What is heart failure?
Heart failure is a condition where the heart is no longer able to pump blood with enough force or fast enough to meet the needs of the body's tissues. In some cases, the heart does pump blood fast enough to meet the body's needs, but it has to work harder to do so. It does this by increasing the pressure within the heart and blood vessels. The increased pressure causes further wear and tear on the heart. This condition is also called congestive (con-JES-tiv) heart failure or heart failure.
The term heart failure sounds like the heart has stopped working completely, but this is not true. Typically, congestive heart failure means that the heart is failing to work. This may take place over several years, although it can also come on swiftly. With heart failure, the blood flow out of the heart decreases. This causes the blood flow into the heart to back up. When the blood flow into the heart slows, it causes fluid to build up in the tissues of the body.
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What causes heart failure?
Conditions that can cause heart failure include:
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Coronary artery disease, where arteries that supply blood to the heart narrow and clog |
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Heart attack, where part of the heart muscle dies and is replaced by scar tissue, which limits the heart muscle from working well |
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High blood pressure, where increased pressure causes the heart to work harder; over time the heart can thicken and eventually fail |
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Heart valve disease, which can reduce how well the heart is able to work |
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Diabetes, which increases the risk for all types of heart disease because of its effect on the blood vessels |
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Infection of the heart or heart valves |
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Heart defects present at birth, called congenital (con-JEN-i-tul) heart disease |
Any one of the conditions listed above can cause heart failure. The risk increases when someone has more than one condition.
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Who is more likely to get heart failure?
Someone with any of these risk factors is more likely to get heart failure:
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Cigarette smoking |
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High blood cholesterol levels |
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Being overweight |
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Coronary artery disease or "hardening of the arteries," known as atherosclerosis (ATH-ur-oh-sklir-OH-sis) |
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High blood pressure |
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Diabetes mellitus |
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History of heart attack or other heart disease |
Approximately 500 000 people in Canada have heart failure, and nearly 50 000 new cases are diagnosed every year. It is slightly more common in men than in women. It is twice as common in African Americans as it is in caucasians.
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What are the types of heart failure?
There are 2 different types of heart failure:
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Systolic (sis-TOL-ick) heart failure. With this type, the heart has trouble pumping blood through the body. Blood coming from the lungs to the heart may back up. This causes fluid to build up in the lungs and other parts of the body. It can also cause fatigue and make it hard to exercise. |
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Diastolic (die-uh-STOL-ick) heart failure. With this type of heart failure, the heart is not able to relax well. The heart cannot fill with blood as well because the heart muscle is so stiff. This condition causes fluid to build up in various parts of the body, such as the feet, ankles, and legs, as well as in the lungs at times. |
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What are the signs or symptoms of heart failure?
Most of the symptoms of heart failure are related to either:
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Build-up of fluid in the body tissues |
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Lack of oxygen and nutrients due to fluid build-up in the lungs |
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Lack of nutrients due to decreased blood flow |
In the early stages, the heart tries to make up for its losses in pumping ability by getting bigger and thicker, and by pumping faster to increase blood flow. This can help prevent symptoms for years. But in time, it's not enough, and symptoms begin to appear.
The symptoms of heart failure include:
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Shortness of breath. This symptom results from the fluid build-up in the lungs. When severe, it is sometimes described as a feeling of drowning. This symptom often gets worse with activity, when lying flat, or at night. |
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Fatigue. This occurs when muscles and other tissues don't get enough oxygen and nutrients from the blood. |
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Edema. This symptom, which means swelling from a build-up of fluid, occurs most often in the feet, legs, belly, or lungs. This fluid build-up can cause sudden weight gain. |
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Coughing, wheezing, or raspy breathing. This symptom occurs when fluid builds up in the lungs. The cough can sometimes produce pink, blood-tinged mucus. |
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How is heart failure diagnosed?
