What is Heart Failure?
Heart failure, also called congestive heart failure, is a chronic condition in which the heart doesn't pump blood as well as it should. Despite its name, heart failure doesn't mean the heart has stopped working—it means the heart is working less efficiently than normal.
When your heart can't pump enough blood to meet your body's needs, blood often backs up and fluid can build up in your lungs, causing shortness of breath. The kidneys may respond by causing the body to retain fluid and salt, which can lead to swelling in the legs, ankles, feet, or abdomen.
Types of Heart Failure
Heart failure can affect the left side, right side, or both sides of your heart. Each type can have different symptoms and requires different treatment approaches:
Main Types
- Left-sided heart failure: The most common type, where the left ventricle can't pump blood efficiently
- Right-sided heart failure: Often occurs as a result of left-sided failure, causing fluid backup in the abdomen, legs, and feet
- Systolic heart failure: The left ventricle can't contract vigorously, indicating a pumping problem
- Diastolic heart failure: The left ventricle can't relax or fill properly, indicating a filling problem
Symptoms and Warning Signs
Heart failure can be ongoing (chronic) or may start suddenly (acute). Signs and symptoms may include:
- Shortness of breath during activity or when lying down
- Fatigue and weakness that limits your ability to exercise
- Swelling in your legs, ankles, and feet
- Rapid or irregular heartbeat
- Reduced ability to exercise
- Persistent cough or wheezing with white or pink blood-tinged phlegm
- Increased need to urinate at night
- Swelling of the abdomen
- Sudden weight gain from fluid retention
- Lack of appetite and nausea
- Difficulty concentrating or decreased alertness
- Chest pain if heart failure is caused by a heart attack
Causes and Risk Factors
Heart failure often develops after other conditions have damaged or weakened your heart. However, the heart doesn't need to be weakened to cause heart failure—it can also occur if the heart becomes too stiff.
Common conditions that can lead to heart failure include:
- Coronary artery disease and heart attack: The most common causes of heart failure
- High blood pressure: Forces the heart to work harder to pump blood
- Faulty heart valves: Makes the heart work harder, which can weaken it over time
- Heart muscle disease (cardiomyopathy): Damage from infections, alcohol, or drugs
- Myocarditis: Inflammation of the heart muscle
- Congenital heart defects: Born with structural heart problems
- Irregular heart rhythms (arrhythmias): Can weaken the heart over time
- Diabetes: Increases risk of high blood pressure and coronary artery disease
Diagnosis
Your doctor will perform a physical examination and may recommend several tests to diagnose heart failure and determine its cause:
- Blood tests: Check kidney and thyroid function, and look for signs of heart disease
- Chest X-ray: Shows the size of your heart and whether fluid is building up in your lungs
- Electrocardiogram (ECG): Records the electrical activity of your heart
- Echocardiogram: Uses sound waves to create a video of your heart in motion
- Stress test: Measures how your heart responds to exertion
- Cardiac CT or MRI: Provides detailed images of your heart
- Coronary angiogram: Shows blockages in your coronary arteries
Treatment and Management
Heart failure is a chronic condition that requires lifelong management. Treatment focuses on improving symptoms, slowing progression, and improving quality of life.
Lifestyle Changes
- Monitor your weight daily: Sudden weight gain indicates fluid retention
- Limit sodium: Reduce salt intake to prevent fluid buildup
- Manage fluids: Your doctor may recommend limiting fluid intake
- Exercise regularly: As recommended by your healthcare team
- Quit smoking: Smoking damages blood vessels and worsens heart failure
- Limit alcohol: Can worsen heart failure symptoms
- Get adequate rest: Elevate your legs when sitting
- Reduce stress: Through relaxation techniques and support groups
Medications
- ACE inhibitors or ARBs: Help blood vessels relax and improve blood flow
- Beta blockers: Slow heart rate and reduce blood pressure
- Diuretics: Reduce fluid buildup (water pills)
- Aldosterone antagonists: Help eliminate excess sodium and fluid
- Digoxin: Increases the strength of heart contractions
Devices and Surgical Procedures
- Implantable cardioverter-defibrillator (ICD): Monitors heart rhythm and delivers shocks if needed
- Cardiac resynchronization therapy (CRT): Pacemaker that coordinates contractions
- Heart valve surgery: Repairs or replaces damaged valves
- Coronary bypass surgery: Improves blood flow to the heart
- Heart transplant: For severe cases when other treatments haven't worked
Living with Heart Failure
Managing heart failure requires active participation in your care. Keep all follow-up appointments, take medications as prescribed, and monitor your symptoms daily. Keep a record of your weight and any symptoms to share with your healthcare team.
With proper treatment and lifestyle changes, many people with heart failure can live full, active lives. The key is working closely with your healthcare team and staying committed to your treatment plan.
When to Seek Immediate Help
Call emergency services immediately if you experience chest pain, severe shortness of breath, fainting, or a rapid or irregular heartbeat with shortness of breath, chest pain, or fainting. These could be signs of a heart attack or other life-threatening emergency.