Heart failure is a condition in which the heart can't pump enough blood throughout the body. Heart failure does not mean that the heart has stopped or is about to stop working. It means that the heart is not able to pump blood the way that it should. The heart can't fill with enough blood or pump with enough force, or both.
Heart failure develops over time as the pumping action of the heart grows weaker. It can affect the left side, the right side, or both sides of the heart. Most cases involve the left side where the heart can't pump enough oxygen-rich blood to the rest of the body. With right-sided failure, the heart can't effectively pump blood to the lungs where the blood picks up oxygen.
The weakening of the heart's pumping ability causes:
Heart failure is a serious condition. About 5 million people in the United States have heart failure, and the number is growing. Each year, another 550,000 people are diagnosed for the first time. It contributes to or causes about 300,000 deaths each year.
What causes heart failure?
Heart failure is caused by other diseases or conditions that damage or overwork the heart muscle. Over time, the heart muscle weakens and is not able to pump blood as well as it should.
The leading causes of heart failure are:
Most people with heart failure also have high blood pressure, and about one in three has diabetes.
Other causes of heart failure
Other heart diseases and conditions that can lead to heart failure are:
Other conditions that may injure the heart muscle and lead to heart failure include:
Who is at risk for heart failure?
Heart failure can happen to anyone, but it's more common in:
Heart failure is very common in people 65 years of age and older. It's the #1 reason for a hospital visit in this age group.
African Americans are more likely to have heart failure and suffer more severely from it. African Americans are more likely to:
Men have a higher rate of heart failure than women. But in actual numbers, more women have heart failure because many more women live into their seventies and eighties, when heart failure is common.
Children with congenital heart defects can also have heart failure. Congenital heart defects happen when the heart, heart valves, and/or blood vessels near the heart do not develop correctly in babies when they are in the womb. This can weaken the heart muscle and lead to heart failure. Children do not have the same symptoms or get the same treatment for heart failure as adults. Children's heart failure will not be discussed here.
What are the signs and symptoms of heart failure?
The most common signs and symptoms are:
Shortness of breath and feeling tired are caused by the buildup of fluid in the lungs and around the lungs (pleural effusions). When symptoms start, you may feel tired and short of breath after routine physical exertion. Climbing two flights of stairs makes you feel winded. As heart failure progresses, the symptoms get worse. You may begin to feel tired and short of breath after simple activities, like getting dressed or walking across the room. Some people have shortness of breath when lying flat.
Fluid buildup in the lungs can also cause a cough. The cough is worse at night and when you are lying down. Excessive fluid in the lungs can cause a life-threatening condition called acute pulmonary edema. This condition requires emergency treatment.
The swelling is from the buildup of fluid in your body (edema). Other signs of fluid buildup are:
Limitation on physical activity
Doctors also classify your symptoms based on how much they limit your daily activity. By class of symptom, your doctor means:
How is heart failure diagnosed?
There is not a specific test to determine if you have heart failure. A clinical diagnosis of heart failure is usually made when symptoms appear. The symptoms – shortness of breath, tiredness, and fluid buildup – are common in other conditions.
Your doctor will determine if you have heart failure by performing a detailed medical history, a physical exam, and several tests. The purpose of these is to:
Medical and family history
Your doctor will ask if you or others in your family have or have had any of the diseases and conditions that can cause heart failure. Your doctor will also ask about your symptoms. This includes the types of symptoms, when they occur, how long you have had them, and their severity. The answers will help your doctor determine the limits on your ability to perform daily activities.
Your doctor will:
If you have signs and symptoms of heart failure, your doctor may order the following tests:
If your doctor suspects heart failure after asking about your medical and family history and performing a physical exam and initial tests (such as tests of kidney function), he or she may refer you to a cardiologist. A cardiologist is a doctor who specializes in the diagnosis and treatment of heart disease. The cardiologist will perform a physical exam and order additional tests.
An echocardiogram is the most useful test for diagnosing heart failure. This test uses sound waves to create a moving picture of your heart. Echocardiogram provides information about the size and shape of your heart and how well your heart chambers and valves are functioning. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow.
There are several different types of echocardiograms, including a stress echocardiogram. During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine into your bloodstream that makes your heart beat faster and work harder. A stress echocardiogram is usually done to find out if you have decreased blood flow to your heart (coronary artery disease).
The cardiologist may order any of the following tests. These tests can help identify the cause of your heart failure:
During exercise stress testing, your blood pressure and EKG readings are monitored while you walk or run on a treadmill or pedal a bicycle. Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time. These would be ordered if your doctor needs more information than the exercise stress test can provide about how well your heart is working. If you are unable to exercise, a medicine can be injected through an intravenous line (IV) into your bloodstream to make your heart work harder and beat faster, as if you are exercising on a treadmill or bicycle. Nuclear heart scanning or echocardiography is then usually done. During nuclear heart scanning, radioactive tracer is injected into your bloodstream, and a special camera shows the flow of blood through your heart and arteries. Echocardiography uses sound waves to show blood flow through the chambers and valves of your heart and to show the strength of your heart muscle.