Diagnosis of heart failure requires a physical exam and a history taken by a healthcare provider. The most common signs are shortness of breath, fatigue, and swelling in the ankles and feet. These symptoms will lead the healthcare provider to suspect heart failure. The physical exam will include listening for heart and lung sounds that point to heart failure. The healthcare provider will also check for risk factors, such as:
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Coronary artery disease or "hardening of the arteries," known as atherosclerosis (ATH-ur-oh-sklir-OH-sis) |
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High blood pressure |
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Being overweight |
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Diabetes mellitus |
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Other heart problems |
If the symptoms and exam don't confirm that a patient has heart failure, the healthcare provider may order tests. A chest x-ray is one type of test. An echocardiogram (EK-oh-CAR-dee-oh-gram) is another. This painless test uses sound waves to check the structure and movement of the heart. Both tests can help rule out other causes of the symptoms.
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What are the treatment choices for heart failure?
Treatment for heart failure can improve quality of life and add years to a person's life. To choose the right course of treatment, the healthcare provider will bear in mind the type of heart failure and its cause. He or she will also look at the patient's age, health status, and health outlook. Treatment plans include lifestyle changes. Such changes can help control heart failure. Changes can include:
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Quitting smoking |
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Losing weight, or maintaining it in a healthy range |
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Avoiding alcohol |
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Eating foods low in salt and low in fat |
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Limiting fluids |
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Staying active, as directed by the healthcare provider |
The person with heart failure also needs to take one or more kinds of medicine. Several types of medicine have proved useful for heart failure:
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ACE (angiotensin-converting enzyme) inhibitors. This type of medicine widens the blood vessels. That helps ease the work of the heart. |
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ARBs (angiotensin II receptor blockers). These are used in people who can't take ACE inhibitors. They also widen the blood vessels and ease the work of the heart. |
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Diuretics (water pills). These reduce the fluid in the body and decrease the pressure in the blood vessels. |
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Beta-blockers (beta-adrenergic receptor antagonists). These help the heart beat more slowly, which decreases the blood pressure. |
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Digitalis (digoxin). This medicine helps the heart beat more strongly. |
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Vasodilators (such as hydralazine, isosorbide, and nitrates). These help relax tension in the blood vessels. When blood vessels are relaxed, the blood flows more easily. |
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Blood thinners (such as warfarin and heparin). These are sometimes prescribed for people with a history of blood clots, very rapid heartbeat called atrial fibrilliation (AY-tree-ul fih-brih-LAY-shun), or stroke. |
Patients who do not respond to lifestyle changes and medicine may need other types of therapies. Other treatments may include special electronic pacemakers, surgery, other devices, or even a heart transplant.
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Does heart failure have to be treated?
Yes. Without treatment, heart failure will continue to get worse. Patients who do not get treatment also have a high risk of heart attack or sudden death. To improve the chance of survival, people with heart failure must take care of themselves. It is vital to see a healthcare provider on a regular basis and follow his or her exact directions. Taking medicines as prescribed can help the heart pump more efficiently.
Patients should know the warning signs of heart failure. If these signs return or get worse, patients need to alert the healthcare provider right away. These warning signs include:
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Sudden weight gain, such as 3 or more pounds in a day or 5 or more pounds in a week |
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Increasing shortness of breath even at rest |
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Swelling in the legs and feet |
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Swelling or pain in the belly |
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Trouble sleeping due to shortness of breath when lying flat |
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Frequent cough that is dry and hacking |
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Worsening fatigue |
Even with the best care and treatment, heart failure can get worse. But the chances of a healthy life are much better when there is effective treatment.
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What questions might I ask the healthcare provider about treating heart failure?
If you or a loved one has been diagnosed with heart failure, you may want to write down any questions you have for the healthcare provider before your next visit. Here are a few suggestions to get you started:
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How bad is my heart failure? |
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Will I get better? |
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What should I expect in terms of how the disease is likely to progress? |
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What are my treatment choices? |
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Which one(s) do you think will work best for me? Why? |
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How well will that treatment work? |
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What kind of side effects does the medicine have? |
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How can I manage the side effects that I have? |
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How will heart failure or its treatment affect my daily activities? |
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How soon can I expect the treatment to start working? |
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What warning signs should I report to you right away? |
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