Understanding Heart Failure

Definition

In heart failure, the heart is unable to pump the right amount of blood throughout the body. This causes blood to back up in the veins. Depending on which part of the heart is affected most, this can lead to a build up of excess fluid in the lungs, feet, and elsewhere. Heart failure can worsen with time, which may lead to the use of many treatments. Because of this, doctors are aggressive in treating heart failure to try to prevent it from worsening.

Blood Flow Through the Heart

© 2009 Nucleus Medical Media, Inc.

Causes

The leading causes of heart failure are:

• Coronary artery disease
• Heart attack

Other common causes include:

• Problems with the heart's valves due to:
  • Rheumatic heart disease
  • Bacterial endocarditis
  • Congenital defects
  • Calcium deposits from atherosclerosis
• High blood pressure
• Diabetes

Other less common causes include:

• Cardiomyopathy (weakened, damaged heart muscle from various causes)
• Certain medications
• Abnormal heartbeats ( arrhythmias )
• Hyperthyroidism (overactive thyroid)
• Amyloidosis
• Kidney failure and/or liver failure
• Thiamine ( vitamin B1 ) deficiency

Symptoms

Symptoms include:

• Shortness of breath—at first only with activity, then progressing to shortness of breath at rest
• Unexplained weight gain
• Swelling of feet, ankles, or legs
• Need to sleep propped up
• Fatigue, weakness
• Wheezing
• Cough —may be dry and hacking or wet sounding, may have a pink, frothy sputum
• Frequent urination, especially at night
• Abdominal pain

Risk Factors

Risk factors include:

• Advancing age
• Obesity
• Excess intake of salt and fat
• Excess alcohol intake
• Sex: male
• Race: Black
• Smoking
• Pregnancy
• High fever
• Severe infection
• Chronic lung disease ( emphysema )
• Chemotherapy

Diagnosis

The doctor will ask about your symptoms and medical history. She will also do a physical exam, which will include:

• Listening to your lungs and heart with a stethoscope
• Feeling the abdomen for tenderness and liver swelling
• Checking your feet, ankles, and legs for swelling

Tests may include:

• Blood tests—to look for certain markers in the blood that help the doctor determine what is happening with your heart
• Urine tests—to look for certain markers in the urine that help the doctor determine what is happening with your heart
• Electrocardiogram (ECG, EKG)—records the heart's activity by measuring electrical currents through the heart muscle
• Echocardiogram —uses high-frequency sound waves (ultrasound) to examine the size, shape, function, and motion of the heart
• Exercise stress test —records the heart's electrical activity during increased physical activity (may be coupled with echocardiogram or neclear scan)
  • If you cannot exercise, you may be given medicine. This medicine simulates physical exertion.
• Nuclear scanning—uses radioactive material (such as thallium) to highlight areas with diminished flow
• Coronary angiography —uses a catheter, dye, and x-rays to look for abnormalities (eg, narrowing, blockage) in the arteries and evaluate the function of the heart

Treatment

Prevention

The best way to prevent heart failure is to reduce your risk of:

• Coronary artery disease
• High blood pressure
• Diabetes

Take these steps to reduce your risk:

• Begin a safe exercise program with the advice of your doctor.
• If you smoke, quit.
• Limit alcohol.
• Lose weight if needed. Once you have lost weight, maintain a healthy weight .
• Eat a healthy diet. The DASH diet , in particular, may reduce the risk of high blood pressure and heart failure, particularly in women. The DASH diet is:
  • Rich in fruits, vegetables, and low-fat dairy foods
  • Low in saturated fat, total fat, and cholesterol
• Eat whole grain breakfast cereal. In addition to the other healthy habits, this may reduce your risk.