Your doctor also may order two newer tests along with stress testing if more information is needed about how well your heart works. These new tests are magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart. MRI shows detailed images of the structures and beating of your heart, which may help your doctor better assess if parts of your heart are weak or damaged. PET scanning shows the level of chemical activity in different areas of your heart. This can help your doctor determine if enough blood is flowing to the areas of your heart. A PET scan can show decreased blood flow caused by disease or damaged muscles that may not be detected by other scanning methods.
How is heart failure treated?
The goals of treatment are to:
Your doctor will continue to treat the underlying diseases or conditions (such as coronary artery disease, high blood pressure, or diabetes) that caused heart failure. The treatment for heart failure includes:
There are things that you can do to help with your treatment. Your doctor will recommend that you:
Your doctor will also tell you to:
Your doctor will prescribe medicines to help improve your heart function and symptoms. The main medicines are:
Specialized care for severe heart failure
As heart failure progresses, lifestyle changes and regular medicines may not be enough to control worsening symptoms. Many people with severe heart failure must be treated in the hospital from time to time. In the hospital, your doctor may prescribe new or special medicines. You will continue to take your regular medicines during this treatment.
Your doctor will also order extra oxygen if you continue to have trouble breathing. The extra oxygen can be given in the hospital and at home.
Persons with very severe heart failure may be considered for a:
A mechanical heart pump is a special device placed inside the body to help pump blood to the rest of the body. There are different kinds of mechanical heart pumps. Some stay in the body for a short period of time, while others can stay in the body for a long time. Many people with a mechanical heart pump will also be considered for a heart transplant.
A heart transplant is surgery to replace a heart failure patient's heart with a healthy heart from someone who has recently died. A transplant is indicated in some people when all other treatments fail to control symptoms.
How can heart failure be prevented?
The major underlying causes of heart failure are coronary artery disease (including angina and heart attack), high blood pressure, and diabetes. Getting treatment and staying in treatment for any underlying condition that you have can greatly reduce your risk.
Other things you can do to reduce your risk include:
Living with heart failure
Heart failure usually can't be cured, and you will likely have to take medicine for the rest of your life. It's important that you know that your symptoms may get worse over time. As your symptoms get worse, you may not be able to do many of the things that you did before you had heart failure.
Treatment can relieve your symptoms and make it easier to do some of the things that you like to do. Treatment can also reduce the chance that you'll have to go to the hospital. For these reasons, it's very important that you follow your treatment plan. You must:
Common causes that worsen symptoms and can lead to a crisis or even a hospital stay are:
If you have trouble following your diet, talk to your doctor. Your doctor can help arrange for a dietitian to work with you on keeping a healthy diet. Alcohol also makes your symptoms worse. If you drink alcohol, don't do so very often, and limit yourself to one drink. If you have severe heart failure, you should not drink alcohol.
People with heart failure often have other serious conditions that require ongoing treatment. If you have other conditions, it's likely that you are taking medicines for those conditions as well as for heart failure. When taking several medicines, there is always a chance for side effects and interaction between the medicines. Tell your doctor immediately about any problems that you notice with your medicines. Also, talk with your doctor before adding any new medicine. This includes over-the-counter medicines and herbal supplements.
It's also important that you try to avoid respiratory infections like the flu and pneumonia. Ask your doctor or nurse about getting flu and pneumonia shots.
It's helpful to have certain information on hand in case you need to go to the hospital or doctor right away. You should plan now to make sure that you have:
Special needs for severe heart failure
In the advanced stages, heart failure is a progressive condition that can generally be expected to get worse and eventually lead to death. If you have severe heart failure and symptoms at rest, you can expect your condition to worsen. It's important that you and your family discuss what you can expect and your final treatment options with your doctor while you are able to do so. The time may come when you are unable to participate in discussions about your care.
Advance directives are documents that tell doctors and hospitals what treatment you want or do not want if you are too ill to speak for yourself. You and your family may decide that you only want treatment to make you comfortable. You, your family, and your doctor may also decide whether you want treatment if your heart or breathing stops.
There are two types of advance directives:
Advance directives are easy to prepare. You can do it yourself without a lawyer. The only requirement is that you are at least 18 years old. You may prepare your advance directive by:
Depending on the State where you live, the document may also need to be:
As long as you are able to make your own decisions, your advance directives will not be used, and you can accept or refuse any medical treatment. But if you become seriously ill, you may not be able to make decisions about your own treatment.
Give a copy of your living will and power of attorney to a family member, and keep another copy in a safe place. People with severe heart failure are in the hospital often. It's important that you or a family member bring a copy of your advance directives every time you go to the hospital.
As heart failure worsens, the time may come when treatment is no longer working. If you and your doctor agree that your treatments are not working, hospice care may be an option. Hospice is an organization that can comfort and support you and your family. A team of people provides hospice care. This team includes:
The goals of hospice care are to:
Hospice supports life and views dying as a natural process. Hospice will work with you and your family to provide the services you need.