Heart Failure

(Congestive Heart Failure; Chronic Heart Failure; Left Ventricular Dysfunction; Left Ventricular Failure)

Definition

In heart failure, the heart is unable to pump the right amount of blood throughout the body. This causes blood to back up in the veins. Depending on which part of the heart is affected, this can lead to a buildup of excess fluid in the lungs, feet, and elsewhere. Heart failure can worsen with time, which may lead to the use of many treatments. Because of this, doctors are aggressive in treating heart failure to try to prevent it from worsening.

Blood Flow through the Heart

Causes

The leading causes of heart failure are:

Other common causes include:

Problems with the heart's valves due to:
- Rheumatic heart disease
- Bacterial endocarditis
- Congenital defects
- Calcium deposits from atherosclerosis
High blood pressure
Diabetes

Other less common causes include:

Cardiomyopathy—weakened, damaged heart muscle from various causes
Certain medicines
Abnormal heartbeats—arrhythmias
Hyperthyroidism—overactive thyroid
Amyloidosis
Kidney failure and/or liver failure
Thiamine (vitamin B1) deficiency

Symptoms

Symptoms include:

Shortness of breath—at first only with activity, then progressing to shortness of breath at rest
Unexplained weight gain
Swelling of feet, ankles, or legs
Need to sleep propped up
Fatigue, weakness
Wheezing
Cough—may be dry and hacking or wet sounding, may have a pink, frothy sputum
Frequent urination, especially at night
Abdominal pain

Risk Factors

Factors that increase your chances of getting heart failure include:

Increased age
Obesity
Excess intake of salt and fat
Excess alcohol intake
Sex: male
Race: Black
Smoking
Pregnancy
High fever
Severe infection
Chronic lung disease—emphysema
Chemotherapy

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

Blood tests
Urine tests

Your heart may be examined. This can be done with:

Treatment

Treatment of Condition Causing the Symptoms

Heart failure may be caused by another condition. Treating this condition should improve your heart failure or prevent it from getting worse.

Lifestyle Changes

The following lifestyle changes can help treat the symptoms of heart failure and slow down its progression:

Avoid alcohol.
If you smoke, quit.
Lose weight if needed
Eat a healthy diet. Your diet should be low in fat and high in fiber.
In some cases, you may need to restrict salt and fluid intake.
Begin an exercise program with guidance from your doctor. Aerobic training may help improve your level of physical activity and quality of life. You should aim to exercise for 20-30 minutes at least five times each week. You can begin slowly and work your way to this goal. Talk to your doctor before you start an exercise program.
Weigh yourself every morning. This will allow you to quickly detect if you are retaining fluid. Call your doctor if you gain three or more pounds in one day, five or more pounds in one week, or whatever amount you were told to report. The best time to weigh yourself is before breakfast and after urinating. You should weigh yourself while wearing the same type of clothes, without shoes, and on the same scale. This will help you to know that your weight is accurate.

Medicines

Your doctor will most likely prescribe a combination of medicines, such as:

Angiotensin-converting enzyme (ACE) inhibitors or their alternatives to widen blood vessels
Digoxin, also called digitalis, to help your heart pump
Beta-blockers to slow your heart rate and lower blood pressure
Diuretics to remove excess fluid in your body
Nitrates to dilate the blood vessels

You may also be given medications to:

Thin the blood, such as aspirin, warfarin
Help manage chest pain, such as nitroglycerin
Help manage cholesterol levels
Help control high blood pressure

If heart failure worsens, you may need medical devices to help your heart pump blood properly. If you have heart failure, follow your doctor's instructions.

Prevention

The best way to prevent heart failure is to reduce your risk of:

Coronary artery disease
High blood pressure
Diabetes

Take these steps to reduce your risk:

Begin a safe exercise program with the advice of your doctor.
If you smoke, quit.
Limit alcohol.
Lose weight if needed. After you have lost weight, maintain a healthy weight.
Eat a healthy diet. The DASH diet, in particular, may reduce the risk of high blood pressure and heart failure, particularly in women. The DASH diet is:
- Rich in fruits, vegetables, and low-fat dairy foods
- Low in saturated fat, total fat, and cholesterol
Eat whole grain breakfast cereal. In addition to the other healthy habits, this may reduce your risk.

RESOURCES:

American College of Cardiology
http://www.cardiosource.org

American Heart Association
http://www.heart.org

American Academy of Family Physicians
http://familydoctor.org

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com

REFERENCES:

ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation . 2009;119(14):1977-20016.

Congestive heart failure. American Heart Association website. Available at: http://www.heart.o.... Updated January 24, 2011. Accessed March 21, 2013.

Dambro MR. Griffith's 5-Minute Clinical Consult. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.

Heart failure. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated March 18, 2013. Accessed March 21, 2013.

Heart failure exercise/activity guidelines—exercise. Cleveland Clinic website. Available at: http://my.clevelan.... Updated January 27, 2012. Accessed March 21, 2013.

Hunt, SA, Abraham, WT, Chin, MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2005;112:e154.

Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult. American College of Cardiology Foundation (ACCF). 2005;46(6):e1-82.

Lifestyle changes for heart failure. American Heart Association website. Available at: http://www.heart.o... . Updated August 20, 2012. Accessed March 21, 2013.

Paterna S, Parrinello G, Cannizzaro S, et al. Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart failure. Am J Cardiol. 2009;103:93-102. Epub 2008 Oct 17.

Physical changes to report. American Heart Association website. Available at: http://www.heart.o.... Updated August 20, 2012. Accessed March 21, 2013.

What is heart failure? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Hf/HF_WhatIs.html. Accessed March 21, 2013.

4/16/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Nilsson BB, Westheim A, Risberg MA. Effects of group-based high-intensity aerobic interval training in patients with chronic heart failure. Am J Cardiol. 2008 Nov 15;102:1361-1365. Epub 2008 Sep 11.

7/6/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Levitan EB, Wolk A, Mittleman MA. Consistency with the DASH diet and incidence of heart failure. Arch Intern Med. 2009;169:851-857.

8/31/2009 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302:394-400.

3/5/2013 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Dinicolantonio JJ, Pasquale PD, Taylor RS, et al. Low sodium versus normal sodium diets in systolic heart failure: systematic review and meta-analysis. Heart. 2013 Jan 24. [Epub ahead of print.]

Last reviewed September 2012 by Michael J. Fucci, DO
Last Updated: 3/21/2013

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