Heart failure

Overview

Heart failure is a condition in which the heart is not strong enough to meet your body's needs, either because it can’t fill with blood or because it can’t pump with enough force. Some forms of heart failure are treated with surgery, such as valve replacements or coronary artery bypass surgery.

Heart failure is not a heart attack; it develops over time, though children also can have heart failure, with some different symptoms that need different treatments. Heart failure is very common, but it has no cure. Treatment and long-term management are the best responses.

Causes

Right-side heart failure is a result of the heart being too weak to pump enough blood to the lungs for oxygenation, while left-side heart failure (LV, or left ventricular) is a result of the heart being unable to pump enough oxygenated blood to the rest of the body. Most heart failure is caused by diseases that damage the heart, such as coronary heart disease (CHD) and diabetes.

Often, heart failure is preceded by another heart condition, such as coronary artery disease (CAD), high blood pressure (hypertension or HBP) or a previous heart attack. If you have or had any heart condition, it must be carefully managed to help prevent heart failure. However, some conditions can exist without symptoms, and put you at more risk for heart failure.

Children’s heart failure may be caused by “overcirculation failure” or “pump failure.” In overcirculation failure, blood mixes inside the heart due to a congenital defect. Pump failure occurs when the heart muscle is damaged and can’t contract normally.

Symptoms

The following are symptoms for most adults:

  • Chest pain or discomfort
  • Edema – Right-side heart failure may cause fluid build-up in the feet, ankles, legs, liver, abdomen, and the veins in the neck. 
  • Discomfort in other areas of the upper body
  • Shortness of breath and fatigue  Failure on either side can cause these symptoms.
  • Other symptoms  These may include a cold sweat, dizziness, lightheadedness, nausea, belching or vomiting. Chest pain may not accompany these symptoms. Some people experience clammy skin or skin that turns pale or blue, particularly around the mouth.

Symptoms in women may be different. Most women will experience pain or discomfort in the chest and other symptoms listed above, but some may not. Other symptoms that a woman might experience include:

  • Pain in the abdomen
  • Pain or discomfort in the center of the back or in the jaw.

Infant heart failure includes breathing trouble, poor feeding or growth, excess sweating or sometimes low blood pressure. Heart failure symptoms may mimic those of colic, pneumonia or other respiratory infections.

Types

  • Left-sided heart failure – The left ventricle, which supplies most of the heart's pumping power, is larger than the other chambers and necessary for the heart to function normally. In LV heart failure, this side must work harder to pump the same amount of blood. There are two types of LV failure, with two different drug treatments:
    • Systolic failure: The left ventricle cannot contract normally.
    • Diastolic failure (diastolic dysfunction): The left ventricle cannot relax normally, so   the heart can't properly fill with blood while resting between each beat.
  • Right-sided heart failure (RV)  RV heart failure usually results from LV failure. The heart pumps out blood that returns through the veins through the right atrium into the right ventricle, which pumps blood back out into the lungs for oxygenation.

    When the left ventricle fails, the lungs experience increased fluid pressure, which damages the heart's right side. When the right side loses pumping power, blood backs up in the veins, causing swelling in the legs, ankles and abdomen (in the GI tract and liver).

  • Congestive heart failure  Congestive heart failure needs quick medical attention. In this condition, blood flow from the heart slows, and blood returning to the heart through the veins backs up, causing congestion or swelling (edema) in the legs and ankles and sometimes elsewhere. Fluid may collect in the lungs, causing shortness of breath, especially when a person is lying down. This is pulmonary edema and if left untreated can cause respiratory distress. Heart failure also affects the kidneys.

Diagnosis

Clinical cardiologists provide a full range of non-invasive and minimally invasive testing, depending on your particular condition. These include:

  • Electrocardiographs (ECGs)
  • Stress tests
  • Cholesterol and blood pressure evaluations
  • Nuclear stress testing
  • Echocardiography (cardiac ultrasound)
  • Computed tomography (CT) angiography
  • Vascular studies
  • Heart monitoring

Risk

Without proper treatment, those who have or had any of the following are at risk for heart failure:

  • CAD or acute coronary syndrome
  • Past heart attack (myocardial infarction)
  • HBP
  • Abnormal heart valves — Mitral valve prolapse, when the valve between the left atrium and left ventricle doesn't close properly, is the most common version of this condition. occurring. Depending on the severity of the condition, it sometimes allows blood to leak through the valve opening (mitral regurgitation). When severe, it can lead to heart failure and arrhythmia.
  • Heart muscle disease (dilated cardiomyopathy, hypertrophic cardiomyopathy) or        inflammation (myocarditis)
  • Congenital heart disease
  • Severe lung disease
  • Diabetes
  • Obesity
  • Sleep apnea

You also could be at risk for heart disease if you:

  • Smoke
  • Have total cholesterol levels of 200 mg/dL or higher, low levels of "good" cholesterol (HDL), or high levels of "bad" cholesterol (LDL)
  • Are a man over 35 years old
  • Are a woman beyond menopause
  • Do not get much exercise or lead a sedentary lifestyle
  • Have a family history of heart disease
  • Have excess stress
  • Use recreational drugs, such as cocaine and amphetamines

Treatment

If you have heart disease or have experienced a heart attack or palpitations, you most likely will see a cardiologist first. Your primary cardiologist will coordinate your care with your primary care physician and a wide range of specialists including electrophysiologists and surgeons, creating a treatment plan tailored to your specific circumstances. Your cardiologist will refer you to a specialist if you need a procedure such as heart surgery or electrophysiology testing.

Our heart failure specialists also work closely with you if you are hospitalized, ensuring that you have a smooth transition to your home. We provide both inpatient and outpatient management of heart failure, including guidance about long-term prevention strategies. Your doctor and nurse educators make sure that you understand how to live with heart failure, know and understand your medications and make regular follow-up appointments, and our cardiologists offer consultation and long-term care. 

Surgery generally isn’t used to treat simple heart failure unless the problem is correctable by that means, such as a heart valve defect or blocked coronary artery. Medication and lifestyle changes usually are the first approaches. These surgical options depend on the type, severity and progression of heart failure:

  • Percutaneous coronary intervention (PCI, or angioplasty)
  • Coronary artery bypass
  • Valve replacement
  • Implantable cardioverter-defibrillator (ICD)
  • Cardiac resynchronization therapy (CRT)
  • Left ventricular assist device (LVAD)
  • CardioMems

Prevention

If you have had a heart attack or been diagnosed with heart disease, talk to your cardiologist to learn all you can about heart disease prevention and how you can live a healthy life. Your cardiologists can work with you to develop a healthy eating plan, a weight management program and a fitness plan. Exercise can strengthen your heart, help you lose weight and lower your cholesterol and blood pressure. Losing even a small amount of weight can help lower blood pressure and reduce your heart’s workload. By making the right kind of lifestyle decisions and changes such as those listed below, you can improve your heart health:

  • Exercise regularly
  • Quit smoking
  • Lose weight
  • Eat a healthy, balanced diet
  • Reduce stress

These changes can make a big difference in your heart health and your overall health.

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