Heart Failure

Heart failure is a medical condition that means the heart muscle doesn’t pump blood as well as it should, so your body’s need for blood and oxygen isn’t easily met. It is usually caused by damage to the heart's main pumping chamber (the left ventricle).

Heart failure is usually ongoing (chronic) but sometimes starts suddenly (acute). Most people with it can live comfortably if they take steps to manage the condition. When the heart doesn’t pump enough blood, hormones (body chemicals) are sent to increase the amount of work the heart does.

Some hormones make the heart grow larger. Others tell the heart to pump faster. These hormones may help the heart pump more blood at first, but they can’t keep up with the ongoing demands. As a result, the heart muscle becomes more damaged. Over time, even less blood is pumped through the heart. This leads to problems throughout the body.

What happens once you have heart failure?

If you have heart failure, your heart pumps less blood than normal to the lungs and to the rest of the body. As a result, the kidneys and other organs don’t get the oxygen-rich blood they need. When the kidneys don’t work right, fluid backs up in the lungs and throughout the body. This results in the symptoms:

• Shortness of breath.


• Swelling.

There are two basic types of heart failure:

• Systolic Heart Failure (“Pumping problem”): The heart muscle becomes weak and bigger. It can’t pump enough blood. With each heartbeat, the system pumps out only a fraction of the total amount of blood in the ventricle.


• Diastolic Heart Failure (“Filling problem”): The heart muscle becomes stiff and doesn’t relax between pumping. This keeps the ventricles from filling with blood.

What causes heart failure?

People of any age can have heart failure, but it is much more common in people over 65.

Causes of heart failure include:

• Cardiomyopathy: Cardiomyopathy is a weakening of or damage to the heart muscle. Heart muscle can become weakened by a previous heart attack, severe coronary artery disease, many years of high blood pressure, many years of drinking too much alcohol, or an infection. Sometimes the cause of a weakened heart cannot be found.


• Diseases of the heart valves: These diseases may cause the valves to become too narrow or “leak.” A narrowed valve, also called stenosis, makes it hard for the heart muscle to pump blood forward. A leaky valve, which is also called regurgitation, allows the blood to flow backward. As a result, the heart must work harder since blood is going back and forth instead of going forward.


• Heart defects present since birth: These defects, also called congenital defects, may or may not cause problems during childhood. Over time, however, the heart becomes weakened because most defects cause the heart to work harder.


• High blood pressure (hypertension): If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform. Eventually, your heart muscle may become either too stiff or too weak to pump blood effectively.


• Myocarditis: This disease is inflammation of the heart muscle. It’s most commonly caused by a virus and can lead to left-sided heart failure.


• Abnormal heart rhythms (heart arrhythmias): Arrhythmias may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken, leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.

What types of tests are used to diagnose heart failure?

Some tests are done in the hospital, and others are done after you are discharged.

• Blood tests check kidney and thyroid function and other diseases that affect the heart.


• Cardiac imaging by CT scan, MRI, and chest X-ray can help your doctor see where your heart is damaged and better diagnose the cause of your heart failure.


• Coronary catheterization (angiogram) is when a catheter inserted into a blood vessel and guided into your coronary arteries makes the arteries visible on an X-ray and helps doctors identify narrowed arteries to your heart (coronary artery disease), which can be a cause of heart failure.


• Echocardiograms use sound waves to produce a video image of your heart. This image can help doctors determine how well your heart is pumping and look for valve problems or evidence of previous heart attacks. This test can also look for valve problems or evidence of previous heart attacks, as well as some unusual causes of heart failure.


• Electrocardiograms (EKG) records your heart's electrical activity as waves displayed on a monitor to diagnose heart rhythm problems and damage.


• Myocardial biopsy diagnoses certain types of heart muscle disease that can cause heart failure. Your doctor inserts a biopsy tool in a vein and small pieces of the heart muscle are taken for testing.


• Stress tests measure how your heart and blood vessels respond to exertion. Stress tests help your doctor see if you have coronary artery disease and determine how well your body is responding to your heart's decreased pumping effectiveness if you have heart failure.

What types of treatments and procedures are used to treat heart failure?

Heart failure can’t be cured, but treatments can reduce symptoms and extend a patient's quality of life. 

Treatments can include putting in cardiac devices and surgery.

• Devices:
  
  • Cardiac Resynchronization Therapy (CRT).
  • Implantable cardioverter defibrillator.
  • Left ventricular assist device.


• Surgery:
  
  • Coronary artery bypass.
  • Heart transplant.
  • Percutaneous coronary intervention (angioplasty). 
  • Valve replacement.

What can I do to support my health when I have heart failure?

There are many ways to prevent your heart failure from getting worse.

• Healthy eating: Eating healthy doesn’t mean only carrot sticks and chicken breasts. You can choose a variety of foods. And cut down on portion sizes to help you manage your weight. Three tips for healthy eating:

1. Reduce the salt. Eating too much salt makes blood pressure go higher. Sodium (salt) from food and drinks makes your body store water. This can lead to swelling and force your heart to work harder. Check the salt content in seasonings and herbs. Eat out less often and eat fewer packaged foods. Remove the salt shaker from the table. You'll get used to eating less salt.
2. Limit saturated fats and avoid transfats. Saturated fats raise your levels of bad cholesterol. They are found in foods such as fatty meats, whole milk, cheese, and palm and coconut oils. Avoid trans fats entirely.
3. Manage calories. Your body burns calories for fuel, but if you eat more calories than your body burns, the extra becomes fat. Your healthcare provider can help you create a diet plan.

• Maintain a healthy weight: Being overweight increases the work your heart has to do. It also raises your risk of other health problems. If you’re overweight, work with your healthcare provider to make weight-loss goals.


• Quit smoking: Smoking is the worst thing you can do for your arteries and heart. It reduces the blood’s oxygen supply, hurts artery walls, and raises heart rate and blood pressure. It also makes the blood more likely to clot. All of this increases the risk of a heart attack.


• Drink less alcohol: If you drink, limit yourself to one drink a day if you’re a woman and one to two drinks a day if you’re a man. One drink equals one 12-ounce beer or four ounces of wine. It's best not to drink at all.


• Eat less sugar (glucose): If you have diabetes, reduce your sugar, exercise regularly, and take the anti-diabetic medications your doctor prescribed.


• Move more: Physical activity can improve your quality of life and reduce heart failure problems. Studies have shown the benefits of physical activity, including a feeling of well-being, less stress, weight loss, and relaxation.

Why choose Presbyterian for heart failure treatment?

Our heart and vascular team has many different options to manage your heart failure. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans for your heart health needs. Depending on the type of heart failure you have and its underlying cause, the team can recommend a wide variety of treatment options. These may include lifestyle modifications, medications, and procedures. Our cardiologists and cardiovascular surgeons work closely together for cases in which surgery is the best treatment option. We also offer a customized cardiac rehabilitation program at our Healthplex, which can improve your endurance and exercise tolerance, as well as improve heart-related symptoms. Your cardiologist will work with the rehabilitation team to create a plan that will be tailored to your individual health needs.