Heart failure occurs when your heart muscle doesn’t pump blood as well as it should. Certain conditions, such as high blood pressure, narrowed arteries in your heart (coronary artery disease), gradually leave your heart too weak or stiff to fill and pump well.
Treatments can help improve the symptoms of heart failure and help you live longer, however, not all conditions that lead to heart failure can be reversed. Lifestyle changes can help improve quality of life. Such changes may include cutting down on sodium intake, exercising, losing weight, and managing stress.
Symptoms of Heart Failure
Heart failure, also known as congestive heart failure, can be chronic (condition is ongoing) or acute (condition may start suddenly).
Heart failure signs and symptoms may include:
- Rapid or irregular heartbeat
- Rapid weight gain from fluid retention
- Swelling of your abdomen (ascites)
- Shortness of breath (dyspnea) when you exert yourself or when you lie down
- Fatigue and weakness
- Swelling (edema) in your legs, ankles and feet
- Chest pain if your heart failure is caused by a heart attack
- Persistent cough or wheezing with white or pink blood-tinged phlegm
- Increased need to urinate at night
- Lack of appetite
- Difficulty concentrating or decreased alertness
- Sudden shortness of breath and coughing up pink, foamy mucus
When to see a doctor
Seek emergency treatment if you experience any of the following:
- Chest pain
- Fainting or severe weakness
- Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting
- Sudden, severe shortness of breath and coughing up pink, foamy mucus
Causes of Heart Failure
Heart failure often occurs after other conditions have damaged or weakened your heart. However, the heart doesn’t need to be weakened to cause heart failure. It can also occur if the heart becomes too stiff or rigid.
In heart failure, the ventricles (main pumping chambers of your heart) may become stiff and not fill properly between beats. In some cases of heart failure, your heart muscle may become damaged, and the ventricles dilate or expand to the point that the heart can’t pump blood properly throughout your body.
An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is 50 percent or higher. This means that more than half of the blood that fills the ventricle is pumped out with each beat.
But heart failure can occur even with a normal ejection fraction. This happens if the heart muscle becomes stiff from conditions such as high blood pressure.
Heart failure can involve the left ventricle, right ventricle or both sides of your heart. Generally, heart failure starts at the main pumping chamber of your heart, which is the left ventricle.
The table below shows the different type of heart failure and descriptions for each condition:
|Type of heart failure||Description|
|Left-sided heart failure||Fluid may back up in your lungs, leading to breathlessness.|
|Right-sided heart failure||Fluid may back up into your legs, feet, and abdomen, causing swelling.|
|Systolic heart failure||The left ventricle can’t contract energetically, signifying a pumping problem.|
|Diastolic heart failure
(also called heart failure with preserved ejection fraction)
|The left ventricle can’t relax or fill fully, indicating a filling problem.|
Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:
- Coronary artery disease and heart attack: This is the most common cause of heart failure. The disease results from the accumulation of fatty deposits in your arteries, which reduce blood flow and can lead to heart attack.
- High blood pressure (hypertension):If your blood pressure is high, your heart has to work extra hard than normal to circulate blood throughout your body. This extra effort can make your heart muscle too stiff or too weak to pump blood effectively over time.
- Faulty heart valves:The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve forces your heart to work harder, which can weaken it over time.
- Damage to the heart muscle (cardiomyopathy): Heart muscle damage (cardiomyopathy) can have many causes, including infections, alcohol abuse and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy. Genetic factors also can contribute.
- Myocarditis is an inflammation of the heart muscle. It is most commonly caused by a virus and can lead to left-sided heart failure.
- Congenital heart defects:These are heart conditions you’re born with. If your heart and its chambers or valves haven’t formed correctly, the healthy parts of your heart have to work harder to pump blood through your heart, which, in turn, may lead to heart failure.
- Abnormal heart rhythms (heart arrhythmias):This condition may cause your heart to beat too fast, creating extra work for your heart. A slow heartbeat also may lead to heart failure.
- Other diseases.Chronic diseases — such as diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron (hemochromatosis) or protein (amyloidosis) — also may contribute to heart failure.
Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.
A single risk factor may be enough to cause heart failure, but a combination of factors also increases your risk.
Risk factors include:
- High blood pressure.Your heart works harder than it has to if your blood pressure is high.
- Coronary artery disease.Narrowed arteries may limit your heart’s supply of oxygen-rich blood, resulting in weakened heart muscle.
- Heart attack.A heart attack is a form of coronary disease that occurs suddenly. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
- Having diabetes increases your risk of high blood pressure and coronary artery disease.
