Basic Facts

Heart failure means the heart's blood-pumping function is weakened.

Approximately 4.9 million Americans currently are living with heart failure.

Typically, heart failure develops slowly. The most common warning symptom is shortness of breath during exertion. As the heart muscle weakens, the heart's pumping function decreases. Blood can back up into the lungs, liver, and other organs.

As the heart muscle weakens, the heart's pumping function decreases. Blood can back up into the lungs, liver, and other organs.

Heart failure means that the heart muscle is weakened. A weakened heart muscle may not be strong enough to pump an adequate amount of blood out of its chambers. To compensate for its diminished pumping capacity, the heart may enlarge. Commonly, the heart's pumping inefficiency causes a buildup of blood in the lungs, a condition called pulmonary congestion.

Types of heart failure

Left-sided Heart Failure

the left ventricle typically pumps out inadequate amounts of oxygenated blood to the rest of the body, and fluid backs up into the lungs.

Right-sided Heart Failure

the resistance to blood flow through the lungs exceeds the right ventricle's ability to pump blood into the lungs. Consequently, blood backs up into the liver and other organs. The most common cause of right heart failure is actually left heart failure.

Systolic Heart Failure

the heart's pumping function is depressed.

Diastolic Heart Failure

the heart is unable to fill up with an adequate amount of blood. Diastolic heart failure usually occurs because the muscular heart wall thickens and stiffens. Abnormal thickening of the heart muscle wall, called hypertrophy, has many causes, the most common of which is hypertension. Less commonly, hypertrophic cardiomyopathy may cause heart muscle to thicken.

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RISK FACTORS

Risk factors for congestive heart failure include:

• Heart attacks
• Uncontrolled or long-standing high blood pressure
• Viral or bacterial infections
• Complications during pregnancy
• Chronic alcohol abuse
• Damage to the mitral and aortic valves
• Aortic valve disease
• Cancer therapies
• Certain courses of treatment for AIDS

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WHAT ARE THE SYMPTOMS?

The symptoms of heart failure often develop slowly because the body can compensate for early effects of the disease, thus the heart's function may diminish significantly without noticeable symptoms. Symptoms include:

• Shortness of breath (dyspnea);
• Coughing;
• Swelling and weight gain; and
• Fatigue.

DIAGNOSIS

Physicians diagnose congestive heart failure through a medical history and a physical exam. Shortness of breath on exertion, or dyspnea, and weakness are the two main symptoms physicians look for when diagnosing the condition. During an exam, a doctor may also hear rales, or wet crackles, indicating fluid in the lungs. Physicians may also listen with a stethoscope for sounds of a 'gallop,' or extra beat, in the heart that indicates abnormal heart function. Physicians use the following tests to confirm the diagnosis:

• Medical history and physical exam;
• Chest x-rays; and
• Echocardiograms.

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TREATMENT APPROACH

The basic strategies for controlling heart failure are to relieve symptoms and to prevent the progressive decrease in the heart's pumping function. Lifestyle changes and medication are the methods most commonly used to achieve these strategies. In some instances, the cause of heart failure may be reversible through valve repair or replacement surgery, bypass surgery, or angioplasty.

Physicians prescribe several medications to relieve symptoms and to improve the function of the heart, including:

• ACE inhibitors;
• Diuretics;
• Digitalis;
• Vasodilators;
• Nitrates;
• Beta-blockers; and
• Angiotensin receptor blockers (ARB).

Physicians also recommend that patients:

• Quit smoking;
• Eliminate salt from the diet;
• Lose weight;
• Increase activity;
• Limit alcohol intake; and
• Weigh themselves daily to detect fluid build up.

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