Cardiac Failure
Heart failure, Congestive heart failure, CHF
When your heart can’t pump blood well enough to meet your body’s needs, a serious condition called heart failure develops. More than 6 million adults in the United States live with this condition, which requires lifelong management but can be controlled with proper treatment and lifestyle changes.
Table of contents
- What is cardiac failure?
- Types of heart failure
- Symptoms
- Causes and risk factors
- Diagnosis
- Treatment
- Living with heart failure
- Outlook
What is cardiac failure?
Heart failure occurs when the heart muscle doesn’t pump blood as well as it should[1]. This doesn’t mean your heart has stopped or is about to stop beating[3]. Rather, your heart is still working, but because it can’t handle the amount of blood it should, blood builds up in other parts of your body[6].
When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath[1]. Blood and fluids also collect in your legs and feet over time[6]. Without enough blood flow, your organs may not work well, which can cause serious problems[7].
Heart failure is sometimes called congestive heart failure, although this name is not widely used now[4]. It’s a long-term condition that tends to get gradually worse over time[4].
Types of heart failure
Heart failure can affect different sides of your heart[7]. With right-sided heart failure, your heart is too weak to pump enough blood to your lungs to get oxygen[7]. With left-sided heart failure, your heart can’t pump enough oxygen-rich blood out to your body[7]. This happens when the left side of your heart becomes either too weak to pump enough blood, or too thick or stiff to relax and fill with enough blood[7].
Left-sided heart failure is more common than right-sided heart failure[7]. Over time, left-sided heart failure can lead to right-sided heart failure[7].
Heart failure can develop suddenly, which is called acute heart failure, or it can develop over time as your heart gets weaker, which is called chronic heart failure[3].
Symptoms
The main symptoms of heart failure include breathlessness after activity or at rest, feeling tired most of the time and finding exercise exhausting, feeling lightheaded or fainting, and swollen ankles and legs[4].
Heart failure symptoms may include[1]:
- Shortness of breath with activity or when lying down
- Fatigue and weakness
- Swelling in the legs, ankles and feet
- Rapid or irregular heartbeat
- Reduced ability to exercise
- Wheezing
- A dry, hacking cough
- Weight gain
- Need to urinate while resting at night
- A full or hard stomach
- Loss of appetite or upset stomach
Symptoms may develop slowly. Sometimes, heart failure symptoms start suddenly[1]. You may have mild symptoms of heart failure or none at all. This doesn’t mean you don’t have heart failure anymore. Symptoms of heart failure can range from mild to severe and may come and go[6].
Most symptoms are caused by reduced blood flow to your organs and fluid buildup in your body[7]. Fluid buildup happens because the flow of blood through your heart is too slow. As a result, blood backs up in the vessels that return the blood to your heart. Fluid may leak from the blood vessels and collect in the tissues of your body, causing swelling[7].
If you experience persistent or gradually worsening symptoms of heart failure, you should see a doctor[4]. Call emergency services as soon as possible if you have sudden or very severe symptoms[4].
Causes and risk factors
Heart failure can start suddenly after a medical condition or injury damages your heart muscle. But in most cases, heart failure develops slowly from long-term medical conditions[7]. It’s often the result of a number of problems affecting the heart at the same time[4].
The most common cause of heart failure is ischemic heart disease, which includes coronary heart disease and heart attacks[4][8]. Some heart conditions slowly leave the heart too weak or stiff to fill and pump blood properly[1].
Conditions that can lead to heart failure include[4][6]:
- Coronary artery disease, where the arteries that supply blood to the heart become clogged up with fatty substances
- High blood pressure, which can put extra strain on the heart
- Conditions affecting the heart muscle (cardiomyopathy)
- Heart rhythm problems (arrhythmia), such as atrial fibrillation
- Damage or other problems with the heart valves
- Birth defects that affect the normal workings of the heart (congenital heart disease)
- Diabetes
- Kidney disease
Sometimes obesity, drinking too much alcohol, an overactive thyroid, or high pressure in the lungs can also lead to heart failure[4].
Your chance of developing heart failure increases if you’re 65 years old or older, as aging can weaken and stiffen your heart muscle[7]. More than 6 million people in the United States have congestive heart failure, and it’s the leading cause of hospitalization in people older than 65[6].
Other risk factors include[5][6]:
- Using tobacco products, cocaine or alcohol
- Having an inactive lifestyle
- Eating foods that have a lot of salt and fat
- Having high blood pressure or coronary artery disease
- Having had a heart attack
- Having a family history of heart failure
Diagnosis
To diagnose heart failure, your healthcare professional examines you and asks questions about your symptoms and medical history[10]. Your care professional checks to see if you have risk factors for heart failure, such as high blood pressure, coronary artery disease or diabetes[10].
Your doctor will listen to your lungs and heart with a device called a stethoscope[10]. They may look at the veins in your neck and check for swelling in your legs and belly[10].
Tests that may be done to diagnose heart failure include[10]:
- Blood tests. Blood tests can help diagnose diseases that can affect the heart. Blood tests also can look for a specific protein made by the heart and blood vessels. In heart failure, the level of this protein goes up.
- Chest X-ray. X-ray images can show the condition of the lungs and heart.
