Heart Failure

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While the term heart failure can be alarming, it does not mean the heart has stopped working. Heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for nutrient-rich blood.

Heart failure often develops after other conditions, such as coronary heart disease or high blood pressure, have damaged or weakened the heart. Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body.

If you or someone you know has been diagnosed with heart failure, learning more about it can help you cope. This section contains information about heart failure, its symptoms, and the tests used to diagnose heart failure.

Heart failure is a serious condition, and usually there's no cure. But many people with heart failure lead a full, enjoyable life when the condition is managed with heart failure medications and healthy lifestyle changes. Read more about these treatment options in Treatment.

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The first symptom of heart failure is generally fatigue. As the Heart Disease Research Institute describes, this occurs because your heart is weaker and pumping less blood to your organs and muscles, making you feel weak. Your body naturally senses that it must divert blood away from your muscles and less vital organs and send more blood to your brain. As the condition worsens, other symptoms of heart failure can include:

  • Shortness of breath and wheezing during exertion, which can eventually worsen to shortness of breath and wheezing when resting or lying flat
  • Chest heaviness or discomfort
  • Chronic dry cough with white or pink blood-tinged phlegm, due to fluid accumulation in the lungs
  • Swelling of the ankles, legs, or abdomen
  • Frequent nighttime urination, caused by fluid accumulation in the kidneys
  • Sudden weight gain of more than 2 lbs over two days or 5 lbs in a single week
  • Confusion, dizziness and memory loss
  • Continuous sensation of being bloated or full
  • Racing or irregular heartbeats
  • Change in or loss of appetite
  • Nausea
  • Elevated blood pressure

See your doctor if you think you might be experiencing any of the signs or symptoms of heart failure above. Seek emergency treatment if you experience chest pain, fainting or severe weakness, or rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting.

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Contrary to its name, heart failure does not mean that the heart has failed completely. Heart failure is a condition in which the heart cannot pump efficiently enough to meet the body's need for nutrient-rich blood.

Heart failure often develops after other conditions, such as coronary heart disease or high blood pressure, have damaged or weakened your heart. Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body. The main pumping chambers of your heart may become stiff and not fill properly between beats and your heart muscle may weaken and dilate to the point that the heart can't pump blood efficiently throughout your body.

The inefficient pumping associated with heart failure causes a backup of blood in the veins leading to the heart. It triggers the kidneys to retain fluid, and as a result, the body's tissues swell. The swelling most commonly affects the legs, but it can also occur in other tissues and organs. When it occurs in the lungs, it causes breathing difficulty. See symptoms for more details.

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. When heart failure affects mainly the left side of the heart, the symptoms are more likely to involve breathing difficulties, according to Harvard Health . When mainly the right side is affected, the main symptoms may be leg swelling and abdominal swelling.

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Firstly, your doctor will take a medical history and perform a physical examination to check for heart failure risk factors. No single test can diagnose heart failure. If you have signs and symptoms of heart failure, your doctor may also order some of these tests:

  • Blood tests: Blood tests are used to evaluate kidney and thyroid function, as well as to check cholesterol levels and the presence of anemia. A blood test to check for a hormone called B-type natriuretic peptide (BNP) can help in diagnosing heart failure, as the level of this hormone rises during heart failure.
  • Chest x-ray: A chest x ray takes pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test can show whether your heart is enlarged, you have fluid in your lungs, or you have lung disease. This test can show whether your heart is enlarged or whether there is fluid build-up around the heart and lungs, which can indicate heart failure. Your doctor can also use an X-ray to diagnose conditions other than heart failure that may explain your signs and symptoms.
  • Electrocardiogram (ECG): An ECG is a simple, painless test that detects and records the heart's electrical activity. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be the underlying cause of heart failure.
  • Echocardiogram: The echocardiogram is a particularly important for diagnosing heart failure. An echocardiogram uses sound waves to produce a video image of your heart. This test shows the size and shape of your heart and how well your heart chambers and valves work. It can determine whether the heart muscles have weakened or become stiff.  
  • Ejection fraction: This is a measurement of the blood pumped out of the heart with each beat. Your ejection fraction can be measured during an echocardiogram or by nuclear medicine tests, cardiac catheterisation and cardiac magnetic resonance imaging (MRI). 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.
  • Stress test: An exercise stress test is used to provide information about how the heart responds to exertion. It generally involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while the ECG, heart rate, and blood pressure are monitored. If you are not able to do activity, you may receive a drug intravenously that stimulates your heart in a similar way to exercise. Stress tests can help guide long-term treatment decisions.
  • Coronary catheterisation (angiogram): In this test, 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. This test helps doctors identify narrowed arteries to your heart that can be a cause of heart failure. 
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Early diagnosis and treatment can help people who have heart failure live longer, more active lives. Treatment for heart failure will depend on the severity of the condition. A variety of approaches can be taken in treating and managing heart failure, which include:

  • Lifestyle changes:  Changes in diet, weight loss, and physical activity can alleviate symptoms and improve your condition. In particular, fluid restrictions and a low-salt diet are essential.
  • Medications: Depending on your symptoms, you might take one or more of these drugs:
    • A diuretic to remove excess body fluid by increasing urine output
    • An angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker to help the heart work less hard
    • A beta-blocker to help the heart work less hard
    • Digoxin (Lanoxin) to strengthen the heart's contractions
    • A potassium-sparing diuretic, which can help people live longer when taken in low doses
    • Anticoagulants (blood thinners) can sometimes be prescribed to prevent blood clots
  • Surgery and medical devices: As heart failure worsens, lifestyle changes and medicines may no longer control your symptoms. You may need a medical procedure or surgery.
    • 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 other parts of your body 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 or repair the valve. Certain types of heart valve repair can now be done without open heart surgery, using either minimally invasive surgery or cardiac catheterisation techniques. Valve replacement is done when valve repair isn't possible. In valve replacement surgery, the damaged valve is replaced by an artificial (prosthetic) valve.
    • Implantable cardioverter-defibrillators (ICDs): If you experience rapid, irregular heartbeats as a symptom of heart failure, your doctor might implant an ICD near your heart to solve this problem. An ICD checks your heart rate and uses electrical pulses to correct irregular heart rhythms.
    • Left ventricular assist devices (LVADs): These mechanical devices are implanted into the abdomen or chest and attached to a weakened heart to help it pump. You may use a heart pump until you have surgery or as a long-term treatment.
    • Heart transplant: A heart transplant is an operation in which a person's diseased heart is replaced with a healthy heart from a deceased donor. Heart transplants are done as a life-saving measure for end-stage heart failure when medical treatment and less drastic surgery have failed.
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The key to preventing heart failure is to reduce your risk factors of the various forms of heart disease that lead to it. To prevent heart disease:

  • Eat a healthy, balanced diet that is high in fruit, vegetables and wholegrains and low in salt and saturated fats
  • Control your blood pressure and cholesterol level with medications prescribed by your doctor
  • Maintain a normal body weight
  • Exercise regularly, with 30 minutes of moderate exercise every day as a good general guideline
  • Don't smoke
  • Avoid alcohol or limit alcohol intake to 1 to 2 drinks per day
  • Reduce and manage stress

For detailed information about heart disease prevention guidelines, see Coronary Heart Disease Prevention.

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