Heart Failure
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What is Heart Failure?
     Types of Heart Failure
     Advanced Heart Failure
     Diagnostic Tests for Heart Failure
     Stages of Heart Failure & Treatments
     Self-check Plan for HF Management

What is Heart Failure?

Heart Failure is a chronic, progressive condition where the heart muscle isn't able to pump enough blood through the heart to meet the body's needs for blood and oxygen. Heart failure usually results in an enlarged heart. This results in fatigue and shortness of breath. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.

At first, the heart tries to compensate by:

  •  Enlarging
  •  Developing more muscle mass
  •  Pumping faster

The body also tries to compensate in other ways:

  •  The blood vessels narrow to keep blood pressure up, trying to make up for the heart's loss of power.
  •  The body diverts blood away from less important tissues and organs to maintain flow to the most vital organs, the heart and brain.

These are temporary measures, which mask the problem of heart failure. Heart failure continues and worsens until these substitute processes no longer work, and eventually the heart and body can no longer keep up.

Lifestyle factors that increase your risk of heart attack and stroke like smoking, being overweight, eating foods high in fat and cholesterol and physical inactivity contribute to heart failure.

The table below from the American Stroke Association lists the most common signs and symptoms of , explains why they occur and describes how to recognize them.

Sign or Symptom
People with Heart Failure May Experience... Why It Happens
Shortness of breath (also called dyspnea) ...breathlessness during activity (most commonly), at rest, or while sleeping, which may come on suddenly and wake you up. You often have difficulty breathing while lying flat and may need to prop up the upper body and head on two pillows. You often complain of waking up tired or feeling anxious and restless. Blood "backs up" in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can't keep up with the supply. This causes fluid to leak into the lungs.
Persistent coughing or wheezing
...coughing that produces white or pink blood-tinged mucus. Fluid builds up in the lungs (see above).
Buildup of excess fluid in body tissues (edema) ...swelling in the feet, ankles, legs or abdomen or weight gain. You may find that your shoes feel tight. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues.
Tiredness, fatigue ...a tired feeling all the time and difficulty with everyday activities, such as shopping, climbing stairs, carrying groceries or walking. The heart can't pump enough blood to meet the needs of body tissues. The body diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain.
Lack of appetite, nausea ...a feeling of being full or sick to your stomach. The digestive system receives less blood, causing problems with digestion.
Confusion, impaired thinking ...memory loss and feelings of disorientation. A caregiver or relative may notice this first. Changing levels of certain substances in the blood, such as sodium, can cause confusion.
Increased heart rate ...heart palpitations, which feel like your heart is racing or throbbing. To "make up for" the loss in pumping capacity, the heart beats faster.

Types of Heart Failure

  • Left-sided Heart Failure

The heart's pumping action moves oxygen-rich blood as it travels from the lungs to the left atrium, then to the left ventricle, which pumps it to the rest of the body. In left-sided or left ventricular (LV) heart failure, the left side of the heart must work harder to pump the same amount of blood. There are two types of left-sided heart failure and drug treatments are different for each.

  • Systolic failure: The left ventricle loses its ability to contract normally and can't pump with enough force to circulate enough blood.
  • Diastolic failure (also called diastolic dysfunction): The left ventricle loses its ability to relax normally because the it has become stiff, so the heart can't properly fill during the resting period between beats.
  • Right-sided Heart Failure

The heart's pumping action moves "used" blood returning from the veins through the right atrium into the right ventricle, then pumps the blood back out of the heart into the lungs to be replenished with oxygen.

Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure is transferred back through the lungs, ultimately damaging the heart's right side. When the right side loses pumping power, blood backs up in the body's veins. This usually causes swelling in the legs and ankles.

  • Congestive Heart Failure

As blood flow from the heart slows, blood returning to the heart backs up, causing congestion in the body's tissues, often causing swelling (edema). Usually, the swelling is in the legs and ankles, but other parts of the body can swell too.

