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List of All Topics
Heart Failure
Introduction
Heart failure, also known as congestive heart failure (CHF) means your heart can't pump enough blood to meet your body's needs. Any number of underlying heart conditions can lead to heart failure. Over time, conditions such as coronary artery disease or high blood pressure gradually sap your heart of its strength, leaving it too weak or too stiff to fill and pump efficiently. You can't reverse many conditions that lead to heart failure, but in some cases, a readily treatable problem could be the cause. Medications can improve the signs and symptoms of chronic heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life. Your best defense against heart failure is to prevent or control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.
Signs and symptoms
Heart failure typically doesn't occur suddenly. It develops slowly, over time. It's usually a chronic, long-term condition. The term "congestive" comes from the fact that as one or both of the heart's lower chambers (ventricles) fail, blood backs up into — or congests — the liver, abdomen, lower extremities and lungs.
The backing up of blood causes symptoms such as shortness of breath, fatigue and leg swelling. Other symptoms develop as the body tries to compensate for the heart's reduced pumping ability. The heart beats faster, its muscle thickens and the ventricles may stretch to accommodate more blood. Damage to the ventricles may cause them to pump out of sync, further reducing the efficient delivery of blood to the body.
Chronic heart failure
Signs and symptoms of chronic heart failure can include:
- Fatigue and weakness
- Shortness of breath (dyspnea) when you exert yourself or when you lie down
- Reduced ability to exercise
- Persistent cough or wheezing with white or pink blood-tinged phlegm
- Swelling (edema) in your legs, ankles and feet
- Swelling of your abdomen (ascites)
- Sudden weight gain from fluid retention
- Lack of appetite and nausea
- Difficulty concentrating or decreased alertness
- Irregular or rapid heartbeat
Acute heart failure can occur when something suddenly affects your heart's ability to function. Signs and symptoms of acute heart failure are similar to those of chronic heart failure, but are more severe and start or worsen suddenly. Signs and symptoms of acute heart failure may include:
- Sudden fluid buildup
- Rapid or irregular heartbeat with palpitations
- Sudden, severe shortness of breath and coughing up pink, foamy mucus
- Chest pain if caused by a heart attack or a bulge in an artery (aneurysm)
Causes
Heart failure often develops after other cardiac conditions have damaged or weakened your heart. Over time, the heart can no longer keep up with even the normal demands placed on it. The ventricles may become stiff and not fill properly between beats. Also, the heart muscle may weaken, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body. The failing pump causes blood and fluid to back up throughout your circulatory system — your lungs, legs, feet and ankles — and your kidneys retain excess water and sodium. This buildup of fluid is the congestive part of heart failure. The lung congestion occurs only with left-sided heart failure with fluid backing up into the lungs. The most common cause of right-sided heart failure is left-sided heart failure. The extra pressure in the lungs is eventually passed on to the right side of the heart, which then fails — causing fluid to collect in the abdomen and lower extremities.
Heart failure can develop quickly after damage caused by a heart attack, or it can develop gradually after years of high blood pressure or coronary artery disease. A defective heart valve may cause heart failure. In this case, repair or replacement of the valve can often reverse heart failure.
All of the behaviors that you probably associate with heart attack or heart disease — such as smoking, being overweight or eating foods high in cholesterol and fat — may cause or contribute to heart failure. Sometimes, your heart becomes weakened without explanation, a condition known as idiopathic dilated cardiomyopathy.
If you have heart failure, you may have one or more of the following conditions, which can damage or weaken your heart over time. Some of these can be present without even knowing it:
- Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. The buildup containing fats and other substances is called a plaque. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle chronically deprived of oxygen-rich blood. These areas of the heart may become weak from the lack of oxygen and pump less vigorously. In many cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if an unstable plaque ruptures, causing a blood clot to completely block blood flow to an area of the heart muscle. A heart attack results in the death of heart muscle, which can quickly weaken the heart's pumping ability. Sometimes the coronary artery disease is limited to the small coronary arteries. If these arteries become blocked, this won't cause a heart attack, but over time, it can gradually weaken the heart.
- High blood pressure (hypertension). Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform. In some cases, the heart will enlarge. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
- Faulty heart valves. The four valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed, if detected in time.
- Cardiomyopathy. This is another type of heart muscle damage. Some of the many causes of cardiomyopathy include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems can also damage heart muscle. If a specific cause can't be found, it is referred to as idiopathic dilated cardiomyopathy.
- Myocarditis. Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
- Heart defects present at birth (congenital heart defects). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to compensate. Genetic defects contribute to the risk of certain types of heart disease, which in turn may lead to heart failure.
- Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
Heart failure can involve the left side, right side or both sides of your heart. Typically, heart failure begins with the left side — specifically the left ventricle, your heart's main pumping chamber. Your doctor may refer to your condition as left-sided or left ventricular heart failure. He or she may define it further as systolic heart failure (when the left ventricle loses its ability to contract vigorously) or diastolic heart failure (when the left ventricle loses its ability to relax or fill fully) or a combination of both. The distinction is important because the drug treatments for each type may differ. Right-sided heart failure can occur independently or be a consequence of left ventricular heart failure.
Diastolic versus systolic heart failure
For your heart to work efficiently, it must be able to pump vigorously and then relax to refill with blood. Some infections and certain conditions such as coronary artery disease make the heart muscle thicken or stiffen or both. The abnormal heart muscle has difficulty relaxing to allow the ventricle to refill with blood. When the ventricle can't fill up with blood, less blood is pumped out to the body, regardless of how strong the "pump" is. A weak pump combined with stiff heart muscle that can't relax to allow the ventricle to refill is doubly difficult for the body.
You may have heart failure caused by a pumping problem, a filling problem — or a combination of both.
- Systolic heart failure occurs when the left ventricle can't contract vigorously — a pumping problem.
- Diastolic heart failure occurs when the left ventricle can't relax or fill fully — a filling problem.
Treatment
Heart failure is a chronic disease needing lifelong management. However, with treatment, a failing heart can become stronger and signs and symptoms of heart failure can improve. Doctors sometimes can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, the treatment of heart failure involves a balance of the right medications, and in some cases, devices that help the heart beat properly.
Experimental treatments
- Cardiac wrap surgery. Researchers are studying a technique that wraps a failing heart in a mesh bag, helping to prevent further failure. A surgeon pulls the mesh wrap over the base of the heart and attaches it with stitches. The goal is to prevent a weakened heart from enlarging (dilating) and failing further. Studies are ongoing.
- Ventricular restoration surgery. This surgery is being used experimentally to treat some people with heart failure caused by a heart attack. During the surgery, doctors remove scar tissue in the ventricular muscle caused by a heart attack and reshape the remaining healthy tissue to restore a more normal elliptical left ventricle shape. Reducing the size of and reshaping the left ventricle help restore normal function to the pumping mechanism.
- Enhanced external counterpulsation (EECP). This noninvasive technique has been used as a treatment for heart-related chest pain, and researchers are studying this treatment to see if it is beneficial for people with heart failure. Inflatable pressure cuffs are placed on the calves, thighs and buttocks. These cuffs are inflated and deflated in sync with your heartbeat. The theory is that EECP increases blood flow back to the heart.
The key to preventing heart failure is to get the risk factors under control. You can control or eliminate many of the risk factors for heart disease — high blood pressure and coronary artery disease, for example — by making lifestyle changes along with the help of any needed medications.
Information obtained from National Institute of Health