Cardiovascular Institute and Center for Cardiovascular Health
Heart FailureBack to Diseases and Conditions Your heart comprises four chambers - the two upper "atria" and the two lower "ventricles" - which pump blood to all the parts of your body. The heart also has four valves which are one-way doors that allow blood to flow through and out of your heart as it contracts and relaxes. Heart failure is a serious condition in which your heart fails to pump blood efficiently. This may leave you feeling short of breath, fatigued, and unable to perform all your daily activities. You may have heart failure because your heart does not pump enough blood to deliver all the nutrients and oxygen your body requires. You may have heart failure because your heart pumps the normal amount of blood, but it is working at higher operating pressures. You may have both problems. The heart contracts and relaxes with each heartbeat. The contraction portion is called" systole" and the relaxation portion is called "diastole" . Every time your heart beats, it pumps or "ejects" blood throughout your body. A normal heart pumps 50-60%of its contents with each beat. Thus, the heart is never completely empty The percentage of blood pumped in a heart beat is called the "ejection fraction". This number helps your doctor determine which type of heart failure you may have. Some people have a type of heart failure called "diastolic dysfunction".. If you have primarily diastolic heart failure, your ejection fraction may be normal. This form of heart failure may be caused by hypertension or by stiffness of the ventricular wall. Diastolic heart failure is more difficult to treat. Most people who have heart failure have primarily "systolic" heart failure, occasionally with some diastolic dysfunction. If you have primarily systolic heart failure your ejection fraction is markedly decreased. It is probably less than 35 - 40%. There are many therapies available for systolic heart failure. Sometimes heart failure leads to a backup of blood returning to the heart. This causes congestion in your body's tissues. You experience this as edema (swelling). Usually this occurs in the ankles or legs but sometimes it occurs in other parts of the body. When fluid builds up in the lungs, it can cause shortness of breath. Heart failure may result in retention of sodium and water by the kidneys This leads to an increase in edema. When heart failure causes an accumulation of fluid, it is called "congestive heart failure". Heart failure is a progressive disease which is divided into four classes:
Your prognosis and treatment plan will depend in part, on your heart Class. If the illness progresses, your Class may change, as will your treatment.
What are the symptoms of heart failure?The most common symptoms of heart failure include: shortness of breath on exertion (dyspnea), inability to lie flat at night due to difficulty in breathing (usually requiring two or more pillows), chronic fatigue, and swelling of the ankles and/or legs. Other symptoms of heart failure include: sudden weight gain, swelling of the abdomen, chest pain, nausea and vomiting, frequent dry hacking cough (especially when lying down), the need to urinate frequently during the night, and dizzy spells. What causes heart failure?Heart failure usually occurs as a result of another illness. Some of these illnesses are: coronary artery disease, chronic hypertension (high blood pressure), myocardial infarction (heart attack), cardiomyopathy (heart muscle disease), heart valve disease (sometimes due to past rheumatic fever), congenital heart disease (disease or structural abnormalities which are present at birth), infection of the heart valve or heart muscle, diabetes, lupus, rheumatoid arthritis, alcohol abuse, and abuse of some drugs. One of the major causes of heart failure is myocardial infarction. After a heart attack, part of your heart muscle is replaced with scar tissue. This scarring prevents the heart muscle from working efficiently. As the weakened heart struggles to pump blood, the muscle fibers of the heart stretch. This results in larger, weaker heart chambers. Sometimes the cause of heart failure is "idiopathic". This means that despite examination and testing, the exact cause remains unknown. Some viral illnesses, such as Coxsackie virus, can cause heart failure. The virus does not have to be a recent one. Less common causes of heart failure include toxins in the environment such as cobalt, and toxins from chemotherapy. Finally, on rare occasions, some women acquire heart failure after childbirth. This form of heart failure is usually severe. How is heart failure diagnosed?Your doctor may make an initial diagnosis of heart failure after taking your medical history and performing a thorough physical examination. The medical history will include questions about your ability to perform daily work, and social activities, your mental health, sleep disturbance, sexual function, onset of symptoms, your history of heart disease, your diet and exercise history, and whether you smoke or drink. Always bring all your current medicines when you visit your doctor. Your doctor will want to determine if you have any underlying conditions which can provoke or mimic heart failure. These