Illnesses & Conditions
Information on diseases and health concerns, including symptoms, treatment options, and prevention.

Heart Failure

Overview

What is heart failure?

Heart failure means your heart muscle does not pump as much blood as your body needs. Failure does not mean that your heart has stopped. It means that your heart is not pumping as well as it should.

Because your heart cannot pump well, your body tries to make up for it. To do this:

• Your body holds on to salt and water. This increases the amount of blood in your bloodstream.
• Your heart beats faster.
• Your heart gets bigger. See a picture of an enlarged heart .

Your body has an amazing ability to make up for heart failure. It may do such a good job that you don't know you have a disease. But at some point, your body will no longer be able to keep up. Your heart gets worn out. Then fluid starts to build up in your body, and you have symptoms like feeling weak and out of breath.

This fluid buildup is called congestion. It is why some doctors call the disease congestive heart failure.

Heart failure usually gets worse over time. But treatment can slow the disease and help you feel better and live longer.

What causes heart failure?

Anything that damages your heart or affects how well it pumps can lead to heart failure. The most common causes of heart failure are:

• Coronary artery disease (CAD).
• Heart attack.
• High blood pressure.

CAD and heart attack are the most common causes of heart failure in men. In women, high blood pressure is the most common cause.¹

Other conditions that can lead to heart failure include:

• Diabetes.
• Diseases of the heart muscle (cardiomyopathies).
• Heart valve disease.
• Disease of the sac around the heart (pericardial disease), such as pericarditis.
• A slow, fast, or uneven heart rhythm (arrhythmia).
• A heart problem that you were born with (congenital heart defect).
• Long-term alcohol abuse, which can damage your heart.

What are the symptoms?

Symptoms of heart failure start to happen when your heart cannot pump enough blood to the rest of your body. In the early stages, you may:

• Feel tired easily.
• Be short of breath when you exert yourself.
• Feel like your heart is pounding or racing (palpitations).
• Feel weak, very tired, or dizzy.

As heart failure gets worse, fluid starts to build up in your lungs and other parts of your body. This may cause you to:

• Feel short of breath even at rest.
• Have swelling (edema), especially in your legs, ankles, and feet.
• Gain weight. This may happen over just a day or two, or more slowly.
• Cough or wheeze, especially when you lie down.
• Need to urinate more at night.
• Feel bloated or sick to your stomach.

If your symptoms suddenly get worse, you will need emergency care.

How is heart failure diagnosed?

Your doctor may diagnose heart failure based on your symptoms and a physical exam. But you will need tests to find the cause and type of heart failure so that you can get the right treatment. These tests may include:

• Blood tests.
• A chest X-ray.
• An electrocardiogram (EKG or ECG) to check your heart’s electrical system.
• An echocardiogram to see the size and shape of your heart and how well it is pumping.
• Cardiac catheterization to check your heart and its blood vessels (coronary arteries).

Echocardiogram is the best and simplest way to find out if you have heart failure, what type it is, and what is causing it. Your doctor can also use it to see if your heart failure is getting worse. It can measure how much blood your heart pumps to your body. This measurement is called the ejection fraction. If your ejection fraction gets lower and you are having more symptoms, it means your heart failure is getting worse.

How is it treated?

Most people with heart failure need to take several medicines. Your doctor may prescribe medicines to:

• Help keep heart failure from getting worse. These include ACE inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, and vasodilators like hydralazine and nitroglycerin.
• Reduce symptoms so you feel better. These include diuretics (water pills), digoxin, and potassium.
• Treat the problem that caused your heart failure.

It is very important to take your medicines exactly as your doctor tells you to. If you don't, your heart failure could get worse.

Depending on the cause of your heart failure, you might need surgery to help your heart work better. For example, you might have bypass surgery or angioplasty to open clogged arteries or surgery to repair or replace a heart valve. If you have a problem with your heart rhythm, you might need to have a pacemaker or defibrillator placed in your chest. These help your heart keep a steady rhythm.

Lifestyle changes are an important part of treatment. They can help slow down heart failure. They may also help control other diseases that make heart failure worse, such as high blood pressure, diabetes, or coronary artery disease. The best steps you can take are to:

• Eat less salt (sodium). Sodium causes your body to retain water and makes it harder for your heart to pump. Your doctor may also ask you to watch how much fluid you drink.
• Get regular exercise. Your doctor can tell you what level of exercise is safe for you, how to check your pulse rate, and how to know if you are doing too much.
• Take rest breaks during the day.
• Lose weight if you are overweight. Even a few pounds can make a difference.
• Stop smoking. Smoking damages your heart and makes it hard to exercise.
• Limit alcohol. Ask your doctor how much, if any, is safe.

To stay as healthy as possible, work closely with your doctor. Have all your tests, and go to all your appointments. It is also important to:

• Talk to your doctor before you take any new medicine, including nonprescription and prescription drugs, vitamins, and herbs. Some of them may make your heart failure worse.
• Keep track of your symptoms. Weigh yourself every day, and write down your weight. Call your doctor if you have a sudden weight gain, a change in your ability to exercise, or any sudden change in your symptoms.

What can you expect if you have heart failure?

Medicines and lifestyle changes can slow or even reverse heart failure for some people. But heart failure often gets worse over time.

Early on, your symptoms may not be too bad. As heart failure progresses, you may need to limit your activities. Treatment can often help reduce symptoms, but it usually does not get rid of them.

Heart failure can also lead to other health problems. These may include trouble with your heart rhythm (arrhythmia), stroke, heart attack, mitral valve regurgitation, or blood clots in your leg or lungs (deep vein thrombosis or pulmonary embolism). Your doctor may be able to give you medicine or other treatment to prevent or treat these problems.

Heart failure can get worse suddenly. If this happens, you will need emergency care. To prevent sudden heart failure, you need to avoid things that can trigger it. These include eating too much salt, missing a dose of your medicine, and exercising too hard.

You may want to think about planning for the future. A living will lets doctors know what type of life-support measures you want if your health gets much worse. You can also choose a health care agent to make decisions in case you are not able to. It can be comforting to know that you will get the type of care you want.

Knowing that your health may get worse can be hard. It is normal to sometimes feel sad or hopeless. But if these feelings last, talk to your doctor. Antidepressant medicines or counseling may help you cope.

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