What is heart failure?
The heart is a muscle that pumps oxygen-rich blood to all parts of the body. When you have heart failure, the heart can’t pump as well as it should. Or the heart muscle can’t relax and fill the pumping chamber with blood. Blood and fluid may back up into the lungs. This causes heart failure. And it causes pulmonary edema. Some parts of the body also don’t get enough oxygen-rich blood. This means they can't work well. These problems lead to the symptoms of heart failure.
What are the symptoms of heart failure?
The most common symptoms of heart failure are:
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Shortness of breath while resting, exercising, or lying flat
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Weight gain from water retention
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Visible swelling of the legs, ankles, and feet from fluid buildup. Sometimes the belly (abdomen) may swell.
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Severe tiredness (fatigue) and weakness
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Loss of appetite, nausea, and belly pain
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Cough that doesn’t go away. It can cause blood-tinged or frothy sputum.
The severity of the condition and symptoms depends on how much of the heart's pumping ability has been affected. The first step in managing heart failure symptoms is knowing your baselines or what’s normal for you. How much do you weigh? Are you gaining weight but eating the same amount? How much can you do before you feel short of breath? Do your socks and shoes fit comfortably? Knowing what’s normal for you will help you see when symptoms are getting worse. Once you know your baselines, watch for changes daily.
The symptoms of heart failure may look like other health problems. Always see your healthcare provider for a diagnosis.
How is heart failure treated?
The cause of heart failure will guide the treatment plan. If heart failure is caused by a valve problem or coronary heart disease, then you may need a procedure. This may be a percutaneous coronary intervention. Or it may be surgery. If heart failure is caused by a problem, such as anemia or an infection, you may need medicine to treat this problem.
Some causes of heart failure are reversible or short-term, such as an acute infection. For many causes of heart failure there is no cure. But many forms of treatment can help with symptoms. They are listed below.
Lifestyle changes
These healthy habits may help with heart failure:
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Controlling blood pressure
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Controlling blood sugar if you have diabetes
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Quitting smoking
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Maintaining a healthy weight. Losing weight, if needed
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Regular exercise
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Limiting salt and fat in your diet
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Not drinking alcohol or using illicit drugs
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Getting enough rest
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Reducing stress
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Other important lifestyle habits include getting vaccines, such as for the flu and pneumococcal pneumonia.
If you have sleep problems, getting a sleep study can help find out what’s causing them. You may need to wear a C-PAP mask while you sleep. This will make sure you get enough oxygen. Too little oxygen can put stress on your heart.
Medicines
Many types of medicines are available for heart failure. They include:
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Angiotensin converting enzyme (ACE) inhibitors. These lower the pressure inside the blood vessels. This reduces the pressure that the heart has to pump against. They can also help the heart have better pumping ability over time.
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Angiotensin receptor blockers (ARB). Some people get a cough and need to stop taking ACE inhibitors. If that happens, an ARB may work for you. These help relax blood vessels and reduce stress on the heart.
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Angiotensin receptor-neprilysin inhibitors (ARNIs). This medicine combines an ARB and a neprilysin inhibitor. This can help the heart as noted above. And it can promote salt and water loss. This medicine is preferred over ACE inhibitors and ARBs alone.
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Diuretics. These reduce the amount of fluid in the body. They are among the most important medicines in helping control fluid buildup in the body.
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Beta-blockers. These reduce the heart’s tendency to beat faster. They can also help the heart pump better over time.
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Aldosterone blockers. These block the effects of the hormone aldosterone. This hormone causes sodium and water retention.
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Vasodilators. These include hydralazine and nitroglycerin. These widen (dilate) the blood vessels. They reduce the workload on the heart.
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Statins or PCSK9 inhibitors. These lower the amount of bad cholesterol in your blood. They are not used to treat heart failure. But you may take one if you have high cholesterol. Or you may take one if you have had a past heart attack and are at risk for heart failure. People who have inherited forms of high cholesterol (familial hypercholesterolemia) may get help from PCSK9 inhibitors. These medicines lower cholesterol.
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Sodium-glucose cotransporter-2 (SGLT2) inhibitors. They block your kidneys from reabsorbing sugar from the blood. This helps your body get rid of extra salt and water and so lowers your blood pressure. Lowering your blood pressure eases the strain on your heart.
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Digitalis. This medicine helps the heart beat stronger. It may help with controlling heart rate if there is an abnormal heart rhythm.
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Antiarrhythmics. These help keep normal heart rhythm.
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Sinus node I-f channel blocker. This may be used to lower your heart rate. It may result in less stress on your heart. This medicine is reserved for people who still have high resting heart rates despite use of beta blockers.
Heart procedures
These include opening blocked arteries in the heart. This brings back blood flow to the heart muscle. It helps the ventricles squeeze as they should. The procedure can be done in the cardiac catheterization lab. It uses balloons to push plaque and blood clots out of the artery. It also uses stents to keep the artery open. This can also be done by bypassing blockages during surgery (coronary artery bypass surgery).
Heart valve repair or replacement
In some cases, medicines can’t help heart failure caused by heart valves that are narrowed (stenosed) or leak (regurgitant). The heart valve can be repaired or replaced. This can be done as an open-heart procedure. Or it can be done by going through a small tube (catheter) that is put into an artery or vein.
Pacemaker
If your heart failure has also damaged your heart’s electrical wiring system, a pacemaker can be implanted. This is done to restore normal heart rate and regularity. A cardiac resynchronizing pacemaker is used when one of the natural heart wires is damaged. This is often the wire located in the left ventricle. These pacemakers use implanted left and right sided wires to restore normal timing of the heart contraction in order to improve heart function.
ICD (implantable cardioverter defibrillator)
When the heart muscle is damaged, dangerous heart circuits can form in the heart muscle. This leads to heart rhythms that can cause death. An ICD is implanted in the body to sense and treat these cardiac arrest rhythms. It does this by overdrive pacing the heart rhythm. Or it sends an energy shock to the heart.
VAD (ventricular assist device)
This device is put in the chest during a surgery. It connects to an outside motor. The motor helps pump blood from the heart to the rest of the body. VADs can allow people with advanced heart failure to improve their overall symptoms and to walk more. This can be used as a long-term treatment. Or it can be used while someone waits for a donor heart for a transplant.
Heart transplant
In some cases, the diseased heart must be replaced with a healthy one from a donor.
Talk with your healthcare providers about the risks, benefits, and possible side effects of all treatments.
What are possible complications of heart failure?
Complications of heart failure include:
How daily issues affect your health
Many things in your daily life impact your health. This can include transportation, money problems, housing, access to food, and child care. If you can’t get to medical appointments, you may not receive the care you need. When money is tight, it may be difficult to pay for medicines. And living far from a grocery store can make it hard to buy healthy food.
If you have concerns in any of these or other areas, talk with your healthcare team. They may know of local resources to assist you. Or they may have a staff person who can help.