The name of this condition can be a little confusing. When you have heart failure, it doesn't mean your ticker stopped beating. What's really going on is that your heart can't pump blood as well as a healthy one.
The chambers of your heart may respond by stretching to carry more blood to pump through your body. They may become stiffer and thicker. This helps keep blood moving for a while, but in time, your heart muscle walls may get weaker.
Your kidneys react by causing your body to hold on to water and salt. Fluid may start to build up in your arms, legs, ankles, feet, lungs, or other organs.
The American Heart Association and American College of Cardiology have defined four stages of heart failure to help people understand how the condition changes over time and the kinds of treatments that are used for each.
Heart failure can be brought on by many conditions that damage the heart.
Coronary artery disease is a problem with the arteries that supply blood and oxygen to your heart. It means less blood flows to your heart muscle. When the arteries narrow or get blocked, your heart becomes starved for oxygen and nutrients and can't pump as well.
Heart attack may happen when a coronary artery is blocked suddenly, which stops the flow of blood to your heart muscle.
Cardiomyopathy is damage to your heart muscle. It can be caused by artery or blood flow problems, infections, and alcohol and drug abuse. Other diseases or genetic issues can also bring it on. Make sure your doctor knows your family's health history.
Conditions that overwork the heart include things like high blood pressure, heart valve disease, thyroid disease, kidney disease, diabetes, or heart defects you've had since you were born.
Systolic heart failure happens when your heart muscle doesn't squeeze with enough force. When that's the case, it pumps less oxygen-rich blood through your body.
With diastolic heart failure, your heart squeezes normally, but the ventricle -- the main pumping chamber -- doesn't relax properly. Less blood can enter your heart, and the blood pressure in your lungs goes up. When that happens, you get fluid in your lungs, legs, and belly.
This is the period when you're more likely to get heart failure. You may be in this stage if you have:
- High blood pressure
- Diabetes
- Coronary artery disease
- Metabolic syndrome
Your chances are also greater when you have a history of:
Your doctor will probably recommend regular exercise and that you stop drinking alcohol, smoking, and using illegal drugs. You'll want to take steps to lower high blood pressure or high cholesterol.
If you have high blood pressure or had a heart attack, your doctor may prescribe beta-blockers.
When you have diabetes, high blood pressure, or other heart and blood vessel conditions like coronary artery disease, you may need to take an ACE inhibitor or an angiotensin II receptor blocker (ARB).
You're in this phase if you never had symptoms of heart failure but you're diagnosed with systolic left ventricular dysfunction, which means the left chamber of your heart doesn't pump well. You may be in this group if you had or have:
- Heart attack
- Valve disease
- Cardiomyopathy
Treatment will depend on your situation. Your doctor may suggest an ACE inhibitor or angiotensin II receptor blocker (ARB), or beta-blockers after a heart attack. They may add an aldosterone inhibitor if your symptoms continue while you're taking beta-blockers and ACE/ARB medications.
Surgery can repair coronary arteries and valves, or valves which may need to be replaced. Sometimes an implantable cardiac defibrillator (ICD) will help.
You're in this phase if you have systolic heart failure along with symptoms such as:
- Shortness of breath
- Fatigue
- Less ability to exercise
Your doctor may prescribe:
- ACE inhibitors and beta-blockers
- Angiotensin receptor blocker and neprilysin inhibitors
If your symptoms don't go away, you may need to take:
- Hydralazine/nitrate combination
- Diuretics (water pills) and digoxin
- Aldosterone inhibitor, when your symptoms stay severe with other treatments
Soluble Guanylate Cyclase (sGC) stimulators
Devices such as a biventricular pacemaker or implantable cardiac defibrillator (ICD) may help.
You may need to change some things about your day-to-day life, too:
- Eat less salt.
- Lose weight if you're overweight.
- Drink fewer fluids if necessary.
- Stop drugs that make your condition worse.
You're in this phase if you have systolic heart failure and advanced symptoms after you get medical care.
Some of the treatments from stages A, B, and C will help stage D, too. Your doctor may also discuss:
- Heart transplant
- Ventricular assist devices
- Surgery options
- Continuous infusion of intravenous inotropic drugs
Heart failure is characterized by the heart’s inability to pump an adequate supply of blood to the body. Without sufficient blood flow, all major body functions are disrupted. Heart failure is a condition or a collection of symptoms that weaken or stiffen your heart.
In some people with heart failure, the heart has difficulty pumping enough blood to support other organs in the body. Other people may have a hardening and stiffening of the heart muscle itself, which blocks or reduces blood flow to the heart.
Heart failure can affect the right or left side of your heart or both at the same time. It can be either an acute (short-term) or chronic (ongoing) condition.
