HealthTricks

Heart failure is a general term that describes a weakening heart. It afflicts about five million Americans, and causes or contributes to about 300,000 deaths a year.

Heart failure is diagnosed when the heart loses pumping power, usually causing widespread swelling, shortness of breath, and fatigue. Mark Herpel, 49, describes the feeling as “having your head held under a pool, but you can’t get to the surface so you begin to panic.”

The National Heart, Blood, and Lung Institute categorizes the two types of heart failure as follows.

- Systolic: This occurs when the heart’s ability to contract decreases. The heart cannot pump with enough force to push a sufficient amount of blood into the circulation. Blood coming into the heart from the lungs may back up and cause fluid to leak into the lungs, a condition known as pulmonary congestion.

- Diastolic: This occurs when the heart has a problem relaxing. It cannot properly fill with blood because the muscle has become stiff, losing its ability to relax. This form may lead to fluid accumulation, especially in the feet, ankles, and legs. Some patients may have lung congestion.

The body shuts down

Ron Gordon, 52, of Avondale, Ga., knew his poor eating habits and lack of exercise weren’t good for his heart, but he never expected to be diagnosed with heart failure. He went to the doctor complaining that he felt his body was choking him to death. “It turns out my whole body was shutting down” he says, adding that his cardiologist told him his heart was pumping at 3% capacity (healthy hearts beat at about 50%). “Later I found that even my thinking was affected because my heart rate was so low.” Watch a video of Gordon describing the harrowing ultimatum that changed his life.

Major factors that may increase the risk of developing heart failure include the following.
- Smoking
- Obesity
- High cholesterol
- High blood pressure
- Diabetes
- Valve-related heart disease

A previous heart attack or a serious infection can also usher in heart failure. New evidence suggests insulin resistance may also be a cause. And the chemotherapy agent doxorubicin has been linked to higher than normal rates of heart failure.

I could not catch my breath

Herpel didn’t think any of those risks factors applied to him in 2006, when he became extremely fatigued, felt fluid gurgling in his lungs, and started gasping. His doctors thought these were symptoms of pneumonia, so they prescribed powerful antibiotics and sent him on his way.

After five weeks of suffering he staggered to the emergency room, barely able to breathe or walk because his heart was too weak to pump blood through his kidneys, which led to fluid buildup in his abdomen. The diagnosis of heart failure and the suggestion by his doctor that he might need a heart transplant shook his world.

Neither Herpel nor Gordon ended up needing a heart transplant. Following their scares, both radically changed their diets, nearly eliminating sodium, which leads to fluid buildup that can exacerbate heart failure. They have also become avid walkers.

Like many patients who’ve had heart failure, Herpel also takes medication, including an ACE-inhibitor and beta-blocker to keep his heart contracting, a diuretic to reduce fluid buildup, and an expectorant to keep his lungs clear. He also keeps nitroglycerin tabs handy to alleviate chest pain.

But his prognosis still spooks him, especially when he starts to feel somewhat normal again. “The worst thing is when I can’t breathe well, but I don’t recognize it,” Herpel says. “I may be taking small shallow breaths all afternoon or for several hours before I recognize that I’m not getting enough oxygen and take a pill. The doctors don’t tell you to watch out for that!”

What is heart failure?

Heart failure means that your heart muscle does not pump as much blood as your body needs. Failure does not mean that your heart has stopped. It means that your heart is not pumping as well as it should.

Because your heart cannot pump well, your body tries to make up for it. To do this:

- Your body holds on to salt and water. This increases the amount of blood in your bloodstream.
- Your heart beats faster.
- Your heart gets bigger. See a picture of an enlarged heart.

Your body has an amazing ability to make up for heart failure. It may do such a good job that you don’t know you have a disease. But at some point, your heart and body will no longer be able to keep up. Then fluid starts to build up in your body, and you have symptoms like feeling weak and out of breath.

This fluid buildup is called congestion. It’s why some doctors call the disease congestive heart failure.

Heart failure usually gets worse over time. But treatment can slow the disease and help you feel better and live longer.

What causes heart failure?

Anything that damages your heart or affects how well it pumps can lead to heart failure. The most common causes of heart failure are:

- Coronary artery disease (CAD).
- Heart attack.
- High blood pressure.

CAD and heart attack are the most common causes of heart failure in men. In women, high blood pressure is the most common cause.1

Other conditions that can lead to heart failure include:

- Diabetes.
- Diseases of the heart muscle (cardiomyopathies).
- Heart valve disease.
- Disease of the sac around the heart (pericardial disease), such as pericarditis.
- A slow, fast, or uneven heart rhythm (arrhythmia).
- A heart problem that you were born with (congenital heart defect).
- Long-term alcohol abuse, which can damage your heart.

What are the symptoms?

Symptoms of heart failure start to happen when your heart cannot pump enough blood to the rest of your body. In the early stages, you may:

- Feel tired easily.
- Be short of breath when you exert yourself.
- Feel like your heart is pounding or racing (palpitations).
- Feel weak or dizzy.

As heart failure gets worse, fluid starts to build up in your lungs and other parts of your body. This may cause you to:

- Feel short of breath even at rest.
- Have swelling (edema), especially in your legs, ankles, and feet.
- Gain weight. This may happen over just a day or two, or more slowly.
- Cough or wheeze, especially when you lie down.
- Need to urinate more at night.
- Feel bloated or sick to your stomach.

If your symptoms suddenly get worse, you will need emergency care.