Sometimes fluid collects in the lungs, interfering with breathing, causing shortness of breath, especially when laying down. This is called pulmonary edema.

Heart failure also affects the kidneys' ability to dispose of sodium and water, and the retained water increases swelling in the body, causing weight gain, as well.

Other warning signs of heart failure might include:

  •  Shortness of breath (also called dyspnea).
  •  Persistent coughing or wheezing.
  •  Lack of appetite, nausea, feeling full or sick to stomach.
  •  Confusion, disorientation, impaired thinking.
  •  Heart palpitations.

Advanced Heart Failure

Of the millions of Americans living with heart failure, about 10 percent have advanced heart failure, considered advanced when conventional heart therapies and symptom management no longer work. Shortness of breath and other symptoms are present even at rest. Of the A-to-D staging or rating system, advanced heart failure is stage D. Another classification system grades the severity of symptoms on a 1-to-4 scale. Symptom severity can fluctuate, even in a single day.

Early on, heart failure can be managed with medication and a healthy lifestyle. But as the disease progresses and the heart weakens, treatment becomes more complex.

Diagnostic Tests for Heart Failure

Tests for Heart Failure include:

Stages of Heart Failure & Treatments

The table below from WebMD outlines a basic plan of care that may or may not apply to you, based on the cause of your heart failure and your special needs. Ask your doctor to explain therapies that are listed if you do not understand why you are or are not receiving them.


Definition of Stage

Usual Treatments

Stage A

People at high risk of developing heart failure (pre-heart failure), including people with:
  • High blood pressure
  • Diabetes
  • Coronary artery disease
  • Metabolic syndrome
  • History of cardiotoxic drug therapy
  • History of alcohol abuse
  • History of rheumatic fever
  • Family history of cardiomyopathy
Exercise regularly.
  • Quit smoking.
  • Treat high blood pressure.
  • Treat lipid disorders.
  • Discontinue alcohol or illegal drug use.
  • An angiotensin converting enzyme inhibitor (ACE inhibitor) or an angiotensin II receptor blocker (ARB) is prescribed if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions.
  • Beta blockers may be prescribed if you have high blood pressure or if you've had a previous heart attack.

Stage B

People diagnosed with systolic left ventricular dysfunction but who have never had symptoms of heart failure (pre-heart failure), including people with:
  • Prior heart attack
  • Valve disease
  • Cardiomyopathy

The diagnosis is usually made when an ejection fraction of less than 40% is found during an echocardiogram test.

  • Treatment methods above for Stage A apply
  • All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) or angiotensin II receptor blocker (ARB)
  • Beta-blockers should be prescribed for patients after a heart attack
  • Surgery options for coronary artery repair and valve repair or replacement (as appropriate) should be discussed

If appropriate, surgery options should be discussed for patients who have had a heart attack.

Stage C

Patients with known systolic heart failure and current or prior symptoms. Most common symptoms include:
  • Shortness of breath
  • Fatigue
  • Reduced ability to exercise
  • Treatment methods above for Stage A apply
  • All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) and beta-blockers
  • African-American patients may be prescribed a hydralazine/nitrate combination if symptoms persist
  • Diuretics (water pills) and digoxin may be prescribed if symptoms persist
  • An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies
  • Restrict dietary sodium (salt)
  • Monitor weight
  • Restrict fluids (as appropriate)
  • Drugs that worsen the condition should be discontinued
  • As appropriate, cardiac resynchronization therapy (biventricular pacemaker) may be recommended
  • An implantable cardiac defibrillator (ICD) may be recommended

Stage D

Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care.

  • Treatment methods for Stages A, B & C apply
  • Patient should be evaluated to determine if the following treatments are available options: heart transplant, ventricular assist devices, surgery options, research therapies, continuous infusion of intravenous inotropic drugs and end-of-life (palliative or hospice) care

Self-check for Heart Failure Management

Click on the following American Heart Association chart to enlarge it.

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