- Some diabetes medications.The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure in some people. Don’t stop taking these medications on your own, though. If you’re taking them, discuss with your doctor whether you need to make any changes.
- Irregular heartbeats
- Sleep apnea.The failure to breathe properly while you sleep at night results in low blood oxygen levels and increased risk of abnormal heart rhythms.
- Congenital heart defects
- Valvular heart disease
- Alcohol use
- Tobacco use
- Certain medications.Some medications may lead to heart failure or heart problems. Medications that may increase the risk of heart problems include nonsteroidal anti-inflammatory drugs (NSAIDs); certain anesthesia medications; some anti-arrhythmic medications; certain medications used to treat high blood pressure, cancer, blood conditions, neurological conditions, psychiatric conditions, lung conditions, urological conditions, inflammatory conditions and infections; and other prescription and over-the-counter medications.
If you have heart failure, your outlook depends on the cause and the severity, your overall health, and other factors such as your age. Complications can include:
- Kidney damage or failure.Heart failure can reduce the blood flow to your kidneys, which can ultimately cause kidney failure if left untreated. Dialysis is often used to treat kidney damage from heart failure.
- Heart valve problems.The valves of your heart, which keep blood flowing in the proper direction through your heart, may not function properly if your heart is enlarged or if the pressure in your heart is very high due to heart failure.
- Heart rhythm problems. Arrhythmias) can be a potential complication of heart failure.
- Liver damage.Heart failure can lead to a collection of fluid that puts too much pressure on the liver. This fluid holdup can lead to scarring, which makes it more difficult for your liver to function properly.
Some people’s symptoms and heart function will improve with proper treatment. However, heart failure can be life-threatening. People with heart failure may have severe symptoms, and some may require heart transplantation or support with a ventricular assist device.
Preventing Heart Failure
The strategy to preventing heart failure is to reduce or eliminate your risk factors. Lifestyle changes you can make to help prevent heart failure include:
- Quit smoking
- Maintaining healthy weight
- Reducing and managing stress
- Controlling certain conditions, such as high blood pressure and diabetes
- Staying physically active
- Eating healthy foods
Your doctor will take a thorough medical history, review your symptoms and perform a physical examination, to diagnose your condition. Your doctor will also check for the presence of risk factors, such as high blood pressure, coronary artery disease or diabetes.
Your doctor will use a stethoscope to listen to your lungs for signs of congestion. The stethoscope also picks up abnormal heart sounds that may suggest heart failure. The doctor may examine the veins in your neck and check for fluid accumulation in your abdomen and legs.
After the physical exam, your doctor may also order some of these tests:
- Blood tests.A sample of your blood will be taken to examine it for signs of diseases that can affect the heart.
- Chest X-ray.X-ray images help your doctor see the condition of your lungs and heart.
- Electrocardiogram (ECG).This test records the electrical activity of your heart through electrodes attached to your skin.
- An echocardiogram uses sound waves to produce a video image of your heart. This test can help doctors inspect the size and shape of your heart along with any abnormalities.
- Stress test.Stress tests measure the health of your heart by how it responds to exertion. You may be asked to walk on a treadmill while attached to an ECG machine, or you may receive a drug intravenously that stimulates your heart similar to exercise.
- Cardiac computerized tomography (CT) scan.This scan involves you lying on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.
- Magnetic resonance imaging (MRI).In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field, which aligns atomic particles in some of your cells. Radio waves are broadcast toward these aligned particles, producing signals that create images of your heart.
- Coronary angiogram.A thin, flexible tube (catheter) is inserted into a blood vessel at your groin or in your arm and guided through the aorta into your coronary arteries. A dye injected through the catheter makes the arteries supplying your heart visible on an X-ray, to help spot blockages.
- Myocardial biopsy.A small, flexible biopsy cord will be inserted into a vein in your neck or groin, and small pieces of the heart muscle are taken. This test may be performed to diagnose certain types of heart muscle diseases that cause heart failure.
Heart failure is a chronic disease needing lifetime management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger. Treatment may help you live longer and reduce your chance of sudden death.
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, use of devices that help the heart beat and contract properly.
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one or more medications, including:
- Angiotensin-converting enzyme (ACE) inhibitors.These drugs help people with systolic heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Zestril) and captopril (Capoten).
- Angiotensin II receptor blockers.These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the same benefits as ACE inhibitors. They may be an alternative for people who can’t tolerate ACE inhibitors.