- Electrocardiogram (ECG or EKG). This quick and painless test records the electrical signals in the heart. It can show how fast or how slowly the heart is beating.
- Echocardiogram. Sound waves create images of the beating heart. This test shows the size and structure of the heart and heart valves and blood flow through the heart.
- Ejection fraction. This measurement is taken during an echocardiogram. It shows the percentage of blood leaving your heart each time it squeezes. The result helps classify heart failure and guides treatment.
- Exercise tests or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored.
A number of tests can be used to help check how well your heart is working[4].
Treatment
Heart failure has no cure. But treatment can help you live a longer, more active life with fewer symptoms[11]. Treatment usually aims to control the symptoms for as long as possible and slow down the progression of the condition[4]. Treatment depends on the type of heart failure you have and how serious it is[11].
For most people, heart failure is a long-term condition that can’t be cured, but the symptoms can often be controlled for many years[4]. Treatment usually needs to continue for the rest of your life[13].
In many cases, a combination of treatments is required[13]. Treatment generally includes healthy lifestyle changes, medications, and sometimes devices implanted in your chest or surgery[4].
Healthy lifestyle changes
Your healthcare provider may recommend these heart-healthy lifestyle changes[11]:
- Lower your sodium (salt) intake. Salt may make fluid buildup worse. Try limiting the salt you eat at home, and watch for hidden sodium when you eat out or shop for food.
- Aim for a healthy weight since extra weight can make your heart work harder. Lose weight if you need to.
- Get regular physical activity. Ask your healthcare provider about how active you should be. You may be offered an exercise-based cardiac rehabilitation program.
- Quit smoking. If you smoke, stopping can improve your overall health.
- Avoid or limit alcohol. Your provider may recommend that you limit or stop drinking alcohol.
- Manage other health problems such as diabetes and high blood pressure.
Having a healthy lifestyle, including eating a balanced diet, doing exercise and not smoking, can help with your symptoms and reduce your risk of becoming seriously ill[13].
Medications
Most people with heart failure are treated with medication. Often you’ll need to take 2 or 3 different medicines[13]. Some of the main medicines for heart failure include[13]:
- ACE inhibitors, which work by relaxing and opening up your blood vessels, making it easier for your heart to pump blood around the body
- Angiotensin-2 receptor blockers (ARBs), which work in a similar way to ACE inhibitors
- Beta blockers, which work by slowing your heart down and protecting your heart from the effects of stress chemicals produced by the body
- Mineralocorticoid receptor antagonists (MRAs), which make you pass more urine and help lower blood pressure and reduce fluid around the heart
- Diuretics (water pills), which make you pass more urine and help relieve ankle swelling and breathlessness
- SGLT2 inhibitors
You may need to try a few different medicines before you find a combination that controls your symptoms but doesn’t cause unpleasant side effects[13].
Devices and surgery
Some people with heart failure may need devices implanted in their chest to help control their heart rhythm or help the heart pump blood[4]. In some cases, surgery such as a bypass operation or a heart transplant may be needed[4].
A cure may be possible when heart failure has a treatable cause. For example, if your heart valves are damaged, replacing or repairing them may cure the condition[4].
Living with heart failure
If you have heart failure, it’s important to look after your own health and wellbeing, with support from those involved in your care[18]. By making lifestyle changes, you can take an active role in treating your heart failure while maintaining a productive life[20].
You’ll have regular contact with your doctor or care team to monitor your condition at least every 6 months[13]. These appointments may involve talking about your symptoms, a discussion about your medication, and tests to monitor your health[13].
You may be asked to help monitor your condition between appointments[13]. For example, your care team may suggest weighing yourself regularly so any changes in your weight, which could be a sign of a problem, are picked up quickly[13]. Weight gain may be a sign that your body is holding on to too much fluid[25].
Contact your doctor or care team if your symptoms are getting worse or you develop new symptoms[13]. Try to become familiar with signs that mean your heart failure is getting worse[25]. Call your doctor if you have sudden weight gain, new or worse swelling in your feet, ankles, or legs, or if your breathing gets worse[25].
Having heart failure shouldn’t prevent you travelling or going on holiday, as long as you feel well enough and your condition is well controlled[18]. However, you should check with your doctor before you travel[18].
You can usually continue to drink alcohol if you have heart failure, but it’s advisable not to exceed recommended limits[18]. If your heart failure is directly related to drinking alcohol, you may be advised to stop entirely[18].
If you have been in the hospital for your heart failure, your doctor will tell you how soon you can return to work after you go home[20]. You should try to work as long as you are able[20].
Outlook
Heart failure is a serious long-term condition that will usually continue to get slowly worse over time[4]. It can severely limit the activities you’re able to do and is often eventually fatal[4].
However, it’s very difficult to tell how the condition will progress on an individual basis. It’s very unpredictable. Lots of people remain stable for many years, while in some cases it may get worse quickly[4].
Heart failure can damage your liver or kidneys. Other conditions it can lead to include pulmonary hypertension, irregular heartbeat, sudden cardiac arrest, heart valve problems, and a collection of fluid in your lungs[3][6].
Proper treatment may improve the symptoms of heart failure and may help some people live longer. Lifestyle changes can improve quality of life[1]. Treatment can help many people live a longer, more active life with fewer symptoms[11].
