Definition

Heart failure exacerbations are when heart failure symptoms get worse. This needs to be treated.

Causes

As heart failure worsens, symptoms get worse. Symptoms also get worse due to problems with treatment or another illness. Examples are:

• Uncontrolled high blood pressure
• A buildup of fluids and sodium
• Conditions that make the heart work harder, such as anemia
• Hormone problems
• Infection, such as pneumonia

Risk Factors

Things that raise the risk of heart failure exacerbations are:

• High blood pressure
• Being obese or overweight
• Kidney problems
• Taking certain medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs)
• Eating foods high in salt and fat

Symptoms

Symptoms may be a worsening of heart failure symptoms or new symptoms. They may be:

• Problems breathing
• Dry, hacking cough
• Problems sleeping
• Sudden weight gain
• Increased swelling of the feet, ankles, and legs
• Swollen belly

Diagnosis

The doctor will ask about symptoms and history of heart failure. A physical exam will be done. Blood and urine will be tested.

The doctor will do tests to view heart and see how it is working. This can be done with:

• Electrocardiogram (ECG)
• Echocardiogram
• Coronary angiography

Treatment

Treatment depends on what is making symptoms worse. Causes will need to be treated.

Treatment options may be:

Lifestyle changes, such as:

• Quitting smoking
• Not drinking alcohol
• Reaching and keeping a healthy weight
• A low fat, low sodium diet
• Regular physical activity

Medicines may need to be changed. New medicine may be given, such as:

• Diuretics—to remove fluid build-up in the body
• Nitrates—to ease blood flow
• Digoxin—to help the heart pump
• Beta blockers—to slow heart rate and lower blood pressure
• Calcium channel blockers—to lower blood pressure
• Angiotensin-converting enzyme (ACE) inhibitors—to widen blood vessels

Medicine may also be given to:

• Thin the blood
• Manage chest pain
• Lower cholesterol

The heart may need extra support to work well. Surgery options may be:

• An implanted device such as pacemaker or cardiac defibrillator—to help the heart beat at a healthy rhythm
• Coronary artery bypass (CABG) surgery—to relieve blockages in blood vessels to the heart

Prevention

Exacerbations cannot always be prevented.