- With acute heart failure, the symptoms appear suddenly but go away fairly quickly. This condition can occur after a heart attack. It may also be a result of a problem with the heart valves that control the flow of blood in the heart.
- With chronic heart failure, symptoms are continuous and don’t improve over time. Most heart failure cases are chronic.
About 6.2 million Americans have heart failure, according to the Centers for Disease Control and Prevention (CDC). Most cases are diagnosed in men. However, women are more likely to die from heart failure when the condition goes untreated.
Heart failure is a serious medical condition that requires treatment. Early treatment increases your chances of long-term recovery with fewer complications. Call your doctor right away if you’re having any symptoms of heart failure.
Heart failure is most often related to another condition. The most common cause of heart failure is coronary artery disease (CAD), a disorder that causes narrowing of the arteries that supply blood and oxygen to the heart. Other conditions that may increase your risk of developing heart failure include:
- cardiomyopathy, a disorder of the heart muscle that causes the heart to become weak
- congenital heart disease
- heart attack
- heart valve disease
- certain types of arrhythmias, or irregular heart rhythms
- high blood pressure
- emphysema, a disease of the lung
- untreated sleep apnea
- diabetes
- an overactive or underactive thyroid
- HIV
- severe forms of anemia
- certain cancer treatments, such as chemotherapy
- substance misuse disorder
The symptoms of heart failure may include:
- fatigue
- sudden weight gain
- a loss of appetite
- persistent coughing
- irregular heart rate
- heart palpitations
- abdominal swelling
- shortness of breath
- exercise intolerance
- leg and ankle swelling or abdomen
- sleeping on extra pillows
- getting short of breath while lying down.
- protruding neck veins
Heart failure can occur in either the left or right side of your heart. It’s also possible for both sides of your heart to fail at the same time.
Heart failure is also classified as either diastolic or systolic.
Left-sided heart failure
Left-sided heart failure is the most common type of heart failure.
The left ventricle is located in the bottom left side of your heart. This area pumps oxygen-rich blood to the rest of your body.
Left-sided heart failure occurs when the left ventricle doesn’t pump efficiently. This prevents your body from getting enough oxygen-rich blood. The blood backs up into your lungs instead, which causes shortness of breath and a buildup of fluid.
Right-sided heart failure
The right heart ventricle is responsible for pumping blood to your lungs to collect oxygen. Right-sided heart failure occurs when the right side of your heart can’t perform its job effectively.
It’s usually triggered by left-sided heart failure. The accumulation of blood in the lungs caused by left-sided heart failure makes the right ventricle work harder. This can stress the right side of the heart and cause it to fail.
Right-sided heart failure can also occur because of other conditions, such as lung disease or valve disease. Right-sided heart failure is marked by swelling of the lower extremities or abdomen. This swelling is caused by fluid backup in the legs, feet, and abdomen.
Diastolic heart failure
Diastolic heart failure occurs when the heart muscle becomes stiffer than normal. The stiffness, which is usually due to heart disease, means that your heart doesn’t fill with blood easily. This is known as diastolic dysfunction. It leads to a lack of blood flow to the rest of the organs in your body.
Diastolic heart failure is more common in people who are female than in those who are male.
Systolic heart failure
Systolic heart failure occurs when the heart muscle loses its ability to contract. The contractions of the heart are necessary to pump oxygen-rich blood out to the body. This problem is known as systolic dysfunction, and it usually develops when your heart is weak and may be enlarged.
Systolic heart failure is more common in males than in females.
Both diastolic and systolic heart failure can occur on the left or right sides of the heart. You may have either condition on both sides of the heart.
Heart failure can happen to anyone. However, certain factors may increase your risk of developing this condition.
There is a higher incidence of heart failure in men compared with women, though the prevalence is about the same for all sexes.
People with diseases that damage the heart are also at an increased risk. These conditions include:
- hypertension
- sleep apnea
- diabetes
- coronary artery disease
- valve disease
- anemia
- hyperthyroidism
- hypothyroidism
- emphysema
Certain behaviors can also increase your risk of developing heart failure, including:
- smoking
- eating foods that are high in fat or cholesterol
- not getting enough exercise
- having overweight or obesity
Your doctor may perform a physical exam to check for signs of heart failure. For instance, leg swelling, irregular heart rate, and bulging neck veins may lead your doctor to diagnose heart failure.
Echocardiogram
An echocardiogram is the most effective way to diagnose heart failure. It uses sound waves to create detailed pictures of your heart, which help your doctor evaluate the damage to your heart, the squeezing and relaxing function and determine the underlying causes of your condition.
Your doctor may use an echocardiogram along with other tests.
Other tests
Treating heart failure depends on the severity of your condition and the type of heart failure you have.