- Beta blockers.This class of drugs not only slows your heart rate and reduces blood pressure but also limits or reverses some of the damage to your heart if you have systolic heart failure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta).
These medicines reduce the risk of some abnormal heart rhythms and lessen your chance of dying unexpectedly. Beta blockers may reduce signs and symptoms of heart failure, improve heart function, and help you live longer.
- Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics, such as furosemide (Lasix), also decrease fluid in your lungs so you can breathe more easily.
Because diuretics make your body lose potassium and magnesium, your doctor may also prescribe supplements of these minerals. If you’re taking a diuretic, your doctor will likely monitor levels of potassium and magnesium in your blood through regular blood tests.
- Aldosterone antagonists.These drugs include spironolactone (Aldactone) and eplerenone (Inspra). These are potassium-sparing diuretics, which also have additional properties that may help people with severe systolic heart failure live longer.
Unlike some other diuretics, spironolactone and eplerenone can raise the level of potassium in your blood to dangerous levels, so talk to your doctor if increased potassium is a concern, and learn if you need to modify your intake of food that’s high in potassium.
- These are intravenous medications used in people with severe heart failure in the hospital to improve heart pumping function and maintain blood pressure.
- Digoxin (Lanoxin).This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms in systolic heart failure. It may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation.
You may need to take two or more medications to treat heart failure. Your doctor may prescribe other heart medications as well — such as nitrates for chest pain, a statin to lower cholesterol or blood-thinning medications to help prevent blood clots — along with heart failure medications.
You may be hospitalized if you have a flare-up of heart failure symptoms. While in the hospital, you may receive additional medications to help your heart pump better and relieve your symptoms. You may also receive supplemental oxygen through a mask or small tubes placed in your nose. If you have severe heart failure, you may need to use supplemental oxygen long term.
Surgery and medical devices
In some cases, doctors recommend surgery to treat the underlying problem that led to heart failure. Some treatments being studied and used in certain people include:
- Coronary bypass surgery.If severely blocked arteries are contributing to your heart failure, your doctor may recommend coronary artery bypass surgery. In this procedure, blood vessels from your leg, arm or chest bypass a blocked artery in your heart to allow blood to flow through your heart more freely.
- Heart valve repair or replacement.If a faulty heart valve causes your heart failure, your doctor may recommend repairing or replacing the valve. The surgeon can modify the original valve to eliminate backward blood flow. Surgeons can also repair the valve by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annuloplasty).
Valve replacement is done when valve repair isn’t possible. In valve replacement surgery, the damaged valve is replaced by an artificial (prosthetic) valve.
Certain types of heart valve repair or replacement can now be done without open heart surgery, using either minimally invasive surgery or cardiac catheterization techniques.
- Implantable cardioverter-defibrillators (ICDs).An ICD is a device similar to a pacemaker. It’s implanted under the skin in your chest with wires leading through your veins and into your heart.
The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also function as a pacemaker and speed your heart up if it is going too slow.
- Cardiac resynchronization therapy (CRT), or biventricular pacing.A biventricular pacemaker sends timed electrical impulses to both of the heart’s lower chambers (the left and right ventricles) so that they pump in a more efficient, coordinated manner.
Many people with heart failure have problems with their heart’s electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction may cause heart failure to worsen. Often a biventricular pacemaker is combined with an ICD for people with heart failure.
- Ventricular assist devices (VADs).A VAD, also known as a mechanical circulatory support device, is an implantable mechanical pump that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. A VAD is implanted into the abdomen or chest and attached to a weakened heart to help it pump blood to the rest of your body.
Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. VADs may also be used as an alternative to transplantation. Implanted heart pumps can enhance the quality of life of some people with severe heart failure who aren’t eligible for or able to undergo heart transplantation or are waiting for a new heart.
- Heart transplant.In some severe cases, where medications and surgery failed, your diseased heart may need to be replaced with a healthy donor heart.
Heart transplants can improve the survival and quality of life of some people with severe heart failure. However, candidates for transplantation often have to wait a long time before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment or device therapy and can be removed from the transplant waiting list.
A heart transplant isn’t the right treatment for everyone. A team of doctors at a transplant center will assess you to determine whether the procedure may be safe and useful for you.
Palliative care and end-of-life care
Your doctor may recommend palliative care in your treatment plan. Palliative care is specialized medical care that centers on easing your symptoms and improving your quality of life. Anyone who has a serious or life-threatening illness can benefit from palliative care, either to treat symptoms of the disease, such as pain or shortness of breath, or to ease the side effects of treatment, such as fatigue or nausea.