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Heart failure occurs when your heart cannot pump enough blood to meet your body’s demand. This can be chronic, meaning it happens slowly over time; or it can be acute, meaning it happens suddenly. Approximately 15 million new cases of heart failure happen every year worldwide. In the U.S., heart failure is the number one cause of people over 65 being admitted to the hospital. (Klabunde, 2011)
Heart failure can be caused by many different problems. The failure could begin on the left or right side of your heart, or both sides may fail at the same time. The chambers where your blood is pumped are called ventricles. These may stiffen so that they no longer fill properly. If your heart muscle is too weak, the ventricles can stretch out and fail to work efficiently.
These are a few different types of heart failure:
Left-sided heart failure: This is the most common type of heart failure. You may become short of breath, due to backed-up fluid in your lungs. There are two types of left-sided heart failure:
Right-sided heart failure: This usually happens simultaneously with left-sided heart failure. When the left ventricle fails it results in increased pressure, and subsequent damage, to the right side of the heart. The right side of the heart cannot pump efficiently, causing fluid to accumulate in the veins, which may cause your legs and feet to swell.
Many conditions weaken or damage the heart over time. This can lead to chronic heart failure. Some result from internal factors, such as disease or a birth defect. Others come from external factors, such as a poor diet and lack of exercise. Conditions leading to chronic heart failure include high blood pressure, diabetes, faulty heart valves, coronary artery disease, inherited heart defects, and a damaged or inflamed heart. With all these conditions, the heart adapts over time until it just cannot adapt anymore. Then it fails.
Heart failure and cardiovascular disease in general can also be genetic. If either one of your parents has experienced heart failure, you are at an increased risk — particularly if they experienced symptoms before age 50, indicating their heart failure was due to genetics rather than only lifestyle choices (poor diet and inactivity leading to high blood pressure, clogged arteries, etc.).
Sometimes one of these chronic conditions leads to an acute event. Other times, the person seems healthy, but then there is a sudden heart event that results in failure. Causes of acute failure include:
While one risk factor could be enough to trigger heart failure, a combination of risk factors can increase the possibility of heart failure. Risk factors include:
Chronic and severe heart failure share many symptoms. But with acute heart failure, these symptoms may be much more pronounced. Your legs and abdomen may suddenly swell, and you could rapidly gain weight from retaining fluid. You might be nauseous or lose your appetite. Other symptoms of both acute and chronic heart failure include:
If you are having a heart attack, you may also have chest pain.
Elderly people may have several health conditions, often making it difficult to isolate symptoms of a heart problem from those caused by other conditions. If you have some of these symptoms and are unsure what is going on, seek emergency medical treatment. According to ScienceDaily, people hospitalized with acute heart failure had an average delay time of 13.3 hours between noticing symptoms and getting treatment. (ScienceDaily, 2009) The faster that symptoms are identified and medical help is sought, the better the outlook.
You doctor will start with a physical exam and medical history. He or she will listen to your heart and lungs with a stethoscope. This will detect congestion or abnormal heart rhythms. Your doctor might check for fluid build-up in your abdomen, legs, and the veins in your neck.
In addition, your doctor might order some combination of the following tests:
This imaging test allows your doctor to better examine your heart and lungs.
The lab might check your thyroid and kidney function through a blood test. Your blood may also be analyzed for levels of certain substances, such as electrolytes and proteins. Abnormal levels of these substances may indicate a strain on the kidneys or liver, which often results from heart failure.
This type of test measures your heart activity during physical exercise. Your doctor might want you to walk on a treadmill or ride a stationary bike to test how your heart responds to exertion. A stress test may also be done by taking a drug that speeds your heart up as if you are exercising. A nuclear stress test monitors the heart both during physical activity and while you’re at rest. This test also uses injectable dye to evaluate blood flow within the heart.
For an electrocardiogram, your doctor attaches electrodes to your skin and then records your heart’s electrical activity.
This test uses sound waves to form an image of your heart. Your doctor will be able to see how much blood your heart is pumping.
Your doctor inserts a catheter, or thin tube, into your groin or arm. This is guided through your blood vessels and eventually into your coronary arteries. After injecting dye through the catheter, your doctor can see an image of your arteries.
Both cardiac computed tomography (CT) scans and magnetic resonance imaging (MRI) help diagnose heart problems by showing your doctor images of your organs. Both involve lying inside machines while your picture is taken via X-ray.
If you are diagnosed with heart failure, your doctor may categorize the severity of your condition on one of several scales. According to the Mayo Clinic, the New York Heart Association scaleranges from one to four, with one being least severe and four being the worst. The American College of Cardiology scale uses the letters A to D.; a score of ‘A’ signifies that a person has certain heart failure risk factors, while ‘D’ indicates end-stage heart failure. (Mayo Clinic, 2011)
Medication, surgery, medical devices, and lifestyle changes are the main ways to treat heart failure.
In many cases, a combination of at least two medications is necessary to manage heart trouble. Some of these medications include:
You might also need medicines to lower your cholesterol or treat chest pain. Your doctor may prescribe a blood thinner to avoid blood clots.
People with acute heart failure are hospitalized. Often they need to be put on oxygen while in the hospital, and may also require supplemental oxygen in the long term.
Surgery is also widely used to treat heart failure. Some common types of heart surgery include:
Changing certain behaviors can also reduce risk factors for, or symptoms of, heart failure.
Though some risk factors for heart failure, such as genetics or chronic illness, cannot be avoided, the key to preventing heart failure is reducing the risk factors you can control. Certain lifestyle changes can help reduce or eliminate conditions that lead to heart failure, such as high blood pressure or high cholesterol. These include:
Your outlook depends on your overall health, the cause, and degree of your heart failure. Many people feel good for years while taking heart medications or living with implanted medical devices.
However, your outlook could be further complicated if your heart failure leads to kidney or liver damage, or problems with your heart valves. Blood clots are also common after heart failure.
Written by: Teresa Bergen
Medically reviewed by George Krucik, MD
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