Close to 5.7 million people in the United States suffer from some congestive heart failure (CHF), and 300,000 of those patients will ultimately succumb to the condition. There are many ways heart failure can be caused, but the condition results in the heart not being able to pump enough blood to supply the needs of the body. When the heart is too weak to pump blood effectively, it is called systolic heart failure. When the heart muscle is too stiff or rigid to properly fill up with blood, it is called diastolic heart failure. Whenever this backup occurs, the non-moving blood causes fluid to fill up in the lungs, liver, and gastrointestinal tract, and causes these organs to fail.
Early diagnosis and treatment can help people who have heart failure live longer, more active lives. Treatment for heart failure will depend on the type and stage of heart failure (the severity of the condition).
The goals of treatment for all stages of heart failure include:
- Treating the condition’s underlying cause, such as coronary heart disease (CHD), high blood pressure, or diabetes
- Reducing symptoms
- Stopping the heart failure from getting worse
- Increasing your lifespan and improving your quality of life
Treatments usually include lifestyle changes, medicines, and ongoing care. If you have severe heart failure, you also may need medical procedures or surgery. Simple lifestyle changes may help you feel better and control heart failure. The sooner you make these changes, the better off you’ll likely be.
A Heart Healthy Diet
Following a heart healthy diet is an important part of managing heart failure. In fact, not having a proper diet can make heart failure worse. Ask your doctor and health care team to create an eating plan that works for you.
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, eggs, poultry without skin, seafood, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt) and solid fats (saturated fat and trans fatty acids). Too much salt can cause extra fluid to build up in your body, making heart failure worse. Saturated fat and trans fatty acids can cause unhealthy blood cholesterol levels, which are a risk factor for heart disease.
A healthy diet also is low in added sugars and refined grains. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber). Examples of refined grains include white rice and white bread.
A balanced, nutrient-rich diet can help your heart work better. Getting enough potassium is important for people who have heart failure. Some heart failure medicines deplete the potassium in your body. Lack of potassium can cause very rapid heart rhythms that can lead to sudden death.
Potassium is found in foods like white potatoes and sweet potatoes, greens (such as spinach), bananas, many dried fruits, and white beans and soybeans.
Talk with your health care team about getting the correct amount of potassium. Too much potassium also can be harmful.
Fluid Intake
It’s important for people who have heart failure to drink the correct amounts and types of fluid. Drinking too much fluid can worsen heart failure. Also, if you have heart failure, you shouldn’t drink alcohol.
Talk with your doctor about what amounts and types of fluid you should have each day.
Medicines
Your doctor will prescribe medicines based on the type of heart failure you have, how severe it is, and your response to certain medicines. The following medicines are commonly used to treat heart failure:
- Diuretics (water or fluid pills) help reduce fluid buildup in your lungs and swelling in your feet and ankles.
- ACE inhibitors lower blood pressure and reduce strain on your heart. They also may reduce the risk of a future heart attack.
- Aldosterone antagonists trigger the body to get rid of salt and water through urine. This lowers the volume of blood that the heart must pump.
- Angiotensin receptor blockers relax your blood vessels and lower blood pressure to decrease your heart’s workload.
- Beta blockers slow your heart rate and lower your blood pressure to decrease your heart’s workload.
- Isosorbide dinitrate/hydralazine hydrochloride helps relax your blood vessels so your heart doesn’t work as hard to pump blood.
Studies have shown that this medicine can reduce the risk of death in African Americans. More studies are needed to find out whether this medicine will benefit other racial groups.
Digoxin makes the heart beat stronger and pump more blood.
Medical Procedures and Surgery
As heart failure worsens, lifestyle changes and medicines may no longer control your symptoms. You may need a medical procedure or surgery.
If you have heart damage and severe heart failure symptoms, your doctor might recommend a cardiac resynchronization therapy (CRT) device or an implantable cardioverter defibrillator (ICD).
In heart failure, the right and left sides of the heart may no longer contract at the same time. This disrupts the heart’s pumping. To correct this problem, your doctor might implant a CRT device (a type of pacemaker) near your heart.
This device helps both sides of your heart contract at the same time, which can decrease heart failure symptoms.
Some people who have heart failure have very rapid, irregular heartbeats. Without treatment, these heartbeats can cause sudden cardiac arrest. Your doctor might implant an ICD near your heart to solve this problem. An ICD checks your heart rate and uses electrical pulses to correct irregular heart rhythms.
People who have severe heart failure symptoms at rest, despite other treatments, may need:
- A mechanical heart pump, such as a left ventricular assist device. This device helps pump blood from the heart to the rest of the body. You may use a heart pump until you have surgery or as a long-term treatment.
- Heart transplant. A heart transplant is an operation in which a person’s diseased heart is replaced with a healthy heart from a deceased donor. Heart transplants are done as a life-saving measure for end-stage heart failure when medical treatment and less drastic surgery have failed.
- Experimental treatments. Studies are under way to find new and better ways to treat heart failure.
