Heart Failure Defined
In heart failure , the heart cannot pump enough blood through the body. The heart cannot fill with enough blood or pump with enough force, or both. Heart failure develops over time as the pumping action of the heart gets weaker. It can affect either the right, the left, or both sides of the heart. Heart failure does not mean that the heart has stopped working or is about to stop working.
In most cases, heart failure affects the left side of the heart when it cannot pump enough oxygen-rich blood to the rest of the body. When heart failure affects the right side, the heart cannot pump enough blood to the lungs, where it picks up oxygen.
In normal hearts, blood vessels called veins bring oxygen-poor blood from the body to the right side of the heart. It is then pumped through the pulmonary artery to the lungs, picking up oxygen. From there, the blood returns to the left side of the heart. Then it is pumped through a large artery called the aorta that distributes blood throughout the body.
When the heart is weakened by heart failure, blood and fluid can back up into the lungs, and fluid builds up in the feet, ankles, and legs. People with heart failure often experience tiredness and shortness of breath.
Heart failure is a serious condition. Scientists estimate that 5 million people in the U.S. have heart failure and that number is growing. It contributes to 300,000 deaths each year. Heart failure is most common in those who are age 65 years and older and is the number one reason older people are hospitalized.
Heart failure tends to be more common in men than in women, but because women usually live longer, the condition affects more women in their 70s and 80s.
Heart failure can also be called congestive heart failure, systolic heart failure, diastolic heart failure, left-sided heart failure, or right-sided heart failure.
- Heart failure occurs when the heart cannot pump enough blood through the body.
TRUE is the correct answer. Heart failure occurs when the heart cannot pump enough blood through the body. Heart failure develops over time as the pumping action of the heart gets weaker.
- When the heart's pumping ability is weakened, this can cause swelling in the ankles and legs, shortness of breath, and fluid in the lungs.
TRUE is the correct answer. The weakening of the heart's pumping ability causes a number of things to happen -- blood and fluid can back up into the lungs, and fluid builds up in the feet, ankles, and legs. People with heart failure often experience tiredness and shortness of breath.
- Heart failure is most common in those who are under 65 years old.
FALSE is the correct answer. Heart failure is most common in those who are age 65 years and older and is the number one reason older people are hospitalized.
- Men have a higher rate of heart failure than women.
TRUE is the correct answer. Heart failure tends to be more common in men than in women, but because women usually live longer, it affects more women in their 70s and 80s.
Risk Factors and Prevention
Heart failure can happen to almost anyone. It is most common in people over 65, and is more common in African-Americans. Also, men have a higher rate of heart failure than women. It is the number one reason for hospitalization for people over age 65.
Heart failure is caused by other diseases or conditions that damage the heart muscle. It is often caused by coronary artery disease, including heart attacks. Diabetes and high blood pressure also contribute to heart failure risk.
Coronary artery disease is the leading cause of death in men and women. It happens when the arteries that supply blood to the heart become hardened and narrowed. People who have had a heart attack are at high risk to develop heart failure.
There are a number of things that you can do to reduce risk of coronary artery disease and heart failure.
Keeping your cholesterol levels healthy can help prevent coronary artery disease. For most people, the targets are:
- LDL, or "bad" cholesterol -- below 100
- HDL, or "good" cholesterol -- above 40 in men and above 50 in women
- Triglycerides, another fat in the blood -- below 150
High blood pressure causes the heart to get larger and work harder, which can then lead to heart failure. You should aim for a blood pressure level of 130/80 or below. Talk to your doctor about ways to lower your blood pressure.
Diabetes is characterized by having too much glucose, or sugar, in the blood for a long time. This can cause heart problems because high blood glucose can damage parts of the body such as the heart and blood vessels. This damage weakens the heart, often leading to heart failure.
You can help prevent heart disease by losing weight if you are overweight, quitting smoking, and limiting the amount of alcohol you drink. Doctors also recommend that you eat a diet low in salt because salt can cause extra fluid to build up in your body.
Limiting foods that are high in saturated fat or cholesterol, such as meats, butter, dairy products with fat, eggs, shortening, lard, and foods with palm oil or coconut oil, can help you maintain a heart-healthy diet. Heart-healthy foods include those high in fiber, such as oat bran, oatmeal, whole-grain breads and cereals, fruits, and vegetables.
