Heart Failure

Heart failure is a long-term condition in which your heart can’t pump blood well enough to meet your body’s needs all the time. Treatment includes exercise and medicine at first and possible surgical procedures when heart failure gets worse.

Causes

  • Coronary artery disease.

  • Heart attack.

  • Cardiomyopathy.

  • Heart issues present at birth (congenital heart disease).

  • Diabetes.

  • High blood pressure (hypertension) - This is a common cause in people assigned female at birth.

  • Arrhythmia (abnormal heart rhythms, including atrial fibrillation).

  • Kidney disease.

  • Having obesity.

  • Tobacco and recreational drug use.

  • Medications - Some drugs used to fight cancer (chemotherapy) can lead to heart failure.

Types

Left-sided heart failure

Heart failure with reduced left ventricular function (HF-rEF) The lower left chamber of your heart (left ventricle) gets bigger and cannot squeeze (contract) hard enough to pump the right amount of oxygen-rich blood to the rest of your body.

Heart failure with preserved left ventricular function (HF-pEF)

Your heart contracts and pumps normally, but the bottom chambers of your heart (ventricles) are thicker and stiffer than normal. Because of this, your ventricles can’t relax properly and fill up all the way. Because there’s less blood in your ventricles, your heart pumps out less blood to the rest of your body when it contracts.

Right-sided heart failure

Heart failure can also affect the right side of your heart. Left-sided heart failure is the most common cause of this. Other causes include certain lung problems and issues in other organs.

Symptoms

  • Shortness of breath.

  • Feeling tired (fatigue) and having leg weakness when you’re active.

  • Swelling in your ankles, legs and abdomen.

  • Weight gain.

  • Need to urinate while resting at night.

  • Rapid or irregular heartbeats (palpitations).

  • A dry, hacking cough.

  • A full (bloated) or hard stomach, loss of appetite or upset stomach (nausea).

Diagnosis

  • Blood tests.

  • NT-pro B-type Natriuretic Peptide (BNP) blood test.

  • Cardiac Catheterization.

  • Chest X-ray.

  • Echocardiogram (echo).

  • Magnetic resonance imaging (MRI).

  • Electrocardiogram (EKG or ECG).

  • Multigated Acquisition Scan (MUGA scan).

  • Stress test.

Treatment

Stage A treatment

The usual treatment plan for people with Stage A heart failure includes:

  • Regular exercise, being active, walking every day.

  • Stopping the use of tobacco products.

  • Treatment for high blood pressure (medication, low-sodium diet, active lifestyle).

  • Treatment for high cholesterol.

  • Not drinking alcohol or using recreational drugs.

  • Angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions.

  • Beta-blocker if you have high blood pressure.

Stage B treatment

The usual treatment plan for people with Stage B heart failure includes:

  • Treatments listed in Stage A.

  • Angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) (if you aren’t already taking one).

  • Beta-blocker if you’ve had a heart attack and your EF is 40% or lower (if you aren’t already taking one).

  • Aldosterone antagonist if you’ve had a heart attack or if you have diabetes and an EF of 35% or less.

  • Possible surgery or intervention as a treatment for coronary artery blockage, heart attack, valve disease (valve repair or replacement) or congenital heart disease.

Stage C treatment

The usual treatment plan for people with Stage C HF-rEF includes:

  • Treatments listed in Stages A and B.

  • Beta-blocker.

  • Aldosterone antagonist if a vasodilator medicine (ACE-I, ARB or angiotensin receptor/neprilysin inhibitor combination) and beta-blocker don’t relieve your symptoms.

  • Hydralazine/nitrate combination if other treatments don’t stop your symptoms. Patients who are Black should take this medication (even if they’re taking other vasodilator medications) if they have moderate­ to severe symptoms.

  • Medications that slow your heart rate if your heart rate is faster than 70 beats per minute and you still have symptoms.

  • A diuretic (“water pill”) may be prescribed if symptoms continue.

  • Restriction of sodium (salt) in your diet.

  • Tracking your weight every day. Tell your healthcare provider if you gain or lose more than four pounds.

  • Possible fluid restriction.

  • Possible cardiac resynchronization therapy (biventricular pacemaker).

  • Possible implantable cardiac defibrillator (lCD) therapy.

  • If the treatment causes your symptoms to get better or stop, you still need to continue treatment to slow the progression to Stage D.

Stage D treatment

The usual treatment plan for people who have Stage D heart failure includes treatments listed in Stages A, B and C. In addition, it includes evaluation for more advanced treatment options, including:

  • Heart transplant.

  • Ventricular assist devices.

  • Heart surgery.

  • Continuous infusion of intravenous inotropic drugs.

  • Palliative or hospice care.

  • Research therapies.

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