HEART FAILURE
If you have – or think you have – heart failure, it’s normal to feel scared. But you’re not alone. More than 6 million Americans have heart failure.
Contrary to how it sounds, heart failure does not mean that your heart has stopped beating. It refers to a number of conditions that can affect the way the heart works, its structure, or both.
Over time, heart failure makes it harder for the heart to pump enough blood and oxygen to meet your body’s needs. That’s why most people with heart failure get short of breath, especially when they are active. Even climbing the stairs or carrying groceries may leave you winded. Of course, your symptoms will depend on the type of heart failure you have.
Because it’s a lifelong condition, you must take an active role in your care to stay well. The more informed and equipped you are to manage heart failure, the better you may feel. Use this condition center to learn more about heart failure and ways to help you feel your best.
Your heart is a pump. It moves blood and oxygen-rich nutrients through your body. If you have heart failure, your heart isn’t pumping as well as it should. As a result, fluid can build up in the body – most often in the legs and lungs.
Your heart also isn’t able to push out enough blood to meet your body’s needs for blood and oxygen. It’s no wonder then that if you have heart failure, you may tire more easily and feel short of breath.
There are two main types of heart failure:
- Heart failure with reduced ejection fraction (HFrEF): Muscle is too weak and cannot pump blood to the rest of the body with enough force. This is also called systolic heart failure.
- Heart failure with preserved ejection fraction (HFpEF): Muscle has trouble relaxing and can’t fill with enough blood. This is also called diastolic heart failure.
Ejection fraction is a measure of how much blood the heart is pumping out to the body.
If you or a loved one has heart failure, you’re not alone. More than 6 million Americans have heart failure. It’s also the leading reason people 65 and older end up in the hospital.
Heart failure is a serious, lifelong condition. But by managing heart failure, people can live normal lives. The hope is to try to avoid emergency or “acute” episodes when someone would need to be in the hospital, and generally improve patients’ quality of life and ability to do the things they usually do.
Many people who have heart failure will have symptoms that include:
- Shortness of breath (even when doing simple tasks like dressing or walking a flight of stairs)
- Swelling in the ankles, feet, legs, abdomen, or veins in the neck
- Extreme tiredness (fatigue)
- Feelings of weakness
- Rapid or irregular heartbeat
- Fast weight gain, or rapid fluctuations in weight
- Pressure or heaviness in the chest when lying flat
Late in the disease, people may notice:
- A lack of appetite or that they feel full more quickly
- Weight loss (cardiac cachexia)
The most common causes of heart failure include coronary artery disease, high blood pressure, and heart attack. Other factors or conditions that can put you at risk include:
- Diabetes
- Heart rhythm problems
- Valve problems
- Certain congenital heart defects or other heart conditions that have damaged or place added strain on the heart
- Obesity
- Family history
In addition, some treatments for cancer (chemotherapy), certain thyroid conditions, and heavy alcohol or drug use have also been linked to damage to the heart muscle.
“Broken heart syndrome,” also known as Takotsubo cardiomyopathy, is usually brought on by severe stress.
African Americans are more likely to develop heart failure. Also, women tend to have more severe symptoms.
Heart failure is usually detected after a review of your full medical history, a physical exam and results from blood and/or cardiac imaging tests. Many patients first learn they have heart failure after going to the emergency room or hospital with symptoms, often shortness of breath with or without swelling.
Blood and/or imaging tests are used to assess any damage to your heart and to check how well it pumps blood. Your doctor may decide to order:
- B-type natriuretic peptide (BNP): this is a simple blood test that’s a good initial test if someone has symptoms such as shortness of breath, but it is unclear if the heart is the reason
- Standard blood tests such as kidney function, electrolytes, and thyroid function
- ECG, chest X-ray
- Heart imaging: usually an echocardiogram (ultrasound), or possibly a cardiac MRI scan
- Cardiac catheterization, if needed
Many of these tests may be repeated over time to determine if your heart function is the same, better or worse with treatment.
- The underlying reason for the heart failure – for example, if you had a prior heart attack, or have high blood pressure or a valve problem.
- Your type of heart failure – often based on your ejection fraction (normal vs. low).
- How severe your heart failure is; there is a very wide range of severity from very mild to extremely severe. This is estimated based on your symptoms.
- Other existing conditions such as your kidney function.
Treatment generally includes a combination of lifestyle changes, medications, cardiac rehab, and procedures.
Remember that managing heart failure means ongoing care and monitoring of your health.
Following your treatment plan is essential. Be sure to keep any follow-up appointments and tests. Following a low-salt diet and taking your medications reliably is very important. It’s often helpful to keep a log with your daily weight, blood pressure and physical activity.
Today, there are many life-saving medications and therapies that help people live well with the disease.
What You Can Do
- Create a support team
- Check and record your weight every day, along with a log of your daily blood pressure and exercise
- Listen to your body and know when the condition might be getting worse. For example, do you notice:
- swelling
- rapid weight gain
- labored breathing, especially when laying down
- not being able to concentrate
- Report problems right away—stay connected with your heart failure team and report changes in weight or new symptoms
- Accept your new normal
- Stay connected to the things you love to do, even if it means you might need to participate in a different way or cut back a bit
- It’s OK if daily tasks seem to take longer
- Share your concerns—for example, many people are scared about over-exerting their heart, but exercise is very important
- Take your medications exactly as directed
- Ask about and take advantage of cardiac rehabilitation
- Bring a trusted friend or family member to your appointments
- Make sure you have a living will and advanced directives in place
Talking To Your Care Team
It is important to talk openly with your health care team about how you are feeling and share any concerns you have related to your condition or treatment. Heart failure can get worse over time, so keep your doctor up to speed on how you’re feeling, and if you have trouble doing certain activities.
Questions to ask:
- What type of heart failure do I have?
- What health checks should I be doing and recording on a daily basis (weight, blood pressure, pulse)?
- How will I know if my condition is getting worse? When should I call 9-1-1?
- What is my goal weight?
- If I notice that I am weighing more, at what point should I call you?
- How much exercise can I do and what activities are best? Is it safe for me to exercise on my own?
- Can you review each of the medications I am taking and what they do?
- How much salt can I consume daily?
- How much water/fluids can I drink a day?
- Would I benefit from an ICD?
- Would I benefit from cardiac rehabilitation?
- How often will I need to have my heart checked?
If you’ve been diagnosed with heart failure, there are several key questions that you should ask your cardiologist during your next visit. These questions will ensure that you and your doctor have discussed your major risk factors so that you can become or stay as healthy as possible.
- What type of heart failure do I have?
- What is my current heart function?
- What is my prognosis?
- What are my treatment options?
- Which of my medicines is for heart failure?
- How will I know if my condition is getting worse? When should I call you? When should I call 911?
- What is my goal weight?
- If I notice that I am weighing more, at what point should I call you?
- How much exercise can I do and what activities are best? Is it safe for me to exercise on my own?
- Can you review each of the medications I am taking and what they do?
- How much salt can I consume daily?
- How much water/fluids can I drink a day?
- Would I benefit from an implantable cardioverter defibrillator (ICD)?
- Would I benefit from cardiac rehabilitation?
- How often will I need to have my heart checked?
VISUAL AIDS
What goes wrong in heart failure
How the Heart and Body compensate in Heart Failure
How Heart Failure causes Fluid Accumulation
How Vasodilators work in Heart Failure
How Diuretics work in Heart Failure
How Medical Devices work in Heart Failure
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