Exercise also helps keep your heart strong. Aim for at least 30 minutes a day of exercise.
- Which diseases and conditions most often damage heart muscle, leading to heart failure?
A. stroke, diabetes, and kidney disease
B. coronary artery disease, diabetes, and high blood pressure
C. cancer, high blood pressure, and stroke
B is the correct answer. Coronary artery disease, diabetes, and high blood pressure all have the potential to damage heart muscle. This damage can then lead to heart failure.
- Heart failure is most common among
A. people over age 65
D. all of the above
D is the correct answer. While heart failure can happen to almost anyone, it is most common in those over the age of 65 and in African-Americans, and more common in men than in women.
- What are some ways to help prevent heart failure?
A. quit smoking
C. limit foods high in cholesterol and saturated fat
D. all of the above
D is the correct answer. There are several steps you can take to lower your risk of heart failure. These include losing weight, limiting alcohol, exercising, and quitting smoking. Ask your doctor for more tips on how to protect your heart.
- What kinds of foods should you eat to follow a heart-healthy diet?
A. bacon, cheeseburgers, and fries
B. ice cream and yogurt
C. vegetables and fruits
C is the correct answer. Heart-healthy foods include vegetables and fruits and other foods that are high in fiber, such as oatmeal, whole-grain breads and cereals, and oat bran.
Symptoms and Diagnosis
The most common symptoms of heart failure include shortness of breath or difficulty breathing, feeling tired, and swelling. Swelling usually occurs in the ankles, feet, legs, and sometimes in the abdomen.
Swelling is caused by fluid buildup in the body and can lead to weight gain and frequent urination, as well as a cough. The cough can be worse at night and when lying down.
When symptoms first begin, you might feel tired or short of breath after routine physical activities, such as climbing stairs. As heart failure progresses, the symptoms get worse. You may feel tired or short of breath after performing simple activities, like getting dressed.
There is not one specific test to diagnose heart failure. Because the symptoms are common for other conditions, your doctor will determine if you have heart failure by doing a detailed medical history, an examination, and several tests.
The tests will identify whether you have any diseases or conditions that can cause heart failure. They will also rule out any other causes of your symptoms and determine the amount of damage to your heart.
During a physical examination, you can expect your doctor to listen to your heart for abnormal sounds and listen to your lungs for a buildup of fluid. Your doctor will also look for swelling in your ankles, feet, legs, abdomen, and in the veins in your neck.
If your doctor determines that you have signs of heart failure, he or she may order several tests.
Tests that are given to determine heart failure include:
- An EKG or ECG -- electrocardiogram -- measures the rate and regularity of your heartbeat. The test can also show if you have had a heart attack and whether the walls of your heart have thickened.
Tests that are given to determine heart failure include:
- A chest X-ray takes a picture of your heart and lungs. It will show whether your heart is enlarged or your lungs have fluid in them, both signs of heart disease. A BNP blood test measures the level of a hormone called
- BNP -- B-type natriuretic peptide -- that increases in heart failure.
Once these initial tests have been performed, your doctor may decide to send you to a cardiologist who specializes in the diagnosis and treatment of heart disease. A cardiologist will perform a physical exam and may order other tests.
There are several tests that can identify the cause of heart failure. These tests include:
- An echocardiogram is one of the most useful tests for diagnosing heart failure. This test uses sound waves to create a picture of the heart and shows how well the heart is filling with blood. Your doctor uses this test to determine whether any areas of your heart are damaged.
- A Holter monitor, which is a small box that is attached to patches placed on your chest. The monitor, which is worn for 24 hours, provides a continuous recording of heart rhythm during normal activity.
- An exercise stress test reads your EKG and blood pressure before, during, or after exercise to see how your heart responds to exercise. This test tells doctors how your heart responds to activity. An echocardiogram is often part of the test to show how your heart pumps.
- The most common symptoms of heart failure include shortness of breath, feeling tired, and swelling.
TRUE is the correct answer. The most common symptoms of heart failure include shortness of breath or difficulty breathing, feeling tired, and swelling. Swelling usually occurs in the ankles, feet, legs, and sometimes in the abdomen.
- Heart failure causes people to feel tired only after strenuous activities.
FALSE is the correct answer. As heart failure progresses, the symptoms get worse. You may feel tired or short of breath after performing simple activities, like getting dressed.