Heart failure develops over time as the heart’s pumping action grows weaker. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart.
Right-side heart failure occurs if the heart can’t pump enough blood to the lungs to pick up oxygen. Left-side heart failure occurs if the heart can’t pump enough oxygen-rich blood to the rest of the body.
Right-side heart failure may cause fluid to build up in the feet, ankles, legs, liver, abdomen, and the veins in the neck. Right-side and left-side heart failure also may cause shortness of breath and fatigue (tiredness).
The leading causes of heart failure are diseases that damage the heart. Examples include coronary heart disease (CHD), high blood pressure, and diabetes.
The most common signs and symptoms of heart failure are:
- Shortness of breath or trouble breathing
- Fatigue (tiredness)
- Swelling in the ankles, feet, legs, abdomen, and veins in the neck
All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.
As your heart grows weaker, symptoms get worse. You may begin to feel tired and short of breath after getting dressed or walking across the room. Some people have shortness of breath while lying flat.
Fluid buildup from heart failure also causes weight gain, frequent urination, and a cough that’s worse at night and when you’re lying down. This cough may be a sign of acute pulmonary edema (e-DE-ma). This is a condition in which too much fluid builds up in your lungs. The condition requires emergency treatment.
Your doctor will diagnose heart failure based on your medical and family histories, a physical exam, and test results. The signs and symptoms of heart failure also are common in other conditions. Thus, your doctor will:
- Find out whether you have a disease or condition that can cause heart failure, such as coronary heart disease (CHD), high blood pressure, or diabetes
- Rule out other causes of your symptoms
- Find any damage to your heart and check how well your heart pumps blood
- Ask whether you or others in your family have or have had a disease or condition that can cause heart failure.
- Your doctor also will ask about your symptoms. He or she will want to know which symptoms you have, when they occur, how long you’ve had them, and how severe they are. Your answers will help show whether and how much your symptoms limit your daily routine.
Physical Exam
During the physical exam, your doctor will:
- Listen to your heart for sounds that aren’t normal
- Listen to your lungs for the sounds of extra fluid buildup
- Look for swelling in your ankles, feet, legs, abdomen, and the veins in your neck Diagnostic Tests No single test can diagnose heart failure. If you have signs and symptoms of heart failure, your doctor may recommend one or more tests.
- Your doctor also may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.
There are several diagnostic tests that your doctor may want to do. They include:
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records the heart’s electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.
An EKG may show whether the walls in your heart’s pumping chambers are thicker than normal. Thicker walls can make it harder for your heart to pump blood. An EKG also can show signs of a previous or current heart attack.
Chest X Ray
A chest x ray takes pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test can show whether your heart is enlarged, you have fluid in your lungs, or you have lung disease.
BNP Blood Test
This test checks the level of a hormone in your blood called BNP. The level of this hormone rises during heart failure.
Echocardiography
Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test shows the size and shape of your heart and how well your heart chambers and valves work.
Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren’t contracting normally, and heart muscle damage caused by lack of blood flow.
Echo might be done before and after a stress test (see below). A stress echo can show how well blood is flowing through your heart. The test also can show how well your heart pumps blood when it beats.
Doppler Ultrasound
A Doppler ultrasound uses sound waves to measure the speed and direction of blood flow. This test often is done with echo to give a more complete picture of blood flow to the heart and lungs.
Doctors often use Doppler ultrasound to help diagnose right-side heart failure.
Holter Monitor
A Holter monitor records your heart’s electrical activity for a full 24- or 48-hour period, while you go about your normal daily routine.
You wear small patches called electrodes on your chest. Wires connect the patches to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck.
Nuclear Heart Scan
A nuclear heart scan shows how well blood is flowing through your heart and how much blood is reaching your heart muscle.
During a nuclear heart scan, a safe, radioactive substance called a tracer is injected into your bloodstream through a vein. The tracer travels to your heart and releases energy. Special cameras outside of your body detect the energy and use it to create pictures of your heart. A nuclear heart scan can show where the heart muscle is healthy and where it’s damaged.
A positron emission tomography (PET) scan is a type of nuclear heart scan. It shows the level of chemical activity in areas of your heart. This test can help your doctor see whether enough blood is flowing to these areas. A PET scan can show blood flow problems that other tests might not detect.
Cardiac Catheterization
During cardiac catheterization (KATH-eh-ter-ih-ZA-shun), a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. This allows your doctor to look inside your coronary (heart) arteries.
During this procedure, your doctor can check the pressure and blood flow in your heart chambers, collect blood samples, and use x rays to look at your coronary arteries.
Coronary Angiography
Coronary angiography (an-jee-OG-rah-fee) usually is done with cardiac catheterization. A dye that can be seen on x ray is injected into your bloodstream through the tip of the catheter.
The dye allows your doctor to see the flow of blood to your heart muscle. Angiography also shows how well your heart is pumping.
Stress Test
Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast.
You may walk or run on a treadmill or pedal a bicycle. If you can’t exercise, you may be given medicine to raise your heart rate.
