Heart Failure

Heart failure, sometimes called congestive heart failure, is a chronic condition where the heart muscle doesn't pump blood as well as it should. This does not mean the heart has stopped working, but rather that it is not effectively circulating blood throughout the body. As a result, the body's organs and tissues do not receive enough oxygen, and fluid can build up in the lungs and other areas. 

Signs and symptoms

Heart failure symptoms can develop gradually over time or appear suddenly, depending on the cause. Symptoms often get worse as the heart's pumping ability weakens. 

Key signs and symptoms:

  • Shortness of breath: You may feel breathless during physical activity, when lying flat, or wake up suddenly at night gasping for air. This is caused by fluid backing up into the lungs.

  • Persistent cough or wheezing: Fluid in the lungs can cause a chronic cough that may produce a white or pink, blood-tinged mucus.

  • Swelling (edema): Poor circulation can cause fluid to build up in the legs, ankles, feet, and abdomen. You may notice your shoes feel tight or have a rapid, unexplained weight gain.

  • Fatigue and weakness: The heart's inability to pump enough blood means your body's tissues are not receiving enough oxygen, causing you to feel unusually tired.

  • Rapid or irregular heartbeat: The heart may beat faster to compensate for its reduced pumping power, which can feel like palpitations.

  • Nausea and lack of appetite: Reduced blood flow to the digestive system can cause problems with digestion.

  • Difficulty concentrating or confusion: A decrease in blood flow to the brain can cause memory loss, confusion, or disorientation. 

Diagnosis

To diagnose heart failure, a doctor will consider your symptoms, review your medical and family history, and conduct a physical exam. Several tests may also be performed to assess your heart's function and identify the underlying cause. 

Common diagnostic tests:

  • Physical exam: The doctor will listen to your heart and lungs for abnormal sounds and check for swelling in your legs and neck veins.

  • Blood tests: A blood test can measure levels of natriuretic peptides, substances that increase in the blood when heart failure is present.

  • Chest X-ray: This can show if your heart is enlarged and if there is fluid buildup in your lungs.

  • Echocardiogram: An ultrasound of the heart that shows its size and shape, how well it's pumping, and if there are any valve issues.

  • Electrocardiogram (ECG): This test records the heart's electrical activity and can help detect a previous heart attack or irregular heart rhythms. 

Treatment

Treatment for heart failure focuses on controlling the underlying cause, managing symptoms, and improving quality of life. In many cases, heart failure can be managed with a combination of medication and lifestyle changes. 

Medications:

  • ACE inhibitors, ARBs, and ARNIs: These drugs relax blood vessels, lowering blood pressure and reducing the heart's workload.

  • Beta-blockers: These medications slow the heart rate and lower blood pressure, which helps the heart work more efficiently.

  • Diuretics ("water pills"): These help the body get rid of excess fluid and sodium, which reduces swelling and makes breathing easier.

  • SGLT-2 inhibitors: Originally for diabetes, these newer drugs have been shown to improve outcomes for people with heart failure. 

Lifestyle changes:

  • Diet: Eating a heart-healthy diet with low salt (sodium) is crucial to prevent fluid buildup.

  • Weight management: Maintaining a healthy weight reduces the strain on your heart.

  • Exercise: Your doctor may recommend a regular, moderate exercise program to improve heart function and strength.

  • Monitoring: Regularly weighing yourself can help you catch early signs of fluid retention. A sudden gain of a few pounds over a couple of days can indicate worsening heart failure. 

Surgical procedures and devices:

For more advanced heart failure, a doctor may recommend devices or surgery.

  • Implantable cardioverter-defibrillator (ICD): This device is implanted to correct dangerously irregular heart rhythms.

  • Pacemakers: Certain pacemakers (CRT devices) can help both sides of the heart pump together more efficiently.

  • Ventricular assist device (VAD): A mechanical pump that helps the heart pump blood to the rest of the body.

  • Heart transplant: In severe cases where other treatments have failed, a heart transplant may be necessary


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