Early treatment can improve symptoms fairly quickly, but you should still get regular testing and follow up with your doctor every 3 to 6 months. The main goal of treatment is to increase your lifespan.
Treatment of heart failure may include one or more of the following:
- medication
- bypass surgery
- percutaneous coronary intervention
- a pacemaker
- an implantable cardioverter defibrillator (ICD)
- transplant surgery
Let’s take a closer look at each of these treatments and what they entail.
Medication
Early stages of heart failure may be treated with medications to help relieve your symptoms and prevent your condition from getting worse. Certain medications are prescribed to:
- improve your heart’s ability to pump blood
- reduce blood clots
- reduce your heart rate, when necessary
- remove excess sodium and replenish potassium levels
- reduce cholesterol levels
- reduce adverse hormones and reactions that occur in your body that can make the heart weaker
These medications can include:
- blood thinners
- angiotensin converting enzyme (ACE) inhibitors
- angiotensin II receptor blockers (ARBs)
- beta-blockers
- calcium channel blockers
- cholesterol-lowering medications
- nitrates
- angiotensin receptor-neprilysin inhibitors (ARNI)
- sodium-glucose cotransporter-2 (SGLT2) inhibitors
- hydralazine
- ivabradine in some cases
- verquvo (vericiguat) in some cases
Always speak with your doctor before taking new medications. Some medications are completely off-limits to people with heart failure, including naproxen (Aleve, Naprosyn) and ibuprofen (Advil, Midol).
Surgery
Bypass surgery
Some people with heart failure will need surgery, such as coronary bypass surgery. During this surgery, your surgeon will take a healthy piece of an artery or vein and attach it to the blocked coronary artery. This allows the blood to bypass the blocked, damaged artery and flow through the new one.
Percutaneous coronary intervention (PCI)
Your doctor may also suggest a procedure known as a percutaneous coronary intervention (PCI). In this procedure, a catheter with a small balloon attached is inserted into the blocked or narrowed artery. Once the catheter reaches the damaged artery, your surgeon inflates a balloon to open the artery.
Your surgeon may need to place a permanent stent, or wire mesh tube, into the blocked or narrowed artery. A stent permanently holds your artery open and can help prevent further narrowing of the artery.
Pacemakers
Other people with heart failure will need pacemakers to help control heart rhythms. These small devices are placed into the chest. They can slow your heart rate when the heart is beating too quickly or increase your heart rate if the heart is beating too slowly. Pacemakers are often used along with bypass surgery as well as medications.
Implantable cardioverter defibrillator (ICD)
An ICD is a battery-powered device that keeps track of your heart rate and will shock your heart if it detects an abnormal heart rhythm. This shock restores the heart rate back to a normal rhythm. An ICD is suggested for people with an ejection fraction (how much blood your heart pumps out with each contraction) less than 35 percent (if not due to blockages) and <30>
Heart transplants are used in the final stages of heart failure when all other treatments have failed. During a transplant, your surgeon removes all or part of your heart and replaces it with a heart from a donor.
Some lifestyle measures can help treat heart failure and prevent the condition from developing. Maintaining a moderate weight and exercising regularly can significantly decrease your risk of heart failure. Reducing the amount of salt in your diet can also lower your risk.
Other habits that may prevent heart failure include:
- limiting alcohol intake
- not smoking
- avoiding high fat foods
- getting the right amount of sleep
- staying active
Untreated heart failure can eventually lead to congestive heart failure (CHF), a condition in which blood builds up in other areas of your body. In this potential life threatening condition, you may experience fluid retention in your limbs as well as in your organs, such as the liver and lungs.
Additional complications of heart failure can include:
- stroke
- thromboembolism
- arrhythmias, like atrial fibrillation
- kidney dysfunction
Heart attack
A heart attack may also occur because of a complication related to heart failure.
Call 911 or your local emergency services right away if you have these symptoms:
- crushing chest pain
- discomfort in the chest, such as squeezing or tightness
- discomfort in the upper body, including numbness or a coldness
- fatigue
- dizziness
- rapid heart rate
- vomiting
- nausea
- cold sweats
Heart failure is usually a long-term condition that requires ongoing treatment to prevent complications. When heart failure is left untreated, the heart can weaken so severely that it causes a life threatening complication.
It’s important to recognize that heart failure can happen to anyone. It’s important to take lifelong preventive measures for your heart health. Always contact your doctor if you suddenly have any new or unexplained symptoms that may indicate a problem with your heart.
Because heart failure is most often a chronic condition, your symptoms will likely get worse over time. Medications and surgeries can help relieve your symptoms, but such treatments may not help if you have a severe case of heart failure. In some cases, heart failure can be life threatening.
The outlook and treatment of heart failure varies depending on the type of heart failure you have. Early treatment is key in preventing the most serious cases of heart failure.