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Heart Failure (more information)

Overview

Heart failure is not a specific disease. It is a condition syndrome that can be brought on by a variety of underlying diseases or health problems. Heart failure is classified according to:

  • Severity using a system developed by the American Heart Association (/51/12744)
  • Stages in the evolution and progression of heart failure, as developed by the American College of Cardiology and the American Heart Association (/185/58200)

Heart failure can involve the left side of the heart, the right side or both. It usually affects the left side first. Each side is made up of two chambers: the atrium, or upper chambers, and the ventricle, or lower chamber. The atrium receives blood into the heart, and the ventricle pumps it throughout the body. Heart failure occurs when any of these chambers lose their ability to keep up with the amount of blood flow.

Left-sided heart failure

Left-sided heart failure or left-ventricular (LV) heart failure involves the left ventricle (lower chamber) of the heart. This chamber is larger than the others and supplies most of the heart's pumping power. Oxygen-rich blood travels from the lungs to the left atrium, and then on to the left ventricle, which pumps it to the rest of the body.

There are two types of heart failure: systolic and diastolic. Systolic failure occurs when the left ventricle losses its ability to contract and can't pump with enough force the blood into circulation. Diastolic failure occurs when the left ventricle become stiff and loses its ability to relax. If the left ventricle cannot relax, the heart cannot properly fill with blood during the resting period between each beat.

With both types of failures, blood coming into the left chamber from the lungs may "back up", causing fluid to leak into the lungs (pulmonary edema). As the heart's ability to pump decreases, blood flow slows down and causes fluid to build up in the tissues throughout the body (edema). This build up or congestion explains why some people refer to heart failure as congestive
heart failure.

Right-sided heart failure

Right-sided or right-ventricular (RV) heart failure usually occurs because of left-sided failure. When the left ventricle fails, increased fluid pressure is transferred back through the lungs, damaging the right side of the heart. When the right side loses pumping power, blood backs up in the body's veins, usually causing swelling in the legs and ankles.

This section from American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=337

Risk factors for heart failure

Heart failure is the result of another disease process. Any risk factors that contribute to the development of that underlying disease (most commonly coronary artery disease and heart attack) are risk factors for heart failure. High blood pressure, physical inactivity and smoking are risk factors for heart attack and are therefore risk factors for heart failure. In fact, young African Americans, ages 25-44 are twenty times more likely than their Caucasian peers to develop heart failure related to high blood pressure (www.well-connected.com/report.cgi/pdf1000014.pdf, 6/27/03). Hypertension precedes congestive heart failure in between 75% and 90% of heart failure cases (http://www.well-connected.com/report.cgi/000014_5.htm, 6/30/03).

Cardiomyopathies, congenital heart defects, heart valve disease, pericardial disease and arrhythmias are risk factors for heart
disease. Alcohol abuse; medication overuse, such as chemotherapy; and the risk factors for diabetes are also risk factors. Having diabetes can cause a condition called diabetic cardiomypathy.

Prevention and Planning Ahead

The best way to prevent heart failure is lower your risk by changing your lifestyle. See your doctor for regular check-ups. Maintain a healthy diet, exercise regimen (with doctor's supervision), healthy cholesterol, blood pressure, and blood sugar levels. Limit your alcohol intake. A recent study concluded that moderate alcohol consumption decreased the risk of developing heart failure in older people (qtd. In webMD www.com/content/healthwise/160/51075). However, heavy alcohol consumption can lead to heart failure.

If you have been diagnosed with heart failure, tell a close friend or relative about your condition. Make you know what to do and they know what to do if you go into cardiac arrest or experience any symptoms of heart failure. Come up with a plan to get to the hospital. Lastly, make sure you take your medication properly and follow your doctor's orders (diet, exercise, etc.).

Warning Signs and Symptoms

The earliest and most common symptoms develop when blood backs up in the lungs and fluid builds up in the body. Typical symptoms include:

Sign or Symptom Why It Happens People with Heart Failure May Experience...
Shortness of breath (also called dyspnea) Blood "backs up" in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can't keep up with the supply. This causes fluid to leak into the lungs. . . . breathlessness during activity (most commonly), at rest, or while sleeping, which may come on suddenly and wake them up. They often have difficulty breathing while lying flat and may need to prop up the upper body and head on two pillows. They often complain of waking up tired or feeling anxious and restless.
Persistent coughing or wheezing Fluid builds up in the lungs (see above). . . . coughing that produces white or pink blood-tinged phlegm.
Buildup of excess fluid in body tissues (edema) As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues. . . . swelling in the feet, ankles, legs or abdomen or weight gain. They may find that their shoes feel tight.
Tiredness, fatigue The heart can't pump enough blood to meet the needs of body tissues. The body diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain. . . . a tired feeling all the time and difficulty with everyday activities, such as shopping, climbing stairs, carrying groceries or walking.
Lack of appetite, nausea The digestive system receives less blood, causing problems with digestion. . . . a feeling of being full or sick to their stomach.
Confusion, impaired thinking Changing levels of certain substances in the blood, such as sodium, can cause confusion. . . . memory loss and feelings of disorientation. A caregiver or relative may notice this first.
Increased heart rate To "make up for" the loss in pumping capacity, the heart beats faster. . . . heart palpitations, which feel like the heart is racing or throbbing.

Used with permission from the American Heart Association.

Diagnosis

in diagnosing heart failure your doctor will ask you about your medical history, perform a physical examination, and may order a chest x-ray. An echocardiogram is the best and simplest way to determine if you have heart failure and, if so, what type of heart failure is present. It can also help to see how severe it is.

