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Other Names:
Congestive Heart Failure, CHF, Left-Sided Heart Failure, Right-Sided Heart Failure, Systolic Heart Failure, Diastolic Heart Failure
Heart Failure

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What Is Heart Failure?

Heart failure is a condition where the heart cannot pump enough blood throughout the body. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way that it should. 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 grows weaker. It can affect the left side, the right side, or both sides of the heart. Most cases involve the left side where the heart cannot pump enough oxygen-rich blood to the rest of the body. With right-sided failure, the heart cannot effectively pump blood to the lungs where the blood picks up oxygen. The weakening of the pumping ability of the heart causes:
  • Blood and fluid to "back up" into the lungs
  • The buildup of fluid in the feet, ankles, and legs
  • Tiredness and shortness of breath
Heart failure is a serious condition. About 5 million people in the U. S. have heart failure and the number is growing. Each year, another 550,000 people are diagnosed for the first time. It contributes to or causes about 300,000 deaths each year.

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What Causes Heart Failure?


Heart failure is caused by other diseases or conditions that damage or overwork the heart muscle. Over time the heart muscle weakens and is not able to pump blood as well as it should. The leading causes of heart failure are:
  • Coronary artery disease (CAD)
  • High blood pressure
  • Diabetes.
CAD, including angina and heart attack, is the most common underlying cause of heart failure. Persons who have a heart attack are at high risk of developing heart failure. Most people with heart failure also have high blood pressure and about 1 in 3 has diabetes. Other Causes of Heart Failure Other heart diseases and conditions that can lead to heart failure are:
  • Cardiomyopathy (a disease of the heart muscle)
  • Diseases of the heart valves
  • Abnormal heartbeats or arrhythmias
  • Congenital heart disease (a heart defect or problem you are born with).
Other conditions that may injure the heart muscle and lead to heart failure include:
  • Treatments for cancer such as radiation and certain chemotherapy drugs
  • Thyroid disorders-having either too much or too little thyroid hormone in the body
  • Alcohol abuse
  • HIV/AIDS
  • Cocaine and other illegal drugs use.

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Who Gets Heart Failure?

Heart failure can happen to anyone, but it is more common in:

  • People 65 years of age and older
  • African Americans.

Heart failure is very common in persons 65 years of age and older. It is the number one reason for a hospital visit in this group.

Blacks are more likely to have heart failure and suffer more severely from it. Blacks are more likely to:

  • Develop symptoms at an earlier age
  • Have their heart failure get worse faster
  • Have more hospital visits
  • Die from heart failure.

Men also have a higher rate of heart failure than women. But in actual numbers, more women have heart failure because many more women live into their 70s and 80s when heart failure is common.

Children with congenital heart disease can also get heart failure. Congenital heart disease happens when the heart, heart valves, and/or blood vessels near the heart do not develop correctly in babies when they are in the womb. This can weaken the heart muscle and lead to heart failure. Children do not have the same symptoms or get the same treatment for heart failure as adults and will not be discussed here.

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What Are the Signs and Symptoms of Heart Failure?

The most common signs and symptom are:
  • Shortness of breath or difficulty breathing
  • Feeling tired
  • Swelling in the ankles, feet, legs, and sometimes the abdomen.
Shortness of breath and feeling tired are caused by the buildup of fluid in the lungs and around the lung (pleural effusions). When symptoms start, you may feel tired and short of breath after routine physical exertion. Climbing two flights of stairs makes you feel winded. As heart failure progresses, the symptoms get worse. You may begin to feel tired and short of breath after simple activities, like getting dressed or walking across the room. Some people have shortness of breath when lying flat. Fluid buildup in the lungs can also cause a cough. The cough is worse at night and when you are lying down. Excessive fluid in the lungs can cause a life-threatening condition called acute pulmonary edema. This condition requires emergency treatment. The swelling is from the buildup of fluid in your body (edema). Other signs of fluid buildup are:
  • Weight gain
  • Frequent urination.
Limitation on Physical Activity Doctors also classify your symptoms based on how much they limit your daily activity. By class of symptom, your doctor means:
  • Class 1: No limits--ordinary physical activity does not cause undue tiredness or shortness of breath.

  • Class 2: Slight or mild limits--comfortable at rest, but ordinary physical activity results in tiredness or shortness of breath.

  • Class 3: Marked or noticeable limits--comfortable at rest, but less than ordinary physical activity causes tiredness or shortness of breath.

  • Class 4: Severe limits--unable to carry on any physical activity without discomfort. Symptoms are also present at rest. If any physical activity is undertaken, discomfort increases.

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How is Heart Failure Treated?

The goals of treatment are to:
  • Treat the underlying cause of your heart failure
  • Improve your symptoms and quality of life
  • Stop your heart failure from getting worse.
  • Prolong your life span
Your doctor will continue to treat the underlying diseases or conditions (such as CAD, high blood pressure, or diabetes) that caused heart failure. The treatment for heart failure includes:
  • Lifestyle changes
  • Medications
  • Specialized care for those in the most advanced stage.
Lifestyle Changes There are things that you can do to help with your treatment. Your doctor will recommend that you:
  • Follow a diet low in salt. Salt can cause extra fluid to build up in your body making your heart failure worse.

  • Limit the amount of fluids that you drink.

  • Weigh yourself every day and let your doctor know right away if you have a sudden weight gain. This could mean you have extra fluid building up in your body.

  • Exercise as directed to help build up your fitness level and ability to be more active.

Your doctor will also tell you to:
  • Lose weight if you are overweight
  • Quit smoking if you smoke
  • Limit the amount of alcohol that you drink.
Medications Your doctor will prescribe medicines to help improve your heart function and symptoms. The main medicines are:
  • Diuretics (water or fluid pills) to help reduce fluid buildup in your lungs and swelling in your feet and ankles.

  • ACE inhibitors to lower blood pressure and reduce the strain on your heart. These medications also may reduce the risk of a future heart attack.

  • Beta blockers to slow your heart rate and lower your blood pressure to decrease the workload on your heart.

  • Digoxin to make the heart beat stronger and pump more blood.
Specialized Care for Severe Disease As the disease progresses, lifestyle changes and regular medications may not be enough to control worsening symptoms. Many people with severe heart failure must be put in the hospital from time to time for treatment. In the hospital, your doctor may prescribe new or special medicines. You continue to take your regular medicines during this treatment. Your doctor will also order extra oxygen if you continue to have trouble breathing. The extra oxygen can be given in the hospital and at home. Persons with very severe heart failure may be considered for a:
  • Mechanical heart pump
  • Heart transplant.
A heart pump is a special device placed inside the body to help pump blood to the rest of the body. There are different kinds of heart pumps. Some stay in the body for a short period of time, while others can stay in the body for a long time. Many people with a heart pump will also be considered for a heart transplant. A heart transplant is surgery to replace the heart of a patient with heart failure with a healthy heart from someone who has recently died. A transplant is indicated in some people when all other treatments fail to control symptoms.

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Preventing Heart Failure

The major underlying causes of heart failure are CAD (including angina and heart attack), high blood pressure, and diabetes. The section "What Causes Heart Failure?" lists all the likely causes. Getting treatment and staying in treatment for any underlying condition that you have can greatly reduce your risk. Other things you can do reduce your risk include:
  • Eating a heart-healthy diet low in salt, saturated fat, and cholesterol.
  • Quitting smoking if you smoke.
  • Losing weight if you are overweight.

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Heart Failure