Coronary Heart Disease

What Is Heart Failure?

Heart Failure

Heart failure, also known as congestive heart failure, is a condition that develops when your heart doesn’t pump enough blood for your body’s needs. This can happen if your heart can’t fill up with enough blood. It can also happen when your heart is too weak to pump properly. The term “heart failure” does not mean that your heart has stopped. However, heart failure is a serious condition that needs medical care.

More than 6 million adults in the United States have heart failure, according to the Centers for Disease Control and Prevention. Children can also have heart failure, but this health topic focuses on heart failure in adults.

Heart failure can develop suddenly (the acute kind) or over time as your heart gets weaker (the chronic kind). It can affect one or both sides of your heart. Left-sided and right-sided heart failure may have different causes. Most often, heart failure is caused by another medical condition that damages your heart. This includes coronary heart disease, heart inflammation, high blood pressure, cardiomyopathy, or an irregular heartbeat. Heart failure may not cause symptoms right away. But eventually, you may feel tired and short of breath and notice fluid buildup in your lower body, around your stomach, or your neck.

Heart failure can damage your liver or kidneys. Other conditions it can lead to include pulmonary hypertension or other heart conditions, such as an irregular heartbeat, heart valve disease, and sudden cardiac arrest.

Causes and Risk Factors

Long-term, or chronic, heart failure is often caused by other medical conditions that damage or overwork your heart. Sudden, or acute, heart failure can be caused by an injury or infection that damages your heart, a heart attack, or a blood clot in your lung.

To understand heart failure, it helps to know how the heart works. The right side of your heart gets oxygen-low blood from your body. It pumps the blood to your lungs to pick up oxygen. The left side of your heart pumps oxygen-rich blood to the rest of your body.

What causes left-sided heart failure?

Left-sided heart failure is more common than right-sided heart failure. There are two types of left-sided heart failure, each based on how well your heart pumps. This measurement is called the ejection fraction.

  • In heart failure with reduced ejection fraction (HFrEF), the left side of your heart is weak and can’t pump enough blood to the rest of your body. Chronic conditions that damage or weaken the heart muscles are the main cause of heart failure with reduced ejection fraction. For example, coronary heart disease or a heart attack can prevent your heart muscle from getting enough oxygen. Other causes of this type of heart failure include faulty heart valves, an irregular heartbeat, or heart diseases that you are born with or inherit.
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  • In heart failure with preserved ejection fraction (HFpEF), the left side of your heart is too stiff to fully relax between heartbeats. That means it can’t fill up with enough blood to pump out to your body. High blood pressure and other conditions that make your heart work harder are the main causes of heart failure with preserved ejection fraction. Conditions that stiffen the chambers of the heart such as obesity and diabetes are also causes of this type of heart failure. Over time, your heart muscle thickens to adapt, which makes it stiffer.

What causes right-sided heart failure?

Over time left-sided heart failure can lead to right-sided heart failure.

In right-sided heart failure, your heart can’t pump enough blood to your lungs to pick up oxygen. Left-sided heart failure is the main cause of right-sided heart failure. That’s because left-sided heart failure can cause blood to build up on the left side of your heart. The build-up of blood raises the pressure in the blood vessels that carry blood from your heart to your lungs. This is called pulmonary hypertension, and it can make the right side of your heart work harder.

Congenital heart defects or conditions that damage the right side of your heart such as abnormal heart valves can also lead to right-side heart failure. The same is true for conditions that damage the lungs, such as chronic obstructive pulmonary disease (COPD).

Symptoms

Symptoms of heart failure depend on the type of heart failure you have and how serious it is. If you have mild heart failure, you may not notice any symptoms except during hard physical work. Symptoms can depend on whether you have left-sided or right-sided heart failure. However, you can have symptoms of both types. Symptoms usually get worse as your heart grows weaker.

Heart failure can lead to serious and life-threatening complications.

One of the first symptoms you may notice is feeling short of breath after routine activities like climbing stairs. As your heart grows weaker, you may notice this while getting dressed or walking across the room. Some people have shortness of breath while lying flat.

Older adults who do not get much physical activity may not experience shortness of breath. However, they may feel tired and confused.

People who have left-sided heart failure may have the following symptoms.

  • Trouble breathing
  • Cough
  • Fatigue (extreme tiredness even after rest)
  • General weakness
  • Bluish color of finger and lips
  • Sleepiness and trouble concentrating
  • Inability to sleep lying flat

People who have right-sided heart failure may also have the following symptoms:

  • Nausea (feeling sick in the stomach) and loss of appetite
  • Pain in your abdomen (area around your stomach)
  • Swelling in your ankles, feet, legs, abdomen, and the veins in your neck
  • Needing to pee often
  • Weight gain

What problems can heart failure cause?

Heart failure can cause some serious problems.

  • Kidney or liver damage is caused by reduced blood flow and fluid buildup in your organs.
  • Fluid may build up in or around your lungs.
  • Malnutrition from nausea and swelling in your abdomen (the area around your stomach) can make it uncomfortable for you to eat. Reduced blood flow to your stomach can make it harder to absorb nutrients from your food.
  • Other heart conditions such as an irregular heartbeat, leaking heart valves, or sudden cardiac arrest can be caused by heart failure.
  • Pulmonary hypertension may also be caused by this condition.
Diagnostic tests and procedures

Blood tests: Your provider may order blood tests to check the levels of certain molecules, such as brain natriuretic peptide (BNP). These levels rise during heart failure. Blood tests can also show how well your liver and your kidneys are working.