conditions include: pulmonary (lung) disease, heart attack, arrhythmias (abnormal heart rhythms), anemia, kidney disease or failure, and thyroid disease. Additional testing may be ordered, which may include: chest x-rays, an electrocardiogram, an echocardiogram, radionuclide ventriculogram, stress tests, and cardiac catheterization. Routine blood and urine tests may be performed. What can I do to prevent heart failure?Don't smoke. Follow a diet that is low in saturated fat and cholesterol. Take your medications to control your high blood pressure and diabetes. Lose weight, exercise regularly, and employ stress avoidance/stress reduction techniques. How is heart failure treated?Your treatment plan will be a multi-pronged approach based upon many factors including your type and Class of heart failure and whether you have any underlying illnesses. Consult with your physician to make sure you understand your disease, the prognosis, the treatment plan, and the importance of following the plan. Your family members and/or caregivers should be encouraged to attend a counseling and decision making session with you. In general, you will be advised to restrict your consumption of sodium, to avoid alcohol and cigarettes, and to engage in moderate amounts of physical exercise. Specifically, sodium (salt) should be restricted to as close to two grams per day as possible. In no case should you consume more than 3 grams daily. You should strive to abstain from alcohol completely. You should also avoid excessive fluid intake. Consult your physician as to the advisability of exercise. Generally, if you have chronic heart failure, you should engage in regular exercise such as walking or cycling, and should stay as active as possible. If you have new onset heart failure, you should refrain from exercise until it is recommended by your physician. In addition to exercise, rest is an important part of treatment. Your doctor will recommend that you schedule rest and relaxation periods throughout your day. Your doctor will probably prescribe medication for your heart failure to improve your life expectancy, reduce symptoms, and improve your ability to function. The medications may include diuretics, which reduce symptoms of congestion; Digoxin, which helps quality of life and stabilizes heart failure; ACE inhibitors, which improve quality of life and sense of well-being and also reduce mortality; and beta blockers which may prevent progression, of disease improve symptoms, and also reduce mortality. These drugs have potential side affects. Call your physician if you experience any of the following:
Your doctor may also advise supplemental potassium. When heart failure is the result of an underlying condition, sometimes it can be reversed or cured once the condition has been addressed. For most people, heart failure is a chronic condition which can be treated and managed, but rarely cured. It is of utmost importance that you follow your treatment plan to the letter to prevent progression of your disease, hospitalization, and death. Will I be hospitalized because of my heart failure?You will be hospitalized if you have severe heart failure or if you cannot be treated adequately outside a hospital setting. Some of the factors that would indicate hospitalization include the presence of acute myocardial ischemia (low oxygen), pulmonary edema (fluid in lungs) or severe respiratory distress, severe complicating medical illness, anasarca, (total body edema) or hypotension (low blood pressure). In the hospital you may receive intravenous medications and fluids. You may receive oxygen and anti-coagulant medications. Catheters with balloon tips may be inserted into your vein to measure the pressure inside your heart and inside your lungs and thereby, monitor your progress. If you have Class IV heart failure, your doctor may recommend that you undergo heart transplantation. Often the demand for donor hearts is greater than the current supply. You may require hospitalization and perhaps the implantation of an assist device while you wait for your new heart. You will be discharged from the hospital when your symptoms have been adequately controlled and all underlying problems have been treated or stabilized. What will my life be like with heart failure?You will have to plan your daily activities to make sure you include adequate periods of exercise and rest. It's a good idea to establish a routine for taking your medicines so that you never skip or run out of them. Some people use special pillboxes which allow organization of a week's worth of medications. You will have frequent follow up visits with your doctor which will decrease in frequency over time.. In between visits you will have phone consultations. Your doctor will ask you to keep a diary of your daily weight Call him if you have a weight gain of 3 or more pounds within 1 week. Such a weight gain may demand an immediate change in your treatment plan. Bring your diary when you visit your physician. If you follow your treatment plan, you can have a full life and engage in many, if not all, of your previous activities. What are the statistics concerning congestive heart failure?According to the American Heart Association:
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