- There is one specific test to diagnose heart failure.
FALSE is the correct answer. Because the symptoms of heart failure are common for other conditions, your doctor will need to rule out any other causes by doing a number of things including a medical history, an examination, and several tests. These tests will also determine the amount of damage to your heart.
- One of the most common tests given to determine heart failure is an EKG or ECG -- electrocardiogram.
TRUE is the correct answer. An EKG or ECG is used to measure the rate and regularity of your heartbeat. The test can show if you have had a heart attack and whether the walls of your heart have thickened.
Treatment and Research
There is no cure for heart failure, but it can be controlled by treating the underlying conditions that cause it. The goals for treatment are to improve symptoms, stop it from getting worse, and prolong life span.
Treatment includes lifestyle changes, medications, and specialized care for those who are in the advanced stages.
Treatment for heart failure will reduce the chances that you will have to go to the hospital and make it easier for you to do the things you like to do. It is very important that you follow your treatment plan by keeping doctors appointments, taking medications, and making lifestyle changes.
Your doctor will probably recommend that you follow a diet low in salt because salt can cause extra fluid to build up in your body, making heart failure worse. You should limit the fluids you drink and weigh yourself every day. Let your doctor know right away if you have sudden weight gain. This could mean extra fluid is building up.
Your doctor may also tell you to lose weight, quit smoking, and limit the amount of alcohol you drink.
Your doctor will prescribe medications to improve your heart function and symptoms. These may include:
- Diuretics, which are water or fluid pills. These reduce fluid in your lungs and swelling in your feet and ankles.
- ACE inhibitors to lower blood pressure and reduce strain on your heart.
Medications your doctor may prescribe include:
- Beta blockers to slow your heart rate. They will also lower blood pressure to relieve some of the workload on your heart.
- Digoxin will help the heart beat stronger and pump more blood.
Those with heart failure should try to avoid respiratory infections like pneumonia and the flu. Ask your doctor about getting an annual flu shot. Your doctor may also order extra oxygen if you have trouble breathing. The oxygen can be used in your home or in the hospital.
People with severe heart failure may also receive a mechanical heart pump that is placed inside the body to help pump blood. Some heart pumps can stay in your body for a long time, while others are temporary.
You may also be considered for a heart transplant. During transplantation, a healthy heart from someone who has recently died is put in to replace yours. A transplant is an option when all other treatments fail to control symptoms.
Many advances in treatment for heart failure have been made over the past few decades, but heart failure is still very common. Scientists are trying to determine the best ways to prevent and treat heart failure.
For example, a recent study by the National Heart, Lung, and Blood Institute of implantable defibrillators -- ICDs -- revealed that the device can prolong the lives of some heart failure patients.
Researchers are also looking at genetics in relation to heart failure treatments. One study is investigating whether patients who have certain genetic markers may respond better to beta blockers than those who do not.
A study supported by the National Heart, Lung, and Blood Institute has shown that drugs called statins, which can reduce cholesterol levels, also improve survival in heart failure patients. Many other new treatments for heart failure are currently being tested.
- Heart failure can be controlled by treating the underlying conditions. Treatment often includes
A. bed rest, fluids, and long-term medication
B. transplantation and psychotherapy
C. lifestyle changes and medications
C is the correct answer. Treatment for heart failure includes lifestyle changes, medications, and specialized care for those who are in the advanced stages.
- If you have heart failure, you should eat
A. diet soda and low-fat chips
B. a diet low in salt
C. a low-carbohydrate diet
B is the correct answer. Those who suffer from heart failure need to watch their salt intake. Salt can cause extra fluid to build up in your body, making heart failure worse.
- The goals for treatment of heart failure are to
A. improve symptoms
B. stop the disease from getting worse
C. prolong lifespan
D. all of the above
D is the correct answer. While there is no cure for heart failure, treatment can alleviate and improve symptoms, slow progression of the disease, and prolong lifespan.
- In treating heart failure, your doctor may prescribe medications that
A. improve heart function
B. reduce strain on the heart
C. lower blood pressure
D. all of the above
D is the correct answer. There are many medications for treating heart failure that a doctor may prescribe to treat the causes and symptoms of the disease and improve the function of the heart.
Source: National Institutes of Health, National Heart, Lung, and Blood Institute
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Last Editorial Review: 4/6/2006