(article quoted from National Institutes of Health)
Heart failure is a condition where the heart cannot pump enough blood
throughout the body. Heart failure does not mean that your heart has
stopped or is about to stop working. It means that your heart is not
able to pump blood the way that it should. The heart cannot fill with
enough blood or pump with enough force or both.
Heart failure develops over time as the pumping action of the heart
grows weaker. It can affect the left side, the right side, or both sides
of the heart. Most cases involve the left side where the heart cannot
pump enough oxygen-rich blood to the rest of the body. With right-sided
failure, the heart cannot effectively pump blood to the lungs where the
blood picks up oxygen.
The weakening of the pumping ability of the heart causes:
Heart failure is a serious condition. About 5 million people in the
U. S. have heart failure and the number is growing. Each year, another
550,000 people are diagnosed for the first time. It contributes to or
causes about 300,000 deaths each year.
How the Heart Works
Your heart is a muscle that is about the size of your fist. It works
like a pump and it is always pumping blood throughout the body. The
average heart beats 100,000 times a day.
The heart has a left and right side, separated by a wall of muscle
called the septum. Blood vessels called veins bring blood
to the heart, while other blood vessels called arteries carry
blood away from the heart. Here is what happens:
The heart also has arteries on its outside surface called the coronary arteries. These important arteries supply the heart muscle itself with the oxygen-rich blood it needs to work normally.
What Causes Heart Failure?
CAD, including
angina and
heart attack, is the most common underlying cause of heart failure.
Persons who have a heart attack are at high risk of developing heart
failure.
Most people with heart failure also have high blood pressure and about 1
in 3 has diabetes.
Other Causes of Heart Failure
Other heart diseases and conditions that can lead to heart failure are:
Other conditions that may injure the heart muscle and lead to heart failure include:
Heart failure is very common in persons 65 years of age and older.
It is the number one reason for a hospital visit in this group.
Blacks are more likely to have heart failure and suffer more severely
from it. Blacks are more likely to:
Men also have a higher rate of heart failure than women. But in
actual numbers, more women have heart failure because many more women
live into their 70s and 80s when heart failure is common.
Children with
congenital heart disease can also get heart failure. Congenital
heart disease happens when the heart, heart valves, and/or blood vessels
near the heart do not develop correctly in babies when they are in the
womb. This can weaken the heart muscle and lead to heart failure.
Children do not have the same symptoms or get the same treatment for
heart failure as adults and will not be discussed here.
What Are the Signs and Symptoms of Heart Failure?
The most common signs and symptom are:
Shortness of breath and feeling tired are caused by the buildup of
fluid in the lungs and
around the lung (pleural effusions). When symptoms start, you may feel tired and short of breath after
routine physical exertion. Climbing two flights of stairs makes you feel
winded. As heart failure progresses, the symptoms get worse. You may
begin to feel tired and short of breath after simple activities, like
getting dressed or walking across the room. Some people have shortness
of breath when lying flat.
Fluid buildup in the lungs can also cause a cough. The cough is
worse at night and when you are lying down. Excessive fluid in the lungs
can cause a life-threatening condition called acute pulmonary edema.
This condition requires emergency treatment.
The swelling is from the buildup of fluid in your body (edema).
Other signs of fluid buildup are:
Limitation on Physical Activity
Doctors also classify your symptoms based on how much they limit your
daily activity. By class of symptom, your doctor means:
Medical and Family History
Your doctor will ask if you or others in your family have or have had
any of the diseases and conditions that can cause heart failure. Your
doctor will also ask about your symptoms. This includes the types of
symptoms, when they occur, how long you have had them, and their
severity. The answers will help your doctor determine the limits on your
ability to perform daily activities.
Physical Examination
Your doctor will:
Tests
If you have signs and symptoms of heart failure, your doctor may order
the following tests:
If your doctor suspects heart failure after the history, physical
exam, and initial tests (such as tests of kidney function), he/she may
refer you to a cardiologist. A cardiologist is a doctor who specializes
in the diagnosis and treatment of heart disease. The cardiologist will
do a physical exam and order additional tests.
An
echocardiogram is the most useful test for diagnosing heart
failure. This test uses sound waves to create a picture of the heart. It
shows how well the heart is filling with blood and pumping it to the
rest of the body. It can also show the areas of your heart muscle that
are not contracting normally. Your doctor uses this test to determine
the areas of your heart that are damaged and causing it to not work
properly. This is very important because more than one area of the heart
can be damaged and contribute to heart failure.
