Contrary to its name, heart failure does not mean the heart has failed completely. It means the heart is pumping inefficiently and no longer can meet the body's need for blood. This inefficient pumping causes a backup of blood in the veins leading to the heart, and causes the kidney to retain fluid. As a result, the body's tissues swell. The swelling (edema) most commonly affects the legs, but it also can occur in the lungs, causing breathing difficulty, and in other tissues and organs.

Heart failure often is the end stage of another form of heart disease. Its many causes include:

• Coronary artery disease
• High blood pressure (hypertension)
• Heart valve disorders (including rheumatic heart disease)
• Congenital heart disorders
• Cardiomyopathy (disease of the heart muscle)
• heart attack
• Cardiac arrhythmias (problems with the heart rate and/or rhythm)
• Exposure to toxins, including excessive alcohol

Hyperthyroidism, diabetes and chronic (long-lasting) lung disease also increase the risk of heart failure.

In some people with heart failure, the heart muscles become weaker and cannot pump as well. In other people, the heart muscles become stiff and the heart cannot fill with enough blood between heartbeats.

The number of cases of heart failure continues to increase in the United States. This probably is the result of an aging population, together with medical advances that have prolonged the lives of people with other forms of heart disease, allowing heart failure to develop.

The first symptom of heart failure can be fatigue. As the condition gets worse, there can be shortness of breath and wheezing during exertion, and eventually also when you are resting. As fluid accumulates in the lungs, people with heart failure may begin to sleep propped up with pillows to make breathing easier. Fluid also can collect in the legs and ankles, causing swelling. In people who are less active, collected fluid can accumulate in the middle of the body. Some people need to urinate several times during the night as the kidneys drain off some of the excess fluid that accumulates in the lower body during the day. As the body accumulates more and more fluid, the person may notice significant weight gain. There also can be a chronic cough due to fluid accumulation in the lungs.

Although heart failure usually affects both sides of the heart, in some people it affects only the left or right side. In these cases, symptoms vary depending on which side is affected. When heart failure affects mainly the left side of the heart, the symptoms are more likely to involve breathing difficulties. When mainly the right side is affected, the main symptoms may be leg swelling and abdominal swelling.

Your doctor will review your medical history and ask for details about your symptoms, including how many blocks you can walk without becoming short of breath, the number of pillows you sleep on and whether you suddenly wake up after falling asleep because of severe shortness of breath.

During your physical examination, your doctor will check your vital signs (such as blood pressure and temperature), check your heart rate and rhythm, and listen for abnormal heart sounds with a stethoscope. He or she will listen to your lungs for abnormal breathing sounds that indicate fluid is building up in your lungs. Your doctor will press on the skin of your legs and ankles to check for edema (swelling). He or she may feel your abdomen to check the size of your liver because fluid backup from the heart may cause liver swelling.

You also will have diagnostic tests, including an electrocardiogram and a chest X-ray, to check for enlargement of the heart and fluid in the lungs. Other diagnostic tests may be needed to find the cause of your heart failure. For example, a test called an echocardiogram may likely be done to look for heart valve abnormalities, abnormal movement of the heart wall (a sign of heart attack) or other cardiac abnormalities. The echocardiogram is a particularly important test because it can determine whether the heart muscles have weakened or become stiff. The treatment can differ depending on the type of heart failure.

Heart failure often is a lifelong condition. However, if the cause is treatable, heart failure can go away.

To avoid heart failure, you must prevent the various forms of heart disease that lead to it. To prevent coronary heart disease, eat a healthy, balanced diet, control your blood pressure and cholesterol level, maintain a normal body weight, exercise regularly and don't smoke. Limit alcohol use to one to two drinks per day. Some types of heart failure cannot be prevented.

The treatment of heart failure focuses on lessening symptoms, decreasing hospitalizations and improving life expectancy. To accomplish these goals, your doctor will advise a low-salt diet and medication. Medications may include:

• A diuretic (water pill) to remove excess body fluid by increasing urine output
• An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to expand blood vessels and improve forward blood flow
• A beta-blocker to help prolong the life of muscle cells
• Digoxin (Lanoxin) to strengthen the heart's contractions
• A potassium sparing diuretic, such as spironolactone (sold as a generic), which has been shown to help people live longer when taken in low doses

Sometimes, anticoagulants (blood thinners) also are prescribed to prevent blood clots, particularly if the patient requires a long period of bed rest.

Your doctor also will address the underlying cause of your heart failure. Heart failure related to coronary artery disease may require additional medications, angioplasty or surgery. When heart failure is caused by a poorly functioning hart valve, your doctor may advise surgical repair and valve replacement. For some people with heart failure, losing weight or stopping all alcohol use can dramatically improve symptoms. Your doctor will tell you how much exercise is appropriate. Balancing physical activity with rest is important in more advanced stages of heart failure.

When medications and self-treatment are no longer helpful, a heart transplant may be considered. This treatment option is limited by a shortage of donor hearts and usually is reserved for patients younger than 65.

Call your doctor if you have any of the following symptoms, particularly if you already have been diagnosed with some form of heart disease:

• Significant fatigue
• Difficulty breathing
• Swelling of the ankles and legs
• Swelling of your abdomen
• Episodes of breathlessness

The outlook depends on the patient's age, the severity of the heart failure, the severity of the underlying heart disease and other factors. When heart failure develops suddenly and has a treatable cause, people sometimes can regain normal heart function after treatment. With appropriate treatment, even people who develop heart failure as a result of long-standing heart disease often can enjoy many years of productive life.

American Heart Association (AHA)
7272 Greenville Ave.
Dallas, TX 75231
Toll-Free: 1-800-242-8721
http://www.americanheart.org/

National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: 301-592-8573
TTY: 240-629-3255
Email: nhlbiinfo@rover.nhlbi.nih.gov
http://www.nhlbi.nih.gov/