What Is Heart Failure?

If you’re diagnosed with heart failure, it means your heart muscle isn’t pumping enough oxygen- and nutrient-rich blood to your body cells.

The condition, sometimes called congestive heart failure, has no cure. However, heart medications and heart-healthy lifestyle changes can help manage heart failure and its symptoms, allowing you to lead a quality life.

Symptoms of Heart Failure

Heart failure symptoms vary from individual to individual and usually start suddenly or develop gradually. Here are the most common signs and symptoms:

• Dyspnea, i.e., shortness of breath: you may experience breathlessness during activity or at rest and may notice your symptoms worsen when you lie down or sleep.
• Fatigue: you may always feel tired, and doing everyday tasks such as grocery shopping and walking up a flight of stairs may be challenging. Moreover, your limbs may often feel weak.
• Swelling in the feet, ankles, and legs: heart failure can cause fluid to build up in your body tissues (edema). Fluid retention can also result in weight gain in some people.
• Abdominal swelling (ascites): fluid can also accumulate in your abdomen, causing increased belly and waistline size, a feeling of fullness, weight gain, and even shortness of breath.
• Persistent coughing or wheezing: due to fluid buildup in your lungs, you may experience a persistent cough with white or pink blood-tinged mucus, especially when lying down.
• Loss of appetite and nausea: you may experience a feeling of fullness or an upset stomach due to your digestive system not receiving enough blood.
• Rapid heartbeat: to make up for your heart’s reduced ability to pump blood, it may beat faster, resulting in heart palpitations, i.e., feeling as though your heart is racing.
• Confusion, difficulty concentrating, dizziness, and fainting: result from your brain not receiving enough oxygen-rich blood.
• Increased urge to urinate at night: lying down causes increased blood flow to your kidneys. Your kidneys, in turn, make more urine hence the need to urinate.

What Causes Heart Failure?

While the risk increases with age due to your heart losing some blood-pumping ability, anyone can develop it.

More so if you have (or had) one or more conditions that either damage, weaken, or overwork the heart. These include:

• Coronary artery disease/coronary heart disease: where the coronary arteries become narrowed or completely blocked with plaque, i.e., deposits of cholesterol and fatty substances.
• Heart attack: when a blood supply to a section of the heart muscle suddenly gets cut off, causing damage or death of the affected heart tissue.
• High blood pressure (hypertension): when the blood pressure in your blood vessels is too high, your heart pumps harder to circulate blood. Over time, the extra strain on your heart can cause its chambers to become too stiff or too weak to function normally.
• Abnormal heart valves: your heart’s four valves keep blood flowing through it in the direction. So a damaged valve due to disease, heart defect, or a heart infection causes your heart to work harder to keep blood circulating, weakening it over time.
• Heart muscle disease (cardiomyopathy): damage to the heart muscle, whether from drug or alcohol abuse, viral infection, genetics, or any other cause, puts you at a higher risk.
• Congenital heart disease: a problem with the structure of your heart, e.g., a hole in the heart or missing or abnormally formed parts of the heart, causes your heart to work harder to pump blood.
• Arrhythmia (abnormal heart rhythm): when your heart beats irregularly, too fast, or too slow, it may not be able to pump blood effectively.
• Diabetes: due to elevated lipid levels, people with diabetes tend to develop high blood pressure and atherosclerosis, risk factors for heart disease.
• Pulmonary hypertension: a rise in blood pressure in your lung’s arteries strains your heart’s right ventricle, causing it to work harder to pump blood.

Different Types of Heart Failure

According to the American Heart Association, these are the three types of heart failure:

Left-sided

Left-sided heart failure means the left side of your heart isn’t pumping blood effectively. Here are two types of left-sided heart failure:

• Systolic, also known as heart failure with reduced ejection fraction (HFrEF): the left ventricle can’t contract as it should, hence unable to pump enough oxygen-rich blood to the rest of your body.
• Diastolic, also known as heart failure with preserved ejection fraction (HFpEF): The left ventricle can’t relax properly and fill up entirely due to being stiff. As a result, less blood gets pumped out to the rest of your body when it contracts.

Right-sided

Right-sided heart failure results from left-sided heart failure. When the left ventricle fails, the increased fluid pressure transfers back to your heart through your lungs.

This damages your heart’s right side as it overworks to pump blood to your lungs. Consequently, fluid builds up in your veins and leaks into your body tissues, often causing swelling in the lowest parts of your body (e.g., legs and feet).

Congestive

Congestive heart failure is severe and requires urgent medical attention. The swelling resulting from blood backing up in your veins can also affect other body parts.

For instance, fluid may also build up in your lungs, leading to shortness of breath, especially when lying down. If left untreated, pulmonary edema can cause respiratory distress, preventing your organs from getting the needed oxygen.

