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Congestive Heart Failure
Heart failure is a condition in which the heart can’t pump enough blood to meet the body’s needs. In some cases, the heart can’t fill The term "heart failure" doesn’t mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care. Heart failure develops over time as the heart’s pumping action grows weaker. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart. Right-side heart failure occurs if the heart can’t pump enough blood to the lungs to pick up oxygen. Left-side heart failure occurs if the heart can’t pump enough oxygen-rich blood to the rest of the body. Right-side heart failure may cause fluid to build up in the feet, ankles, legs, liver, abdomen, and the veins in the neck. Right-side and left-side heart failure also may cause shortness of breath and fatigue (tiredness). The leading causes of heart failure are diseases that damage the heart. These include coronary heart disease (CHD), also called coronary artery disease; high blood pressure; and diabetes. Heart failure is a very common condition. About 5.7 million people in the United States have heart failure, and it results in about 300,000 deaths each year. Both children and adults can have heart failure, although the symptoms and treatments differ. This article focuses on heart failure in adults. Currently, heart failure has no cure. However, treatments—such as medicines and lifestyle changes—can help people live longer and more active lives. Researchers continue to study new ways to treat heart failure and its complications. Signs and SymptomsThe most common signs and symptoms of heart failure are: Shortness of breath or trouble breathing All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs. As your heart grows weaker, symptoms get worse. You may begin to feel tired and short of breath after getting dressed or walking across the room. Some people have shortness of breath while lying flat. Fluid buildup from heart failure also causes weight gain, frequent urination, and a cough that's worse at night and when you're lying down. This cough may be a sign of acute pulmonary edema (e-DE-ma). This is a condition in which too much fluid builds up in your lungs. Acute pulmonary edema requires emergency treatment.
DiagnosisYour doctor will diagnose heart failure based on your medical and family histories, a physical exam, and the results of tests. Because the signs and symptoms of heart failure also are common in other conditions, your doctor will:
Early diagnosis and treatment can help people who have heart failure live longer, more active lives. Medical and Family Histories Your doctor will ask whether you or others in your family have or have had a disease or condition that can cause heart failure. Your doctor also will ask about your symptoms. He or she will want to know which signs and symptoms you have, when they occur, how long you've had them, and how severe they are. Your answers will help show whether your symptoms limit your daily routine, and, if so, how much. Physical Exam During the physical exam, your doctor will:
Diagnostic Tests No single test can diagnose heart failure. If you have signs and symptoms of heart failure, your doctor may recommend one or more of the following tests. He or she also may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions. EKG (Electrocardiogram) An EKG is a simple, painless test that detects and records the heart’s electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart. An EKG may show whether the walls in your heart's pumping chambers are thicker than normal. Thicker walls can make it harder for your heart to pump blood. An EKG also can show signs of a previous or current heart attack. Chest X Ray A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. This test can show whether your heart is enlarged, whether you have fluid in your lungs, or whether you have lung disease. BNP Blood Test This test checks the level of a hormone in your blood called BNP. The level of this hormone rises during heart failure. Echocardiography Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart chambers and valves are working. Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by lack of blood flow. Echo may be done before and after a stress test (see below). This is called a stress echo. A stress echo can show how well blood is flowing in various parts of your heart and/or how well your heart pumps blood when it beats. Doppler Ultrasound
Doppler ultrasound often is used to find out whether you have right-side heart failure (this is when the heart can't fill with enough blood).
