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Heart Failure

Heart failure does not mean that your heart has stopped, but rather that a slow, progressive weakening of the heart is affecting how efficiently it can pump. Although there is no cure, medications, procedures, and lifestyle changes help patients live their lives to the fullest.

About 6 million people suffer from heart failure, also called congestive heart failure. There may be differences in each patient about where and how the pumping action is compromised (left-sided heart failure, right-side heart failure, heart failure with preserved EF), but the symptoms and treatments are similar.

Symptoms

Whether you suspect you have heart failure, or have already been diagnosed, it is important to track your symptoms and report them to your doctor. Signs of heart failure can include:

  • Shortness of breath (also called dyspnea) – breathlessness during activity and even at rest or asleep. If you notice you need to prop your head up at night to breathe, or that you feel tired and anxious even after a full night’s sleep, this could also be considered dyspnea.
  • Persistent coughing or wheezing (that may or may not produce white or pink blood-tinged mucus) – could be caused by fluid backing up into the lungs.
  • Edema – when blood flow is impaired, causing fluid to build up in the tissues. The kidneys are also unable to dispose of sodium and water efficiently, which causes additional fluid retention. This swelling is most often noticed in the legs, ankles, feet and abdomen.
  • Tiredness and fatigue – from the heart not pumping enough blood to meet the needs of the whole body.
  • Lack of appetite, nausea, and digestion issues – a problem with blood flow that affects your digestive tract.
  • Confusion and impaired thinking – caused by inadequate blood flow to the brain as well as unstable sodium levels and other blood chemicals affected by poor blood flow. A caregiver or relative may notice this first.
  • A racing or throbbing feeling in your chest – may mean the heart is trying to compensate for its lack of efficient pumping.
  • Weight gain – adding two or three pounds in a day may indicate fluid retention.

Causes / Risk Factors

Heart failure is more likely to happen as we age, but this risk is increased if there is another heart condition present like coronary artery disease, previous heart attack or uncontrolled high blood pressure. If you have been diagnosed with one of these conditions, managing it under a doctor’s care is crucial to prevent or delay heart failure. However, anyone can develop heart failure, even without known risk factors.

Research has also shown that being overweight and having a sedentary lifestyle contribute to the onset of heart failure. So maintaining a normal weight, moving more and sitting less all need to be important parts of your healthcare routine.

Diagnosis

After an examination, your doctor may decide that tests and procedures should be ordered to help determine exactly which part of the heart is having trouble pumping.

These tests and procedures may include:

  • Blood tests – to check for sodium and potassium levels, as well as kidney function.
  • X-ray – picture of the chest to look at the heart muscle or fluid in the lungs.
  • Electrocardiogram (ECG or EKG) – a test that measures the electrical activity of the heartbeat.
  • Echocardiogram – an ultrasound movie of the inside of the heart.
  • Transesophageal echocardiogram – a special type of ultrasound movie of the heart done through a tiny tube inserted through the mouth that sends sound waves to a receiver that produces a picture.
  • Exercise Stress Test – walking on a treadmill while doctors monitor both the heart and lung function.
  • MRI – an image using magnetic waves to look at the blood vessels connected to the heart and lungs.
  • CT scan – multiple X-ray images to give a more detailed picture of the heart and lung.
  • Cardiac catheterization – a minimally invasive procedure that allows the cardiologist to get direct information about the blood pressure and the heart’s blood flow.
  • Angiogram – an X-ray movie that's taken while a special dye is injected into a cardiac chamber or major blood vessel.

Treatment Options

Successful treatment of heart failure depends on your commitment to following a care plan that usually includes a comprehensive approach including lifestyle changes, medications, and procedures.

Lifestyle changes your doctor may prescribe include:

  • Healthy eating, exercise
  • Limiting sodium and alcohol
  • Quitting smoking
  • Managing stress
  • Monitoring weight
  • Cutting caffeine
  • Getting flu and pneumonia vaccines
  • Tracking specific symptoms that your doctor recommends.

Your Erlanger doctor can point you toward resources for help in these areas.

If your heart is weak, certain medications may be prescribed to make you feel better and live longer. You may need more than one medication to treat heart failure symptoms. Follow dosing instructions carefully and talk to your doctor about any side effects that may concern you.

Percutaneous coronary intervention (PCI), commonly known as angioplasty, is a procedure used to treat narrowed arteries found in coronary heart disease, which can cause heart failure. PCI is part of Erlanger’s Cycle IV Chest Pain accreditation, which is the highest and most difficult level of certification to achieve. Erlanger is the first and only facility in the region to earn the Cycle IV accreditation.

If a doctor identifies a specific problem like a valve issue that is contributing to heart failure, this will be addressed and additional treatments may be needed to improve the function of the valve.

Some devices like an implantable cardioverter defibrillator or a pacemaker may help synchronize and stabilize your heartbeat. These may be implanted with a minimally invasive procedure, which uses small incisions and tiny instruments to position and attach the devices to the heart.

In rare cases, a patient may need a heart pump (left ventricular assist device—LVAD) or heart transplant. This is a major procedure that your Erlanger team will discuss in great detail with you and your family.

Outcomes

Living with a chronic condition like heart failure can be challenging, but following your doctor’s orders and living a healthy lifestyle will help you enjoy life. Tracking your symptoms is also an important step in monitoring how heart failure is progressing.

Erlanger Cardiac Rehabilitation is a comprehensive program that combines exercise, education and support. It can greatly increase quality of life for patients with a heart failure diagnosis.

Prevention

Some risk factors, like age and a genetic predisposition toward heart disease, cannot be changed. But in the vast majority of patients at risk for heart failure, a healthy lifestyle can reduce the complications from these risks.

A healthy diet low in saturated fats and rich in fiber and nutrient-dense foods like vegetables, fruits and whole grains is the most important step you can take toward preventing heart disease of all kinds. Maintaining a normal weight and being active, including regular exercise for the whole family is not only good for your heart, it has been shown to reduce incidences of heart failure.


Erlanger Resources

Erlanger is on the forefront of cardiology therapies for adults and children. The following resources are available for patients with congenital artery disease.