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Heart Failure

What is heart failure?
How does the heart work?
Are there different types of heart failure?
How did I get heart failure?
What are the symptoms of heart failure?
How is heart failure diagnosed?
How is heart failure treated?

What is heart failure?

Heart failure occurs when the heart is not able to pump enough blood to meet the needs of the rest of the body. The weakened heart muscle strains to pump out blood and the muscle fibers of the heart stretch, which over time, leaves the heart with larger chambers. In most cases, heart failure develops slowly, over many years. Heart failure does not mean that the heart has stopped working altogether.

How does a heart work?

Regional_medical_Center_Antheart4The heart has four chambers: two on the left side and two on the right. The upper chamber on each side, called the atrium, receives and collects blood. The lower chamber on each side, called the ventricle, pumps blood out of the heart.

Four valves control the flow of blood within the heart. These valves are like one-way doors, allowing blood to move forward, preventing it from backing up into the chamber where it came from.

The four heart chambers work together to contract and pump blood. As it circulates, blood delivers oxygen and nutrients throughout the body. A damaged heart pumps blood with less force, causing slower blood flow to the body. It also causes blood to back up into the lungs and/or veins and tissues. The heart may increase in size from having to work harder to pump blood.

Are there different types of heart failure?

Congestive heart failure is an older term for heart failure. This is when the heart isn't functioning as effectively as it should be and fluid backs up into the lungs.

There are two main categories of heart failure, although within each category symptoms and effects may differ from patient to patient. The two categories are:

Systolic Heart Failure (Left Heart Failure): Occurs when the left ventricle (the main pumping chamber) loses the ability to contract properly and becomes unable to pump enough blood into the circulation. Blood coming into the heart from the lungs may back up and cause fluid to leak into the lungs.

Diastolic heart failure (Right Heart Failure): Occurs when the right ventricle has a problem relaxing and does not fill properly. This condition usually happens when the left ventricle is thickened and stiff, leading to fluid accumulation in the feet, ankles, lungs and legs.

How did I get heart failure?

The causes of heart failure can be from one or many factors including:

  • Coronary artery disease: A build-up of fatty deposits in the coronary arteries reduces blood supply to the heart muscle. As a result, the heart may not be able to work efficiently enough to supply blood to the rest of the body.
  • Past heart attack: When a heart attack occurs, the coronary artery is completely blocked by a blood clot. The heart muscle around the artery dies and then turns into scar tissue as it heals. A scarred heart may not pump as efficiently as a normal heart.
  • Hypertension (high blood pressure): High blood pressure increases the workload of the heart. If left untreated, hypertension may weaken the heart over time and lead to heart failure.
  • Heart valve disease: Heart valves normally keep blood moving forward. If a valve is narrowed, the heart has to work harder to push blood through the smaller opening. If a valve does not close tightly, blood may leak backwards, making the heart pump harder. Over time, the extra workload weakens the heart muscle and may lead to heart failure.
  • Cardiomyopathy: This can be caused by a variety of conditions in which the heart muscle weakens and heart chambers (and/or heart muscle) enlarge.
  • Other conditions that can lead to heart failure include: chronic lung disease, kidney disease, pregnancy, heart infections, alcoholism or a heart defect present at birth. Diabetes, obesity and cardiac arrhythmias, or irregular heart beats, can also be risk factors.

What are the symptoms of heart failure?

Heart failure may have many symptoms. Blood and extra fluid may back up into your lungs making it difficult for you to breathe. The problem can worsen at night since lying down causes fluid to collect in the lungs. This can also cause a frequent, dry, hacking cough.

Extra fluid buildup shows by swelling in ankles, legs, fingers and stomach. This extra fluid also shows as weight gain. That's why a sudden weight gain (2-5 pounds in 1-3 days) is an important symptom to document if you have heart failure.

As the heart decreases its capacity to pump, muscles and other tissues receive less oxygen and nutrition. This causes the body to get inadequate “fuel” and it cannot perform as much work. You may notice that you don’t have energy to do your normal activity. Or you may notice excessive fatigue with exercising.

When you lie down at night, the built-up fluid in your body can go back into the blood vessels and then to your kidneys where it is made into urine. This may cause you to urinate more frequently during the night. Lying down flat can also cause fluid to back up into the lungs making it difficult to breathe. Let your physician know if you are requiring more pillows to sleep.

You may notice loss of appetite or nausea. Sometimes dizzy spells can occur due to the brain receiving less blood.

How is heart failure diagnosed?

Your physician will do a physical exam, ask you many questions about your symptoms and health history, and may schedule other tests to reveal the extent of your heart disease, such as:

  • Chest X-ray: Shows the size of your heart (with heart failure, it may be larger than normal) and whether there is fluid buildup around your heart and lungs.
  • EKG (electrocardiogram): Measures how well your heart is beating and if there is heart muscle damage.
  • Echocardiogram: Ultrasound of your heart to see valves and the efficiency of your heart’s pumping. The amount of blood in the heart chamber pumped with each beat is called the ejection fraction. A normal ejection fraction is about 55 percent.
  • Exercise stress test: Involves walking on a treadmill or pedaling a stationary bike while your heart rate, blood pressure and ECG are monitored. This test shows if there are blockages or narrowing in the arteries surrounding your heart and the heart’s response to exercise.
  • Nuclear imaging scans/MUGA/Myocardial Perfusion/Thallium Scan: Compares images of the heart at rest with images taken after your heart is stressed with either medicine or by walking on a treadmill. These images indicate whether there is a blockage in the blood vessels and an estimation of your heart's pumping ability.
  • Cardiac catheterization/Angiogram: Catheter is inserted through a blood vessel in your arm or groin and guided to your heart. X-ray contrast is injected through the catheter into the blood vessels of your heart and pictures are taken. This shows any narrowed or blocked arteries around your heart. It can also record problems with pumping, heart chambers, blood flow and valves.
  • Holter event monitor: Special device that you wear on your chest to record changes in the regularity of your heartbeat.

How is heart failure treated?

Heart failure is treated with:

  • Medications
  • Devices such as pacemakers
  • Surgery
  • Lifestyle changes