What is Heart Failure?

What Is Heart Failure?

Heart failure is a condition involving the heart being unable to fill with enough blood or having trouble sending blood throughout the body. 

When the right side of the heart is affected, the heart has trouble pumping blood to the lungs to receive oxygen. When the left side of the heart is affected, the heart struggles to deliver blood to the rest of the body. This blood contains the oxygen and vital nutrients all organs in the body depend on to live and work at their best.

Heart failure is most prominent in people who are 65 or older. Being overweight or obese increases the risk of heart failure since extra weight forces the heart to work harder. Conditions that limit blood flow, such as coronary artery disease, are another significant factor. African Americans are also at a greater risk, often developing the disease sooner and suffering from more severe forms of heart failure.

Heart failure can affect those with a stiff heart even with normal pumping function. This is called diastolic dysfunction or diastolic heart failure. 

Causes

Heart failure is primarily caused by other conditions that damage the heart. These conditions include:

• Congenital heart defects
• Coronary artery disease
• Diabetes
• Heart muscle disease
• Heart value disorder
• High blood pressure
• HIV/AIDS
• Obstructive sleep apnea
• Thyroid disorders

Over time, these conditions weaken the heart and make its job more difficult.

Certain cancer treatments, alcohol abuse, illegal drugs and excess vitamin E also can place strain on the heart and contribute to heart failure. 

Types of Heart Failure

Left-Sided Heart Failure

The left side of the heart is responsible for pumping oxygen-rich blood from the lungs to the rest of the body. The left ventricle, which is the largest and strongest chamber of the heart, does most of this work. When it cannot pump efficiently, the body does not receive enough oxygenated blood to meet its needs.

In left-sided (left ventricular) heart failure, the left ventricle must work harder to move blood forward. Doctors measure the heart’s pumping ability using something called ejection fraction (EF) — the percentage of blood pumped out with each heartbeat. A normal EF is about 55–60%.

There are two main types of left-sided heart failure:

Systolic Heart Failure (HFrEF)

In systolic heart failure, also known as heart failure with reduced ejection fraction (HFrEF), the left ventricle does not contract effectively. As a result, less blood is pushed out into circulation. This occurs when the EF is 40% or lower.

Diastolic Heart Failure (HFpEF)

In diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), the left ventricle becomes stiff and cannot relax normally between beats. This prevents the chamber from filling properly with blood. In HFpEF, the EF is typically 50% or higher.

Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF)

This newer category describes patients whose EF falls between 41–49%. It shares features of both HFrEF and HFpEF.

Right-Sided Heart Failure

The right side of the heart pumps blood low in oxygen into the lungs, where it can be re-oxygenated. Right-sided heart failure often develops as a result of left-sided failure. When the left ventricle weakens, pressure builds in the lungs, which strains the right ventricle.

As the right side loses strength, blood begins to back up into the veins. This causes fluid buildup in the body, leading to swelling (edema), particularly in the legs, ankles, and abdomen.

Biventricular Heart Failure

In biventricular heart failure, both sides of the heart are affected. Symptoms often include:

• Shortness of breath
• Fatigue and low energy
• Swelling in body tissues (edema), especially in the legs, ankles, or abdomen

Congestive Heart Failure (CHF)

The term congestive heart failure (CHF) refers to heart failure that involves fluid buildup, or congestion, in the body’s tissues. CHF requires prompt medical care.

When the heart cannot pump enough blood forward, it backs up in the veins and causes swelling (edema). While swelling is most common in the legs and ankles, it can also occur in the abdomen or other areas.

Fluid may also collect in the lungs, a condition called pulmonary edema. This makes breathing difficult, especially when lying flat, and can cause serious respiratory distress if untreated.

Heart failure also disrupts how the kidneys process sodium and water. This leads to fluid retention, which further increases swelling and strain on the body.

Advanced Heart Failure

About one in ten people living with heart failure develop advanced heart failure. At this stage, standard treatments and symptom management are no longer effective. People with advanced heart failure often experience shortness of breath and other symptoms even when they are resting. Symptom severity can vary throughout the day depending on how a person feels.

Medications and healthy lifestyle choices can be very effective in the earlier stages of heart failure. As the condition progresses and the heart becomes weaker, treatment becomes more complex. 

Signs and Symptoms

As the heart grows weaker in a person with heart failure, symptoms become more apparent. Common symptoms of heart failure include:

• Fatigue
• Shortness of breath or difficulty breathing
• Swelling in the ankles, feet, legs, and/or abdomen (Caused by buildup of fluids in the body).

A person with heart failure may feel tired doing ordinary physical tasks, such as getting dressed, or may experience difficulty breathing even while sitting or lying down.