How is heart failure diagnosed?

Your doctor may diagnose heart failure based on your symptoms and a physical exam. But you will need tests to find the cause and type of heart failure so that you can get the right treatment. These tests may include:

- Blood tests.
- A chest X-ray.
- An electrocardiogram (EKG or ECG) to check your heart’s electrical system.
- An echocardiogram to see the size and shape of your heart and how well it is pumping.
- Cardiac catheterization to check your heart and its blood vessels (coronary arteries).
- A stress test to look for coronary artery disease.

An echocardiogram is the best and simplest way to find out if you have heart failure, what type it is, and what is causing it. Your doctor can also use it to see if your heart failure is getting worse. It can measure how much blood your heart pumps to your body. This measurement is called the ejection fraction. If your ejection fraction gets lower and you are having more symptoms, it means that your heart failure is getting worse.

How is it treated?

Most people with heart failure need to take several medicines. Your doctor may prescribe medicines to:

- Help keep heart failure from getting worse. These drugs include ACE inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, and vasodilators like hydralazine and nitroglycerin.
- Reduce symptoms so you feel better. These drugs include diuretics (water pills), digoxin, and potassium.
- Treat the cause of your heart failure.

It is very important to take your medicines exactly as your doctor tells you to. If you don’t, your heart failure could get worse.

Depending on the cause of your heart failure, you might need surgery to help your heart work better. For example:

- You might have bypass surgery or angioplasty to open clogged arteries, or you may need surgery to repair or replace a heart valve.
- You might need to have a pacemaker or a defibrillator if you have a problem with your heart rhythm. These help your heart keep a steady rhythm.

Lifestyle changes are an important part of treatment. They can help slow down heart failure. They may also help control other diseases that make heart failure worse, such as high blood pressure, diabetes, and coronary artery disease. The best steps you can take are to:

- Eat less salt (sodium). Sodium causes your body to retain water and makes it harder for your heart to pump. Your doctor may also ask you to limit how much fluid you drink.
- Get regular exercise. Your doctor can tell you what level of exercise is safe for you, how to check your pulse, and how to know if you are doing too much.
- Take rest breaks during the day.
- Lose weight if you are overweight. Even a few pounds can make a difference.
- Stop smoking. Smoking damages your heart and makes exercise harder to do.
- Limit alcohol. Ask your doctor how much, if any, is safe.

To stay as healthy as possible, work closely with your doctor. Have all your tests, and go to all your appointments. It is also important to:

- Talk to your doctor before you take any new medicine, including nonprescription and prescription drugs, vitamins, and herbs. Some of them may make your heart failure worse.
- Keep track of your symptoms. Weigh yourself at the same time every day, and write down your weight. Call your doctor if you have a sudden weight gain, a change in your ability to exercise, or any sudden change in your symptoms.

What can you expect if you have heart failure?

Medicines and lifestyle changes can slow or even reverse heart failure for some people. But heart failure often gets worse over time.

Early on, your symptoms may not be too bad. As heart failure gets worse, you may need to limit your activities. Treatment can often help reduce symptoms, but it usually does not get rid of them.

Heart failure can also lead to other health problems. These may include:

- Trouble with your heart rhythm (arrhythmia).
- Stroke.
- Heart attack.
- Mitral valve regurgitation.
- Blood clots in your legs (deep vein thrombosis) or lungs (pulmonary embolism).

Your doctor may be able to give you medicine or other treatment to prevent or treat these problems.

Heart failure can get worse suddenly. If this happens, you will need emergency care. To prevent sudden heart failure, you need to avoid things that can trigger it. These include eating too much salt, missing a dose of your medicine, and exercising too hard.

You may want to think about planning for the future. A living will lets doctors know what type of life-support measures you want if your health gets much worse. You can also choose a health care agent to make decisions in case you are not able to. It can be comforting to know that you will get the type of care you want.

Knowing that your health may get worse can be hard. It is normal to sometimes feel sad or hopeless. But if these feelings last, talk to your doctor. Antidepressant medicines, counseling, or both may help you cope.

Prevention

The best way to prevent heart failure is to:

- Lower your risk of getting heart disease by making lifestyle changes.
- Control certain health problems, such as high blood pressure and diabetes.

To reduce your risk:

- Don’t smoke. If you smoke, quit. Smoking greatly increases your risk for heart disease. Avoid secondhand smoke too.

- Lower your cholesterol. If you have high cholesterol, follow your doctor’s advice for lowering it. Eating a heart-healthy diet—such as the TLC diet —exercising, and quitting smoking will help keep your cholesterol low.

- Control your blood pressure. High blood pressure raises your risk of getting heart disease. Studies show that lowering blood pressure to normal levels in people who have high blood pressure could reduce the cases of heart failure by half.2 Exercising, limiting alcohol, and controlling stress will help keep your blood pressure in a healthy range.

- Get regular exercise. Exercise will help control your weight, blood pressure, and stress. Controlling these things will help keep your heart healthy. Try to do activities that raise your heart rate. Aim for at least 2½ hours of moderate exercise a week.3 One way to do this is to be active at least 10 minutes 3 times a day, 5 days a week. Talk to your doctor before starting an exercise program.

- Control diabetes. Take your medicines as directed, and work with your doctor to make a diet and exercise plan to control diabetes.
Limit alcohol. If you drink alcohol, drink moderately. This means no more than 2 drinks a day for men and 1 drink a day for women. Heavy consumption of alcohol can lead to heart failure.