Heart failure does not mean that your heart has stopped working. Heart failure means the left or right ventricle (lower chambers of the heart) are not contracting with enough force (systolic heart failure), or the ventricles are stiff and do not relax and fill properly (diastolic heart failure).
With heart failure, blood moves through the heart and body at a slower rate, and pressure in the heart increases. Therefore, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart respond by stretching to hold more blood to pump through the body or by becoming thicker and stiffer. This helps to keep the blood moving for a short while, but then the heart muscle walls weaken and are not able to pump as strongly. The heart muscle walls are damaged and do not pump or fill normally. The kidneys often respond by causing the body to retain fluid (water) and sodium.
If fluid builds up in the arms, legs, ankles, feet, lungs or other organs, the body becomes congested; congestive heart failure is the term used to describe this condition.
You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms are related to the changes that occur in your heart and body, including:
- Shortness of breath or difficulty breathing with exercise, at rest or when lying flat in bed. Shortness of breath occurs when fluid backs up into the lungs (congestion) or when your body does not have enough oxygenated blood to allow you to continue your activity or exercise without a rest period. Even though you think of shortness of breath as a lung problem, it is your heart condition that causes episodes of shortness of breath. In some cases, these symptoms may cause you to wake up suddenly at night, disrupting your normal sleep patterns.
- A dry, hacking cough or wheezing.
- Swollen ankles, legs and abdomen and weight gain. Less blood to the kidneys causes fluid and water retention, resulting in edema (swelling) and water weight gain.
- Need to urinate while resting at night. Another symptom may include an increased need to urinate during the night.
- Tiredness (fatigue) and weakness during exercise or activities occur because the heart is not pumping enough oxygen-rich blood to major organs and muscles.
- Dizziness, confusion, difficulty concentrating or fainting may occur because the heart is not pumping enough oxygen-rich blood to the brain.
- Rapid or irregular heartbeats (palpitations): When the heart muscle does not pump effectively, the heartbeat speeds up to help the heart get enough oxygen-rich blood to major organs and muscles. An irregular heartbeat can occur from many problems, including an enlarged heart, not enough oxygen-rich blood to the heart muscle, and too much volume or pressure in the heart. In addition, heart failure causes the electrical conduction system in the chambers of the heart to be irritable, leading to irregular heartbeats.
- Other symptoms include a feeling of fullness (bloating) in your stomach, loss of appetite or nausea.
If you have heart failure, you may have one or all of these symptoms. Sometimes, people with heart failure do not have any symptoms.
A healthy heart beats about 60 to 80 times per minute to pump blood throughout the body. The right and left sides of the heart work together. Blood that is low in oxygen first enters the right upper chamber (right atrium) of the heart. The blood flows from the right atrium to the lower chamber (right ventricle) through the open tricuspid valve. Blood passes through a valve before leaving each chamber of the heart. There are four valves in your heart; valves make sure blood flows in only one direction through your heart. The blood then travels through the pulmonary artery to the lungs where oxygen is added.
Oxygen-rich blood then returns to the left side of the heart. The blood flows from the left upper chamber (left atrium) to the lower chamber (left ventricle) through the open mitral valve. From the left ventricle, the blood is pumped into a network of arteries (blood vessels) that carry the blood throughout the body.
With systolic heart failure, the left ventricle’s pumping power is weaker than normal, causing less blood to move from the heart to the body. Less blood flow to main organs and tissues of the body can cause symptoms, as described on the first page.
Systolic left ventricular dysfunction (or systolic heart failure) occurs when the left ventricle heart muscle doesn’t contract with enough force, so less oxygen-rich blood is pumped throughout the body.
Heart failure with preserved left ventricular function (diastolic heart failure) occurs when the heart contracts normally, but the ventricles do not relax properly or are stiff and less blood enters the heart during normal filling.
A test called the ejection fraction (EF) is used to measure how well your heart pumps with each beat to determine if systolic dysfunction or heart failure with preserved left ventricular function are present. Ejection fraction is the measurement of how much blood is being pumped out of the left ventricle of the heart. Heart failure can occur due to a weakened heart muscle (systolic heart failure) or may be related to a stiff, inflexible heart muscle (diastolic heart failure). In diastolic heart failure, the ejection fraction can be normal, but the stiff heart muscle causes increased pressures inside the heart and lungs, leading to symptoms. Your doctor can discuss which condition is present in your heart. A number of different tests are used to define which kind of Heart Failure you suffer from.
Heart failure affects nearly five million Americans, and about 550,000 people are diagnosed with heart failure each year. Heart failure is the leading cause of hospitalization in people over age 65.
Heart failure affects about 2.5 million women in the United States. Women tend to develop heart failure with preserved left ventricular function and with a more normal ejection fraction than men. In general, women with heart failure survive longer than men with heart failure.
Heart failure in women is often linked to high blood pressure, coronary artery disease, valve disease and diabetes. Although the signs and symptoms of heart failure are the same among men and women, women tend to have more symptoms of exercise difficulty and shortness of breath than do men. Women also experience ankle swelling more frequently than do men.
Heart failure is caused by many conditions that damage the heart muscle, including:
- Coronary artery disease (also called coronary atherosclerosis) — a disease of the arteries that supply blood and oxygen to the heart. Coronary artery disease occurs when the normal lining of the arteries breaks down, the walls of the arteries thicken and deposits of fat and plaque block the flow of blood through the arteries. The arteries that supply blood to the heart become severely narrowed and the heart can no longer respond to increased activity. Extra strain on the heart may result in chest pain (angina pectoris) and other symptoms of heart disease.
- Heart attack — occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle and damaging it. All or part of the heart muscle becomes cut off from its supply of oxygen. A heart attack can damage the heart muscle, resulting in a scarred area that does not function.
- Cardiomyopathy — damage to the heart muscle from causes other than artery or blood flow problems. Causes include viruses, alcohol or drug abuse, and genetics or inherited.
- Heart defects present at birth
- Diabetes Mellitus
- High blood pressure (hypertension) — Blood pressure is the force of blood pushing against blood vessel walls. High blood pressure means the pressure in the arteries is above the normal range.
- Chronic kidney disease
- Obesity (being overweight)
In addition, heart failure often occurs when several diseases or conditions are present at once.
Together, you and your doctor will discuss your treatment options. Your doctor will determine which treatment methods are right for you. Heart failure management is a team effort, and you are the key player on the team.
Your heart doctor will prescribe your medications and manage other medical problems. Other team members, including nurses, dietitians, pharmacists, exercise specialists and social workers, will help you achieve success. But it is up to YOU to take your medications, make dietary changes, live a healthy lifestyle, keep your follow-up appointments, and be an active member of the team. Together, you and your doctor will discuss your treatment options.
Daily weight monitoring is a mainstay of heart failure management. Your weight will reflect how much fluid you have accumulated before it is so much that you will develop symptoms. Having a weight log is a good idea. you should alert your doctor if you gain more than 2 pounds in 2 to 3 days. This is generally a refelection of fluid accumulation.
With the right care, heart failure will not stop you from doing the things you enjoy. Your prognosis or outlook for the future will depend on how well your heart muscle is functioning, your symptoms, and how well you respond to and follow your treatment plan.
Everyone with a long-term illness, such as heart failure, should discuss their desires for extended medical care with their doctor and family. An "advance directive" or "living will" is one way to let everyone know your wishes. A living will expresses your desires about the use of medical treatments to prolong your life. This document is prepared while you are fully competent in case you are unable to make these decisions at a later time.