Signs that heart failure is worsening include:

• Coughing
• Fluid in the lungs
• Frequent urination
• Weight gain

Fluid in the lungs is a sign of very severe heart failure and needs emergency medical treatment.

Diagnosis

Medical and family histories are very important in diagnosing heart failure. If you or a family member has a condition that damages the heart, such as diabetes or coronary artery disease, you are at greater risk for developing heart failure. Your doctor also will evaluate any symptoms you may have.

A physical exam is usually necessary. Your doctor will examine your heart and lungs carefully, checking for abnormal sounds and fluid buildup. Different imaging tests may be used in accordance with your doctor’s evaluation. 

Imaging Tests

Cardiac Magnetic Resonance Imaging (MRI)

A cardiac MRI test can often be used to help determine the causes of heart failure and can also accurately measure the heart's pumping function. An MRI shows the structure and beating of your heart and can reveal signs of damage.

Chest X-Ray

An X-ray can show heart enlargement, along with other signs of heart failure. 

Echocardiography

An echocardiogram uses sound waves to produce an image of the heart, showing how well it's working. It can help determine which areas of the heart are having problems and help identify any damage to the heart.

Electrocardiogram (EKG)

An electrocardiogram or EKG measures how fast your heart is beating and looks for an irregular heart rhythm. It also determines if your heart walls are thicker than normal and whether or not you've previously had a heart attack.

Doppler Imaging

This test uses sound waves to measure the speed and direction of blood flow and valvular function.

Positron Emission Tomography (PET)

A PET scan can help your doctor see whether enough blood is flowing to and from the heart.

Lab Tests

BNP Blood Test

A BNP (B-type natriuretic peptide) measures the levels of the BNP hormone. Elevated levels of BMP can indicate heart failure.

Thyroid Function Tests

Having too much or too little thyroid hormone in the blood can cause heart failure. Various thyroid blood tests are performed to determine if the cause of heart failure is due to thyroid problems. 

Diagnostic Procedures

Cardiac Catheterization (Angiography)

A thin, flexible tube called a catheter is put into a blood vessel in your arm, upper thigh, or neck and threaded to your heart to study the interior of coronary arteries and measure heart function. A dye that can be seen with X-rays is injected into the blood through the tip of the catheter. The dye allows your doctor to see blood flow to the heart muscle.  

Treatment

The best ways to treat heart failure involve medications and lifestyle management.  

Medications

A variety of medicines are available to help treat heart failure. Some of the most frequently prescribed medications include:

• ACE inhibitors: Decrease blood pressure and lessen any strain on the heart. They may also help lessen the chance of a heart attack.
• Aldosterone antagonists: Cause the body to dispose of excess salt and water in urine, helping lower the volume of blood that the heart must pump and lessening its workload.
• Angiotensin receptor blockers: Help decrease blood pressure and relax blood vessels.
• Beta blockers: Decrease heart rate and blood pressure.
• Diuretics (water or fluid pills): Reduce fluid buildup in the lungs and body swelling.
• Digoxin: Makes the heart beat stronger.
• Isosorbide dinitrate/Hydralazine hydrochloride: Relaxes blood vessels.

If you have trouble breathing, you may be given an oxygen tank to make breathing easier and more productive.

Lifestyle Management

There are several steps you can take in your own life to make your heart healthier and lessen the negative effects caused by heart failure. 

• Avoid alcohol. Drinking alcoholic beverages can make the heart weaker.  
• Eat a healthy, balanced diet. Eat a diet that's low in salt, fat, saturated fat, trans fat and cholesterol. These are the main components of food that make the heart work harder than it needs to, leading to excess fluid in the body, plaque buildup in the arteries and even heart disease. Vitamins and minerals are important for a healthy heart. One of the most important nutrients is potassium because some heart medications lead to a loss of potassium in the body. Low blood potassium can lead to irregular heart rates. All fruits and vegetables are good sources of potassium, with bananas, melons, beans, raisins, beets and potatoes being especially good sources.
• Exercise. Regular physical activity under the recommendations of your doctor can help build a strong heart and healthy lungs.
• Get more sleep. Sleep deprivation can put you at risk for heart disease. 
• Lose weight. If you're overweight or obese, your heart must work harder. Losing weight can help ease a lot of stress placed on an overworked heart.
• Reduce salt intake. Diets that are high in sodium are associate with increased risk for cardiovascular diseases and events. 
• Stop smoking and avoid illegal drugs. Both smoking and illegal drugs can make the heart beat faster than normal and lower your overall health.

See a Specialist

It’s important to be evaluated by a cardiologist if you or a loved one: 

• Has symptoms of heart failure 
• Would like strategies to help improve your current treatment of heart failure 

At National Jewish Health in Denver, Colorado, we have one of the world’s leading cardiology programs. Learn more about our program or use the button below to make an appointment.