What is heart failure?
The term “heart failure” sounds scary. But it simply means your heart isn’t pumping blood as well as it should. It can be caused by multiple different heart conditions and tends to get worse over time. It does not mean your heart has stopped working or that you are having a heart attack. (Though people who have heart failure often have had a heart attack in the past.) The most common cause of heart failure is congestive heart failure (CHF). “Congestive” means fluid is building up in the body because the heart isn’t pumping properly.
Symptoms of heart failure
Some people who have heart failure have few problems or symptoms. Others have many symptoms. People with heart failure might experience:
- Shortness of breath during activity.
- Shortness of breath when lying down.
- Lack of appetite.
- Waking up in the night, suddenly breathless.
- General tiredness or weakness, including the reduced ability to exercise.
- Swelling of the legs, feet, or ankles.
- Swelling of the abdomen.
- Rapid or irregular heartbeat.
- Rapid weight gain (1 or 2 pounds a day for 3 days in a row).
- Chronic cough or wheezing.
Call your doctor if you have any of these symptoms, especially if you’ve had heart problems in the past.
What causes heart failure?
Heart failure has many causes. Most of these are other conditions or diseases that damage the heart muscle. These could include:
- Coronary artery disease (when the blood supply to the heart is partially or completely blocked). This could be with or without a heart attack in the past.
- Problems with the heart muscle itself (cardiomyopathy).
- High blood pressure (hypertension).
- Problems with any of the heart valves.
- Abnormal heart rhythms (arrhythmias).
- The use of toxic substances (such as alcohol or drug abuse).
- Congenital heart defect (a heart problem you were born with).
- Thyroid problems.
Sometimes, the exact cause cannot be found. Some people are at higher risk of developing heart failure. Any of the following could increase your risk:
- Being 65 years or older.
- Being African American.
- Being overweight.
- Being male.
- Having had a heart attack in the past.
How is heart failure diagnosed?
There is no single test to diagnose heart failure. Your doctor will ask you about your medical history and symptoms. He or she will give you a physical exam and may order some the following tests:
- Blood tests – measure the level of the BNP hormone that increases in heart failure.
- Chest X-ray – shows if your heart is enlarged or your lungs have fluid in them.
- Electrocardiogram (also called an EKG or ECG) – measures the rate and regularity of your heartbeat. It can help diagnose heart rhythm problems or damage to the heart.
- Echocardiogram (also called an echo) and doppler ultrasound – use sound waves to make pictures of the heart. These show how well your heart is working and pumping blood.
- Holter monitor – a small box attached to electrodes on your chest records your heart rhythm for 24 hours or more.
- Stress test – measures your heartbeat and blood pressure. This can be done before, during, or after exercise to see how your heart responds to activity.
- Radionuclide ventriculography – injects a very small amount of a radioactive substance into your blood. This substance travels to your heart. A special camera or scanner produces pictures that show how well your heart is pumping. The radioactive substance is safe and leaves your body completely after the test is finished.
Can heart failure be prevented or avoided?
Heart failure is the result of other diseases or conditions weakening your heart. These can include coronary artery disease, high blood pressure, and diabetes. The best way to avoid heart failure is to prevent those conditions. The following can help you maintain a healthy lifestyle:
- Quit smoking.
- Maintain a healthy weight.
- Exercise regularly.
- Eat a healthy diet.
- Limit alcohol.
- Limit sodium.
If you do have a condition such as high cholesterol, high blood pressure, or diabetes, you need to manage it. Keep levels under control and take any medicines you’ve been prescribed.
Heart failure treatment
Heart failure cannot be completely cured. But treatment can improve how well the heart pumps and can help relieve your symptoms. An important part of treatment is taking care of any underlying problems. This includes lowering high blood pressure or fixing a heart valve. Treatment also includes lifestyle changes and medicine.
What medicines will I need to take?
A variety of medicines are used to treat heart failure. You may need one or more medicines, depending on your symptoms. Your doctor will talk about these medicines with you. It may take some time to find the best type of medicine and the best dosage of medicine for you.
Several kinds of medicines are commonly used to treat heart failure:
- ACE inhibitors.ACE inhibitors help open (dilate) your arteries and lower your blood pressure, improving blood flow.
- Diuretics are often called “water pills.” They cause you to urinate more often and help keep fluid from building up in your body. They can also decrease fluid that collects in your lungs. This will help you breathe easier.
- Beta blockers.Beta blockers can lower blood pressure and slow a rapid heartbeat. They may also help prevent some heart rhythm problems.
- Digoxin (also called digitalis) helps the heart pump better by strengthening the muscle contractions of the heart.
If you have other problems or experience side effects, you might need to take other medicines.
When you’re taking medicine for heart failure, you’ll also need to have regular blood tests. These will check your potassium level and kidney function. How often you need blood tests depends on the type and strength of medicine you’re taking. Many patients take heart failure medicines without any problems. If you have concerns about the medicine or think you’re having side effects, talk to your doctor. It’s important that you take your medicine exactly as your doctor tells you.
If your heart failure is severe, your doctor may recommend placing a small defibrillator in your chest. It can restart your heart if your heart stops.
Living with heart failure
Heart failure has no cure. You’ll probably have to follow a treatment plan for the rest of your life. This treatment plan can include medicines, lifestyle changes, guides on activity levels, and keeping your appointments. Your restrictions will depend on how severe your heart failure is.
The following tips can help you manage your heart failure at home.
- Follow a diet that’s healthy for your heart. You may need to make changes to your diet in order to stay healthy. Many doctors recommend the DASH diet. Avoid eating too much salt or too many salty foods (such as canned vegetables or soups, chips, or pizza). Salty and high-sodium foods can cause your body to retain water.
- Talk to your doctor before using salt substitutes. They often contain potassium and may not be good for your health. This will depend on your kidney function and what medicines you’re taking. Some people need extra potassium, but others don’t.
- Keep your blood pressure under control. High blood pressure strains your heart and further weakens it.
- Ask your doctor to recommend an exercise program for you. Try to reduce the stress in your life and get plenty of sleep. If you smoke, quit! If you’re overweight, talk to your doctor about how to lose weight safely.
- Talk to your doctor before you take any over-the-counter medicines. Common arthritis medicines such as naproxen (Aleve) and ibuprofen (Advil) can cause fluid retention.
Weigh yourself daily at the same time of day and report any unexplained changes to your doctor. Fluid retention and weight gain are signals that your CHF may not be in control.
When should I call my doctor?
Talk to your doctor if you have any of the following:
- Shortness of breath that gets worse.
- A weight gain of more than 5 pounds in one week.
- Leg swelling that is new for you.
- Coughing or wheezing in the night or needing to sleep propped up or sitting up.
- Chest pain or a heavy feeling in your chest.
- Side effects from the medicine.
- Failure to lose weight, even though you take more water pills.
You should also call your doctor if you have any questions about your condition or medicine.
Questions to ask your doctor
- What is the likely cause of my heart failure?
- How serious is my condition?
- How will my life change now that we know I have heart failure?
- How will I know if my condition is getting worse? When should I contact you or seek treatment?
- What is the best treatment option for me? Will I need medicine? Surgery?
- What are the side effects of the medicines used to treat heart failure?
- Will I need a heart transplant?
- Is it safe for me to exercise? What kind of exercise should I do?
- Should I make any lifestyle changes at home to reduce my risk of complications?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.