Complications

Due to the heart's reduced pumping ability, the body must try to compensate for the reduction. The heart may enlarge, develop more muscle mass, or pump faster Your blood vessels narrow to keep blood pressure up, trying to make up for the heart's loss of power. The body diverts blood away from less important tissues and organs to maintain flow to the most vital organs, the
heart and brain. Your body's compensation masks the problem of heart disease. This explains why some people may not be aware of their problem until after the heat is severely impaired. The heart cannot keep up forever. Eventually, the person begins experiencing symptoms that usually signal its time to go the doctor.

As heart failure worsens, you may become very fatigued and weak, even when taking medication and following your treatment plan. Because of the reduced blood supply, other organs of your body may not be able to function properly. Very often the kidneys are affected by the decreased blood and oxygen flow. Other complications may include:

  • Arrhythmia (irregular heartbeat), which may result in sudden death
  • Stroke
  • Heart attack
  • Deep vein thrombosis or pulmonary embolism
  • Heart valve problems, such as mitral valve regurgitation
  • Sudden heart failure

It is important to mention sudden heart failure in detail. Sudden heart failure develops quickly when fluid rapidly builds up in the lungs (pulmonary edema). It may be caused by not taking medications properly, a new heart attack, blood clots that travel to the lungs, infections, alcohol use, a high- sodium meal or too much physical activity. Symptoms of sudden heart failure are severe shortness of breath, an irregular or rapid heart beat, and/or a cough with foamy, pink mucus. Sudden heart failure is a
medical emergency and requires immediate medical care.

Additionally, some patients with heart failure are at high risk for sudden cardiac death and should be evaluated by a cardiologist who specializes in heart rhythm problems. These specialists, called electrophysiologist, can do tests to determine if a patient is at risk for a life-threatening rhythm disorder.

more on complications www.webmd.com/content/healthwise/185/58163
www.webmd.com/content/healthwise/161/51090

Intervention/Treatment

If you have been diagnosed with heart failure, diet and lifestyle changes-including limiting salt intake, balancing rest and activity,
avoiding infection, and careful use of medications- are important to control heart failure and prevent complications, hospitalization, and sudden death.

for more intervention tips see Know When to Call a Doctor:
www.webmd.com/content/healthwise/161/51084

Treatment for heart failure depends on the cause of your heart failure, the type of heart failure (systolic or diastolic), how serious your symptoms are, and how well your body is able to compensate. Treatment can begin before symptoms occur. A patient with early heart failure without symptoms or a patient that has just experienced a heart attack is treated with angiotensin-converting enzyme (ACE) inhibitor. This patient is also encouraged to make healthy lifestyle changes to reduce his chances of developing heart failure (qtd. in Heart failure-treatment overview webmd).

If you have heart failure, a doctor might prescribe the following medications:

  • ACE inhibitor
  • Diuretic (water pill)
  • Beta-blocker
  • Digoxin

It is important to know that medication does not cure heart failure; however, they do help the heart to pump better, control symptoms, slow the progression of the disease, and reduce the risk of complications.

for more on medicine see: Heart failure- medications
www.webmd/content/healthwise/161/51087

Your doctor may recommend a surgical treatment, such as coronary artery bypass surgery, if blood vessels in your heart are blocked. Surgery to correct certain types of heart valve disease may also improve symptoms of or reverse heart failure.

Heart transplants are considered only when symptoms have not responded to other standard forms of treatment. New treatments options include using dual-chambers or biventricular pacemakers. Left ventricular assist devices (LVADs) and artificial hearts are an option only for a very small number of people and on an experimental basis. (from Heart failure-treatment overview webmd).

for more on heart failure surgery:
www.webmd.com/content/healthwise/160/51077

for other treatments:
www.webmd.com/content/healthwise/161/51085

Remember that heart failure is the result of another underlying problem (such as high blood pressure, diabetes, or coronary artery disease). You may need additional treatment to correct or control any underlying problems. You may also need treatment for contributing factors or triggers of heart failure (such as fever, arrhythmia, anemia, or infection). (from webmd heart
failure-treatment overview).

Alternative treatments

You may want to consult the following sites for alternative treatments to heart failure:

Frequently Asked Questions

Q: Does heart failure mean that the heart stops working?

A: No. Heart failure occurs when the heart is not pumping blood as well as it should.

Q: Is heart failure curable?

A: No. Medications help the heart to pump better, control symptoms, slow the progression of the disease, and reduce the risk of complications.

Q: What special risks are there for African-Americans?

A: High blood pressure is prevalent in the African-American community. In fact, African Americans, ages 25-44 are twenty times more likely than their Caucasian peers to develop heart failure related to high blood pressure.

Q: What is sudden cardiac death?

A: Sudden cardiac death occurs when the heart stops working. During cardiac death, the electrical system of the heart suddenly becomes irregular. The ventricles may flutter or quiver, and blood is not delivered to the body. People with heart failure are at an increased risk for sudden cardiac death.

Q: Why are some people not aware of heart failure?

A: Some people are not aware of their heart failure because the body does a good job of compensating for the heart's reduced pumping ability. The heart may enlarge, develop more muscle mass, or pump faster. A person's blood vessels narrow to keep blood pressure up, trying to make up for the heart's loss of power. The body diverts blood away from less important tissues and organs to maintain flow to the most vital organs, the heart and brain. However, the heart cannot keep up forever. Eventually, the person will experience heart failure symptoms and decide to take a trip to the doctors.

For an interactive guide on heart failure see http://www.nlm.nih.gov/medlineplus/tutorials/congestiveheartfailure.html, National Patient Institute, 6/30/03)

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