Heart Failure
Heart failure, sometimes called congestive heart failure (CHF), is a chronic, progressive condition where the heart muscle cannot pump blood as efficiently as it should. This means the heart cannot keep up with its workload, causing symptoms like shortness of breath and fatigue. Heart failure doesn't mean your heart has stopped working—it means it needs support to work better. There are two main types: heart failure with reduced ejection fraction (HFrEF, or systolic heart failure) where the heart muscle doesn't contract effectively, and heart failure with preserved ejection fraction (HFpEF, or diastolic heart failure) where the heart muscle is stiff and doesn't relax properly.
Causes
- Coronary artery disease - Narrowed arteries that supply blood to the heart muscle.
- Heart attack - Damage to the heart muscle from previous heart attacks.
- Hypertension - Long-term high blood pressure forces the heart to work harder.
- Valve disease - Damaged heart valves make the heart work harder to pump blood.
- Cardiomyopathy - Disease of the heart muscle itself, sometimes genetic or from toxins.
- Myocarditis - Inflammation of the heart muscle, usually caused by infection.
- Congenital heart defects - Heart problems present at birth.
- Arrhythmias - Abnormal heart rhythms that affect efficient pumping.
- Diabetes - Can damage blood vessels and the heart muscle over time.
- Obesity - Increases the risk of heart disease and makes the heart work harder.
- Severe lung diseases - Like COPD or pulmonary hypertension that affect heart function.
- Substance abuse - Alcohol, tobacco, or recreational drugs can damage the heart.
- Certain cancer treatments - Some chemotherapy drugs and radiation can damage the heart.
Signs and Symptoms
- Shortness of breath (dyspnea) - During activity, at rest, or while lying flat.
- Fatigue and weakness - Making daily activities difficult.
- Swelling (edema) - In the legs, ankles, and feet due to fluid buildup.
- Rapid or irregular heartbeat - Feeling like your heart is racing or throbbing.
- Reduced ability to exercise - Due to shortness of breath and fatigue.
- Persistent cough or wheezing - Sometimes with white or pink blood-tinged mucus.
- Increased need to urinate - Especially at night.
- Sudden weight gain - From fluid retention.
- Lack of appetite, nausea - Feeling full or sick to your stomach.
- Difficulty concentrating or decreased alertness - Due to changing levels of substances in the blood.
- Chest pain - If heart failure is caused by a heart attack.
- Abdominal swelling - Due to fluid buildup in the abdomen (ascites).
Diagnosis
Physical Examination
Your doctor will listen to your heart and lungs, check for fluid retention, and look for signs of conditions that might lead to heart failure.
Blood Tests
Tests like BNP (B-type natriuretic peptide) measure proteins produced by your heart when it's under stress. Other tests check kidney, thyroid, and liver function and look for anemia or other conditions.
Chest X-ray
Shows the size and shape of your heart and lungs, and can detect fluid in your lungs.
Electrocardiogram (ECG)
Records the electrical activity of your heart to detect abnormal rhythms, previous heart attacks, or other heart problems.
Echocardiogram
Uses sound waves to create images of your heart, showing its size, structure, and function, including the ejection fraction (percentage of blood pumped out with each beat).
Stress Test
Measures how your heart responds to exertion, either through exercise or medication that simulates exercise.
Cardiac MRI
Creates detailed images of your heart to assess its structure and function.
Coronary Angiogram
Uses dye and X-rays to see inside your coronary arteries and identify blockages.
Myocardial Biopsy
In rare cases, a small sample of heart tissue may be removed and examined to identify specific types of heart muscle disease.
Treatment Options
Medications
Various medications can help improve heart function, reduce symptoms, and prolong life. These may include ACE inhibitors, ARBs, beta blockers, diuretics, aldosterone antagonists, SGLT2 inhibitors, and more, depending on your specific condition and symptoms.
Lifestyle Changes
Adjustments to daily habits can significantly impact heart failure management, including limiting sodium intake, restricting fluid intake if necessary, getting regular physical activity as recommended by your doctor, quitting smoking, limiting alcohol, and managing stress.
Implantable Devices
For some patients, devices like pacemakers, implantable cardioverter-defibrillators (ICDs), or cardiac resynchronization therapy devices (CRT) can help regulate heart rhythm and improve heart function.
Surgical Procedures
When appropriate, procedures like coronary bypass surgery, heart valve repair or replacement, or heart transplantation may be considered to address underlying causes or advanced heart failure.
Home Remedies
Low-Sodium Diet
Restrict sodium to 1,500-2,000 mg daily. Read food labels, avoid processed foods, cook without adding salt, and use herbs and spices for flavoring instead.
Fluid Management
If your doctor has prescribed fluid restrictions, carefully monitor your daily fluid intake. Spread fluids throughout the day and try ice chips or frozen grapes to relieve thirst without consuming much liquid.
Daily Weight Monitoring
Weigh yourself at the same time each morning, after using the bathroom and before eating or drinking. Report weight gains of 2-3 pounds in a day or 5 pounds in a week to your healthcare provider.
Activity Pacing
Balance activity with rest periods. Plan important activities for times when you have more energy, and organize your home to reduce unnecessary exertion.
Sleep Positioning
Elevate your head and upper body with pillows or by raising the head of your bed to reduce shortness of breath while sleeping.
Stress Reduction
Practice relaxation techniques like deep breathing, meditation, or gentle yoga. Consider joining a support group to connect with others who understand your challenges.
Medication Management
Use pill organizers, set alarms, or use smartphone apps to help remember to take medications as prescribed. Never stop taking medications without consulting your doctor.
Preventive Care
- Take all medications exactly as prescribed, even when feeling well.
- Keep all follow-up appointments with your healthcare team.
- Monitor and record your weight daily to detect fluid retention early.
- Follow your recommended diet, especially regarding sodium and fluid restrictions.
- Get regular physical activity as approved by your doctor.
- Know the warning signs of worsening heart failure and when to seek medical attention.
- Manage other health conditions like diabetes, high blood pressure, and high cholesterol.
- Get vaccinated against influenza and pneumonia to prevent infections that could strain your heart.
- Avoid alcohol, tobacco, and recreational drugs.
- Reduce stress through relaxation techniques and adequate rest.
- Wear compression stockings if recommended to reduce leg swelling.
- Consider cardiac rehabilitation programs to improve your heart health under supervision.
Surgical Options
Coronary Artery Bypass Graft (CABG)
For heart failure caused by coronary artery disease, bypass surgery improves blood flow to the heart muscle by creating new pathways around blocked arteries using blood vessels from other parts of the body.
Learn More About This ProcedureHeart Valve Repair or Replacement
When heart failure is caused by diseased heart valves, surgical repair or replacement of the affected valves can improve heart function and reduce symptoms.
Learn More About This ProcedureVentricular Assist Device (VAD)
A mechanical pump implanted to help a weakened heart pump blood. VADs can be used as a bridge to transplant, as destination therapy for those who aren't transplant candidates, or as a temporary support until the heart recovers.
Learn More About This ProcedureHeart Transplantation
For end-stage heart failure that hasn't responded to other treatments, replacing the diseased heart with a healthy donor heart may be considered for suitable candidates.
Learn More About This ProcedureSchedule a Consultation
If you're experiencing symptoms of heart failure, our expert team is here to help you find the right treatment approach for your specific needs.