The cardiologist may order any of the following tests. These tests can
help identify the cause of your heart failure:
Your doctor will continue to treat the underlying diseases or conditions (such as CAD, high blood pressure, or diabetes) that caused heart failure. The treatment for heart failure includes:
Lifestyle Changes
There are things that you can do to help with your treatment. Your
doctor will recommend that you:
Your doctor will also tell you to:
Medications
Your doctor will prescribe medicines to help improve your heart function
and symptoms. The main medicines are:
Specialized Care for Severe Disease
As the disease progresses, lifestyle changes and regular medications may
not be enough to control worsening symptoms. Many people with severe
heart failure must be put in the hospital from time to time for
treatment. In the hospital, your doctor may prescribe new or special
medicines. You continue to take your regular medicines during this
treatment.
Your doctor will also order extra oxygen if you continue to have trouble
breathing. The extra oxygen can be given in the hospital and at home.
Persons with very severe heart failure may be considered for a:
A heart pump is a special device placed inside the body to
help pump blood to the rest of the body. There are different kinds of
heart pumps. Some stay in the body for a short period of time, while
others can stay in the body for a long time. Many people with a heart
pump will also be considered for a heart transplant.
A heart transplant is surgery to replace the heart of a patient
with heart failure with a healthy heart from someone who has recently
died. A transplant is indicated in some people when all other treatments
fail to control symptoms.
Preventing Heart Failure
The major underlying causes of heart failure are CAD (including angina
and heart attack), high blood pressure, and diabetes.
The section "What Causes Heart Failure?" lists all the likely causes.
Getting treatment and staying in treatment for any underlying condition
that you have can greatly reduce your risk.
Other things you can do reduce your risk include:
Common causes of worsening of symptoms that can lead to a crisis or even a hospital visit are:
If you have trouble following your diet, talk to your doctor. Your
doctor can help arrange for a dietitian to work with you on how to keep
to a healthy diet. Alcohol also makes your symptoms worse. If you drink
alcohol, don't do so very often and limit yourself to one drink. If you
have severe heart failure, you should not drink alcohol.
People with heart failure often have other serious conditions that
require ongoing treatment. If you have other conditions, it is likely
that you are taking medications for those conditions as well as for
heart failure. When taking several medications, there is always a chance
for side effects and interaction between the medications. Tell your
doctor immediately about any problems that you notice with your
medications. Also, talk with your doctor before adding any new medicine.
This includes over-the-counter medicines and herbal supplements.
It is also important that you try to avoid respiratory infections like
the flu and pneumonia. Ask your doctor or nurse about getting a flu shot
and pneumonia vaccination.
It is helpful to have certain information on hand in case you need to go
to the hospital or doctor right away. You should plan now to make sure
that you have:
Special Needs for Severe Heart Failure
In the advanced stages, heart failure is a progressive condition that
can generally be expected to get worse and eventually lead to death. If
you have severe disease and symptoms at rest, you can expect your
condition to worsen. It is important that you and your family discuss
what you can expect and your final treatment options with your doctor
while you are able to do so. The time may come when you are unable to
participate in discussions about your care.
Advance directives are documents that tell doctors and hospitals
what treatment you want or do not want if you are too ill to speak for
yourself. You and your family may decide that you only want treatment to
make you comfortable. You, your family, and your doctor may also agree
on whether you want treatment if your heart or breathing stops.
There are two types of advance directives:
Advance directives are easy to prepare. You can do it yourself without a lawyer. The only requirement is that you are at least 18 years old. You may prepare your advance directive by:
Depending on the state where you live, the document may also need to be:
As long as you are able to make your own decisions, your advance
directives will not be used and you can accept or refuse any medical
treatment. But if you become seriously ill, you may not be able to make
decisions about your own treatment.
Give a copy of your living will and power of attorney to a family member
and keep another copy in a safe place. People with severe heart failure
are in the hospital often. It is important that you or family a member
bring a copy every time you go to the hospital.
Hospice care. As heart failure worsens, the time may come when
treatment is no longer working. If you and your doctor agree that your
treatments are not working, hospice care may be an option. Hospice is an
organization that can comfort and support you and your family. A team of
people provides hospice care. This team includes:
The goals of hospice care are to:
Links to Other Information about Heart Failure
The National Heart, Lung, and Blood Institute (NHLBI)
Other