Tests to measure your ejection fraction: Your provider may order an echocardiography (echo) or other imaging tests to measure your ejection fraction. Your ejection fraction is the percent of the blood in the lower left chamber of your heart (the left ventricle) that is pumped out of your heart with each heartbeat. Ejection fraction measures how well your heart pumps. This helps diagnose the type of heart failure you have and guides your treatment.

  • If 40% or less of the blood in your left ventricle is pumped out in one beat, you have heart failure with reduced ejection fraction.
  • If 50% or more of the blood in your left ventricle is pumped out in one beat, you have heart failure with preserved ejection fraction.
  • If your ejection fraction is somewhere in between 41% to 49%, you may be diagnosed with heart failure with borderline ejection fraction.

Other tests

  • Other imaging tests show how well your heart is working, such as a cardiac CT scan, cardiac MRI, or nuclear heart scan. You may also need cardiac catheterization with coronary angiography to look inside the arteries in your heart and see if they are blocked.
  • Tests for your heart’s electrical activity may also be necessary. This might include an electrocardiogram (EKG) or a Holter or event monitor that you wear for 24 to 48 hours or more while going about your normal activities.
  • A stress test measures how much exercise your body can handle and how well it works during physical activity. Some heart problems are easier to diagnose when your heart is working hard and beating fast.
Treatment

Heart failure has no cure. But treatment can help you live a longer, more active life with fewer symptoms. Treatment depends on the type of heart failure you have and how serious it is.

Healthy lifestyle changes

Your provider may recommend these heart-healthy lifestyle changes alone or as part of a cardiac rehabilitation plan:

  • Lower your sodium (salt) intake. Salt may make fluid buildup worse.
  • Aim for a healthy weight since extra weight can make your heart work harder.
  • Get regular physical activity. Ask your healthcare provider about how active you should be, including during daily activities, work, leisure time, sex, and exercise. Your level of activity will depend on how serious your heart failure is. Sometimes, your provider might recommend outpatient cardiac rehabilitation services to improve your exercise level and reduce your risk factors.
  • Quit smoking. 
  • Avoid or limit alcohol. Your provider may recommend that you limit or stop drinking alcohol.
  • Manage contributing risk factors. Controlling some of the factors that may worsen heart failure like blood pressure, heart rhythm, and anemia will often improve heart health.
  • Manage stress. Learning how to manage stress and cope with problems can improve your mental and physical health. Relaxation techniques, talking to a counselor, and finding a support group can all help lower stress and anxiety.
  • Get good-quality sleep. Sleep disorders such as sleep apnea are common in people who have heart failure. Treating your sleep disorder helps improve your sleep and may help improve your heart failure symptoms.
Medicines

Left-sided heart failure

The following medicines are commonly used to treat heart failure with reduced ejection fraction.

  • Medicines that remove extra sodium and fluid from your body, including diuretics and aldosterone antagonists (such as spironolactone) lower the amount of blood that the heart must pump. Very high doses of diuretics may cause low blood pressure, kidney disease, and worsening heart failure symptoms. Side effects of aldosterone antagonists can include kidney disease and high potassium levels.
  • Medicines to relax your blood vessels makes it easier for your heart to pump blood. Examples include ACE inhibitors and angiotensin receptor blockers (ARBs). Possible side effects include cough, low blood pressure, and short-term reduced kidney function.
  • Medicines to slow your heart rate, such as beta blockers and ivabradine make it easier for your heart to pump blood and can help prevent long-term heart failure from getting worse. Possible side effects include a slow or irregular heart rate, high blood pressure, and fuzzy vision or seeing bright halos.
  • Newer medicines, including two new groups of medicines approved to lower blood sugar in patients with diabetes, called sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide (GLP) agonists. They may also reduce heart failure hospitalizations. Their use in treating heart failure is currently being studied.
  • Digoxin makes your heart beat stronger and pump more blood. This medicine is mostly used to treat serious heart failure when other medicines do not help improve your symptoms. Side effects may include digestive problems, confusion, and vision problems.

Currently, the main treatments for heart failure with preserved ejection fraction are diuretics. Your doctor also may prescribe blood pressure medicines to help relieve your symptoms.

Right-sided heart failure

If you have right-sided heart failure, your doctor may prescribe two types of medicines.

  • Medicines that remove extra sodium and fluid from your body,
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     including diuretics and aldosterone antagonists (such as spironolactone) lower the amount of blood that the heart must pump. Very high doses of diuretics may cause low blood pressure, kidney disease, and worsening heart failure symptoms. Side effects of aldosterone antagonists can include kidney disease and high potassium levels.
  • Medicines to relax your blood vessels make it easier for your heart to pump blood. Examples include angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Possible side effects include cough, low blood pressure, and short-term reduced kidney function.

Procedures and surgeries

If you have heart failure with reduced ejection fraction and it worsens, you may need one of the following medical devices:

  • A biventricular pacemaker, also called cardiac resynchronization therapy, can help both sides of your heart contract at the same time to relieve your symptoms.
  • A mechanical heart pump, such as a ventricular assist device or a total artificial heart may be used until you have surgery or as a long-term treatment.
  • An implantable cardioverter defibrillator (ICD) checks your heart rate and uses electrical pulses to correct irregular heart rhythms that can cause sudden cardiac arrest.

You may also need heart surgery to repair a congenital heart defect or damage to your heart. If your heart failure is life-threatening and other treatments have not worked, you may need a heart transplant.

For people with heart failure and preserved ejection fraction, there are no currently approved devices or procedures to improve symptoms. Researchers are continuing to study possible treatments.

Source: https://www.nhlbi.nih.gov/health/heart-failure

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