoms of heart failure, a doctor will review a patient’s personal and family medical history, assess the patient’s risk factors, conduct a physical exam and order diagnostic tests. The following tests help a doctor evaluate the extent of heart failure, its effect on the function of the heart and the best form of treatment for a particular patient:

Blood tests
Electrocardiogram (EKG) – measures rate and regularity of heartbeat
Echocardiogram – creates moving picture of heart showing size, shape and valve and chamber movement and function
Stress test – monitors heart rate and blood pressure during physical activity
Chest X-ray – shows size of heart and fluid build-up around the heart and lungs
Angiogram – views blood flow through the heart by injecting a special dye into the arteries that can be seen by a chest x-ray
Ejection fraction – determines how well a heart pumps with each beat; an ejection fraction is obtained from a muga scan, echocardiogram, angiogram or cardiac catheterization
Cardiac catheterization – examines arteries for blockage with a thin, flexible tube passed through an artery in the groin or arm to reach the coronary arteries

Treatment

The overall goals of heart failure treatment are to correct underlying causes for heart failure, relieve symptoms and prevent the worsening of the condition. Symptoms are relieved by removing excess fluid from the body, improving blood flow, improving heart muscle function and increasing the delivery of oxygen to the body tissues.

When deciding how to treat heart failure, the most important question is what caused the heart failure in the first place and to reverse that if possible. Treatment can include lifestyle changes, medications or specialty procedures.

Lifestyle changes can include the following:

Healthy diet
- Reduce sodium intake
- Eat foods high in fiber and potassium
- Limit foods high in fat, cholesterol and sugar
- Reduce alcohol and caffeine
Quit smoking, if currently smoking
Exercise, as directed by a doctor
Lose weight, if overweight or obese
Modify daily activities
Reduce stress

Medications

In addition to making lifestyle changes, medications may be needed to treat heart failure. Several types of medicine are commonly used to treat heart failure:

ACE (angiotensin-converting enzyme) inhibitors help to lower blood pressure and reduce strain on the heart. They also may reduce the risk of a future heart attack and heart failure.
ARB (Angiotensin II receptor blockers) help to lower blood pressure and reduce strain on the heart in a similar manner as the ACE.
Beta blockers slow the heart rate and lower blood pressure to decrease the workload on the heart. Beta blockers are used to relieve angina and may also reduce the risk of a future heart attack.
Calcium channel blockers help to regulate heart rate and lower blood pressure.
Digoxin is an herbal extract that mildly increases the heart’s pumping action so more blood is ejected with each heartbeat.
Diuretics help the body eliminate excess salt and water.
Potassium or magnesium are chemicals naturally found at nerve endings and in muscles that help conduct muscle activity/contractions.
Vasodilators are a category of medications that help relax blood vessels to lower blood pressure. Examples of medications in this category include ACE, ARB, calcium channel blockers, beta blockers, and nitroglycerin.

Heart Surgeries

The following surgical procedures may slow further damage to the heart and improve the heart’s function:

Bypass surgery: The most common surgery for heart failure is bypass surgery to route blood around a blocked heart artery.
Left ventricular assist device (LVAD): The LVAD helps your heart pump blood throughout your body. It allows you to be mobile, sometimes returning home to await a heart transplant.
Heart valve surgery: As heart failure progresses, the heart valves that normally help direct the flow of blood through the heart to the rest of the body stretch out of shape, allowing blood to "leak" backward. The valves can be repaired or replaced.
Infarct exclusion surgery (Modified Dor or Dor Procedure): When a heart attack occurs in the left ventricle (left lower pumping chamber of the heart), a scar forms. The scarred area is thin and can bulge out with each beat (an aneurysm). A heart surgeon can remove the infarcted (dead) area of heart tissue or the aneurysm.
Heart transplant: A heart transplant is considered when heart failure is so severe that it does not respond to all other therapies, but the person's health is otherwise good.