Holter Monitor A Holter monitor records your heart’s electrical activity for a full 24- or 48-hour period, while you go about your normal routine. You wear small patches called electrodes on your chest that are connected by wires to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck. Nuclear Heart Scan A nuclear heart scan shows how well blood is flowing through your heart and how much blood is reaching your heart muscle. During a nuclear heart scan, a safe, radioactive substance called a tracer is injected into your bloodstream through a vein. The tracer travels to your heart and releases energy. Special cameras outside of your body detect the energy and use it to create pictures of your heart. A nuclear heart scan can show where the heart muscle is healthy and where it’s damaged. A positron emission tomography (PET) scan is a type of nuclear heart scan. It shows the level of chemical activity in areas of your heart. This test can help your doctor see whether enough blood is flowing to these areas. A PET scan can show blood flow problems that other tests may not detect. Cardiac Catheterization During cardiac catheterization (KATH-e-ter-i-ZA-shun), a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. This allows your doctor to look inside your coronary (heart) arteries. During this procedure, your doctor can check the pressure and blood flow in your heart chambers, collect blood samples, and use x rays to look at your coronary arteries. Coronary Angiography Coronary angiography (an-jee-OG-ra-fee) usually is done with cardiac catheterization. A dye that can be seen on x ray is injected into your bloodstream through the tip of the catheter. The dye allows your doctor to see the flow of blood to your heart muscle. Angiography also shows how well your heart is pumping. Stress Test Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise (or are given medicine if you can't exercise) to make your heart work hard and beat fast. You may walk or run on a treadmill or pedal a bicycle. Heart tests, such as nuclear heart scanning and echo, often are done during stress testing. Cardiac MRI Cardiac MRI (magnetic resonance imaging) uses radio waves, magnets, and a computer to create pictures of your heart as it’s beating. The test produces both still and moving pictures of your heart and major blood vessels. A cardiac MRI can show whether parts of your heart are damaged. Doctors also use MRI in research studies to find early signs of heart failure, even before symptoms appear. Thyroid Function Tests Thyroid function tests show how well your thyroid gland is working. These tests include blood tests, imaging tests, and tests to stimulate the thyroid. Having too much or too little thyroid hormone in the blood can lead to heart failure. TreatmentEarly diagnosis and treatment can help people who have heart failure live longer, more active lives. Treatment for heart failure will depend on the type and stage of heart failure (the severity of the condition). The goals of treatment for all stages of heart failure include:
Treatments usually include lifestyle changes, medicines, and ongoing care. If you have severe heart failure, you also may need medical procedures or surgery. Lifestyle Changes Simple changes can help you feel better and control heart failure. The sooner you make these changes, the better off you’ll likely be. A Heart Healthy Diet Following a heart healthy diet is a very important part of managing heart failure. In fact, not having a proper diet can make heart A heart healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar. Too much salt can cause extra fluid to build up in your body, making heart failure worse. Saturated and trans fats can cause unhealthy blood cholesterol levels, which are a risk factor for heart disease. A balanced diet with varied nutrients can help your heart work better. Getting enough potassium is important for people who have heart failure. Some heart failure medicines deplete the potassium in your body. Lack of potassium may cause very rapid heart rhythms that can lead to sudden death. Potassium is found in foods like white potatoes and sweet potatoes, greens (such as spinach), bananas, many dried fruits, and white beans and soybeans. Talk with your health care team about getting the correct amount of potassium. For more information about following a healthy diet, see the National Heart, Lung, and Blood Institute’s Aim for a Healthy Weight Web site, "Your Guide to a Healthy Heart," "Your Guide to Lowering Your Blood Pressure With DASH," and "Your Guide to Lowering Cholesterol With TLC." All of these resources include general information about healthy eating. Proper Fluid Intake It’s very important for people who have heart failure to drink the right amounts and types of fluid. Drinking too much fluid can worsen heart failure. Also, if you have heart failure, you shouldn't drink alcohol. Talk with your doctor about what amounts and types of fluid you should have each day. Other Lifestyle Changes Taking steps to control risk factors for CHD, high blood pressure, and diabetes also will help control heart failure.
Medicines Your doctor will prescribe medicines based on the type of heart failure you have, how severe it is, and your response to certain medicines. The following medicines are commonly used to treat heart failure:
Ongoing Care It's important to watch for signs that heart failure is getting worse. For example, weight gain may mean that fluids are building up in your body. Discuss with your doctor how often to check your weight and when to report weight changes. It's also important to get medical care for other related conditions. If you have diabetes and/or high blood pressure, work with your health care team to control these conditions. Have your blood sugar level and blood pressure checked. Talk with your doctor about when you should have tests and how often to take measurements at home. Try to avoid respiratory infections like the flu and pneumonia. Talk with your doctor or nurse about getting flu and pneumonia vaccines. Many people who have severe heart failure may need treatment in a hospital from time to time. Your doctor may recommend oxygen therapy (oxygen given through nasal prongs or a mask). Oxygen therapy can be given in a hospital or at home. Medical Procedures and Surgery As heart failure worsens, lifestyle changes and medicines may no longer control your symptoms. You may need a medical procedure or surgery. If you have heart damage and severe heart failure symptoms, you may need a cardiac resynchronization therapy (CRT) device or an implantable cardioverter defibrillator (ICD). In heart failure, the right and left sides of the heart may no longer contract at the same time. This disrupts the heart's pumping. To correct this problem, your doctor may implant a CRT device (a type of pacemaker) near your heart. This device helps both sides of your heart contract at the same time, which may decrease heart failure symptoms. Some people who have heart failure have very rapid, irregular heartbeats. Without treatment, the problem can cause sudden cardiac arrest. Your doctor may implant an ICD near your heart to solve this problem. An ICD checks your heart rate and uses electrical pulses to correct irregular heart rhythms. People who have severe heart failure symptoms at rest, despite other treatments, may need:
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with enough blood. In other cases, the heart can’t pump blood to the rest of the body with enough force. Some people have both problems.
failure worse. Talk with your doctor and health care team to create an eating plan that works for you.
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