Heart tests, such as nuclear heart scanning and echo, often are done during stress testing.
Cardiac MRI
Cardiac MRI (magnetic resonance imaging) uses radio waves, magnets, and a computer to create pictures of your heart as it’s beating. The test produces both still and moving pictures of your heart and major blood vessels.
A cardiac MRI can show whether parts of your heart are damaged. Doctors also have used MRI in research studies to find early signs of heart failure, even before symptoms appear.
Thyroid Function Tests
Thyroid function tests show how well your thyroid gland is working. These tests include blood tests, imaging tests, and tests to stimulate the thyroid. Having too much or too little thyroid hormone in the blood can lead to heart failure.
If you think you may have heart failure, or you are worried about your heart failure risk because of other underlying conditions, make an appointment with your family doctor. If heart failure is found early, your treatment may be easier and more effective.
Because appointments can be brief, and because there’s often a lot of ground to cover, it’s a good idea to be prepared for your appointment. Here’s some information to help you get ready for your appointment, and know what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet. For some imaging tests, for example, you may need to fast for a period of time beforehand.
- Write down any symptoms you’re experiencing, including any that may seem unrelated to heart failure.
- Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you’re taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Be prepared to discuss your diet and exercise habits. If you don’t already follow a diet or exercise routine, be ready to talk to your doctor about any challenges you might face in getting started.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For heart failure, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What kinds of tests will I need?
- What’s the best treatment?
- What foods should I eat or avoid?
- What’s an appropriate level of physical activity?
- How often should I be screened for changes in my condition?
- What are the alternatives to the primary approach that you’re suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you’re prescribing for me?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting? In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
What you can do in the meantime
It’s never too early to make healthy lifestyle changes, such as quitting smoking, cutting down on salt and eating healthy foods. These changes can help prevent heart failure from starting or worsening.
Heart failure is more common in:
- People who are 65 years old or older: Aging can weaken the heart muscle. Older people also may have had diseases for many years that led to heart failure. Heart failure is a leading cause of hospital stays among people on Medicare.
- African Americans: African Americans are more likely to have heart failure than people of other races. They’re also more likely to have symptoms at a younger age, have more hospital visits due to heart failure, and die from heart failure.
- People who are overweight: Excess weight puts strain on the heart. Being overweight also increases your risk of heart disease and type 2 diabetes. These diseases can lead to heart failure.
- People who have had a heart attack.
- Men have a higher rate of heart failure than women.
Children who have congenital heart defects also can develop heart failure. These defects occur if the heart, heart valves, or blood vessels near the heart don’t form correctly while a baby is in the womb.
Congenital heart defects can make the heart work harder. This weakens the heart muscle, which can lead to heart failure.
Children don’t have the same symptoms of heart failure or get the same treatments as adults. This article focuses on heart failure in adults.
Currently, heart failure has no cure. You’ll likely have to take medicine and follow a treatment plan for the rest of your life.
Despite treatment, symptoms may get worse over time. You may not be able to do many of the things that you did before you had heart failure. However, if you take all the steps your doctor recommends, you can stay healthier longer.
Researchers also might find new treatments that can help you in the future.
Follow Your Treatment Plan
Treatment can relieve your symptoms and make daily activities easier. It also can reduce the chance that you’ll have to go to the hospital. Thus, it’s important that you follow your treatment plan.
Take your medicines as your doctor prescribes. If you have side effects from any of your medicines, tell your doctor. He or she might adjust the dose or type of medicine you take to relieve side effects.
Make all of the lifestyle changes that your doctor recommends.
Get advice from your doctor about how active you can and should be. This includes advice on daily activities, work, leisure time, sex, and exercise. Your level of activity will depend on the stage of your heart failure (how severe it is).
Keep all of your medical appointments, including visits to the doctor and appointments to get tests and lab work. Your doctor needs the results of these tests to adjust your medicine doses and help you avoid harmful side effects
Take Steps To Prevent Heart Failure From Getting Worse
Certain actions can worsen your heart failure, such as:
- Forgetting to take your medicines
- Not following your diet (for example, eating salty foods)
- Drinking alcohol
These actions can lead to a hospital stay. If you have trouble following your diet, talk with your doctor. He or she can help arrange for a dietitian to work with you. Avoid drinking alcohol.
People who have heart failure often have other serious conditions that require ongoing treatment. If you have other serious conditions, you’re likely taking medicines for them as well as for heart failure.
Taking more than one medicine raises the risk of side effects and other problems. Make sure your doctors and your pharmacist have a complete list of all of the medicines and over-the-counter products that you’re taking.
Tell your doctor right away about any problems with your medicines. Also, talk with your doctor before taking any new medicine prescribed by another doctor or any new over-the-counter medicines or herbal supplements.
Try to avoid respiratory infections like the flu and pneumonia. Ask your doctor or nurse about getting flu and pneumonia vaccines.
Emotional Issues and Support
Living with heart failure may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with heart failure. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.