It also affects your kidney’s function, i.e., filtering your blood of waste products and excess fluids, which, if trapped, can cause edema.

Congenital (CHF)

Congenital heart failure (CHF), also known as a congenital heart defect, is a heart problem that exists from birth. It is caused by a woman abusing drugs, taking certain medications, or consuming too much alcohol during pregnancy.

In addition, congenital heart defects can be caused by conditions such as Down syndrome or a viral infection like rubella in a pregnant mother during the first trimester.

Risk Factors for Heart Failure

We’re all at risk of heart failure, especially as we age. And while a combination of risk factors puts you at a greater risk of developing one, having one risk factor may be all it takes.

Here are the known risk factors of heart failure:

• High blood pressure
• Coronary artery disease
• Heart attack
• Congenital heart defects
• Valvular heart disease
• Diabetes
• Viral infections
• Certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), blood pressure medications, antiarrhythmic medications, and medications used to treat diabetes, cancer, lung conditions, and psychiatric conditions.
• Alcohol and tobacco use
• Obesity

Diagnosing Heart Failure

Heart failure diagnostic tests and procedures include:

Physical examination

• Your doctor asks about your medical history and reviews your symptoms
• Your blood pressure is measured
• You get weighed
• Using a stethoscope, your doctor listens to your lungs for signs of congestion and your heart for any abnormal heart rhythm.

Blood Tests

Your doctor draws a blood sample from your arm to look for specific substances such as sodium and potassium, creatinine, albumin, and biomarkers.

These blood tests may show if there’s a strain on your heart or other organs, such as the liver and kidneys, which is often an indicator of heart failure.

Chest X-rays

Chest X-ray imaging shows whether you have an enlarged heart or congestion in your lungs. X-rays can also diagnose other conditions that may cause your signs and symptoms.

Electrocardiogram (EKG or ECG)

The test records your heart’s rhythm, heart rate, and electrical signals to reveal:

• Evidence of an ongoing or previous heart attack
• Arrhythmias, i.e., heart rhythm problems

Echocardiogram

An echocardiogram uses sound waves to produce live images of your heart. It reveals the size and shape of your heart and assesses your heart’s ejection fraction, i.e., the amount of blood your left ventricle pumps out whenever it contracts.

Exercise stress test

Stress tests show how your heart responds during physical activity, revealing any blood flow problems within your heart.

Radionuclide ventriculography or multiple-gated acquisition scanning (MUGA)

The procedure involves injecting radioactive substances into the bloodstream and taking images of the lower chambers of your heart (ventricles) to check how well they’re pumping blood.

Cardiac catheterization

The test shows any blockages in your coronary arteries through a catheter and angiograms, i.e., X-ray images.

Magnetic resonance imaging (MRI)

An MRI is a medical imaging test that uses a strong magnetic field and radio waves to study the heart’s structure and how blood flows through your heart and blood vessels.

Classes of Heart Failure

Your test results help your doctor classify your heart failure and determine the appropriate course of treatment. The New York Heart Association (NYHA) classification is the most popular classification system.

• Class I: you don’t exhibit any symptoms during physical activity.
• Class II: you’re comfortable resting, but everyday activities trigger symptoms.
• Class III: although you’re still comfortable at rest, less than ordinary physical activity triggers symptoms.
• Class IV: you have symptoms at rest, and any physical activity you undertake causes discomfort.

Heart Failure Treatment

Your treatment plan may include the following:

• Making lifestyle changes: these include quitting smoking, eating a heart-healthy diet, avoiding or limiting alcohol and caffeine intake, maintaining a healthy weight, and being physically active.
• Medications: your doctor may prescribe angiotensin-Converting Enzyme (ACE) Inhibitors, angiotensin II receptor blockers, angiotensin-Receptor Neprilysin Inhibitors (ARNIs), beta-blockers, aldosterone antagonists, diuretics, digoxin, blood thinners, and cholesterol-lowering drugs.
• Medical devices: examples include implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT) devices, and ventricular assist devices (VADs).
• Surgical procedures: your doctor may recommend surgery if your heart has a correctable problem. Surgery options include heart transplant, heart valve repair or replacement surgery, coronary bypass surgery, and percutaneous coronary intervention (PCI).

Living With Heart Failure

Although heart failure may limit your activities, you can still enjoy a full life. For notable improvement in your symptoms and emotional well-being:

• Take good care of yourself by practicing a healthy lifestyle that includes eating a healthy diet, exercising as recommended by the doctor, and getting vaccinated for influenza and pneumonia.
• Monitor and manage your condition by tracking your symptoms, medication side effects, weight, and blood pressure. Your doctor or healthcare team will advise you about which changes you should report.