Heart Failure

What Is Heart Failure?

Heart failure, also known as congestive heart failure (CHF), is a medical condition in which the heart cannot pump enough blood to meet the body's needs for oxygen and nutrition. Heart failure does not mean that the heart is no longer working. Rather, it means that the heart cannot keep up with its workload. Heart failure is a serious disease, and it can sometimes be life threatening. There are about 23 million heart failure patients worldwide, and 1 million new cases are diagnosed yearly. In the United States, heart failure is the most common reason for hospitalization in patients aged over 65 years. In addition to advanced pharmacological, surgical, and device therapies, lifestyle changes are critical to slowing down progression heart failure and improving symptoms. Adapting to healthy lifestyles enables many heart failure patients live a full and enjoyable life.

How Is Heart Failure Diagnosed?

The following medical tests and procedures help doctors to diagnose heart failure:

• History and physical examination: Your doctor will ask you about your medical history and symptoms (e.g. shortness of breath and fatigue). The doctor will take a careful physical examination. Vital signs (i.e. body temperature, pulse rate, respiration rate, and blood pressure) will be taken. The veins in the neck will be examined for venous pressure, and fluid buildup in the abdomen and legs will be checked. The doctor will listen to your heart and lungs using a stethoscope.
• Blood tests: Blood samples will be taken to determine the possible abnormalities of heart structure and function. These tests may include routine laboratory tests (such as complete blood count) and special tests [such as tests for brain natriuretic peptide (BNP) and C-reactive protein (CRP)]. The doctor may learn from the blood tests’ results about the severity and prognosis of heart failure.   
• Chest x-ray: The chest x-ray is a traditional method to determine the size and shape of the heart, as well as the structure of the lungs. Although newer technology (like echocardiography) gives more accurate estimation of the size and shape of the heart, excessive fluid built up around the lungs is still best determined with x-rays.
• Electrocardiogram (EKG or ECG): The electrocardiograph machine records the heart's rhythm, frequency of beats and electrical conduction. Electrocardiographic changes are common in heart failure.  A normal ECG almost excludes the diagnosis of heart failure. 
• Exercise Testing: Exercise testing measures the heart function.  During the test, you will first walk slowly on a treadmill. Then the speed is increased for a faster pace and the treadmill is tilted to produce the effect of going up a small hill. Your heart rate, heart beat rhythm, breathing, blood pressure and how tired you feel will be monitored during the test. Normal results from exercise testing almost exclude the diagnosis of heart failure. 
• Echocardiography (Echo): Echocardiography has emerged as the preferred diagnostic methods for assessing the structure and function of the heart. This technique is noninvasive, safe, reliable, and reproducible, and allows serial measurements.   

What Are the Symptoms of Heart Failure?

Structural and functional changes of the heart may precede the development of symptoms very quickly (by days or weeks) or very slowly (by months or years).  Common symptoms seen in heart failure patients are:

• Shortness of breath (dyspnea) when lying down
• Fatigue and reduced ability to exercise
• Swelling (edema) in the feet, ankles, and legs
• Swelling of your abdomen (ascites)
• Rapid or irregular heartbeat
• Persistent cough or wheezing with white or pink blood-tinged phlegm

What Are the Risk Factors for Heart Failure?

Scientists have identified several factors that can increase the probability of developing heart failure.  The major risk factors include:

• High blood pressure (hypertension)
• Coronary artery disease
• Past heart attack (myocardial infarction)
• Abnormal heart valves
• Heart muscle disease (dilated cardiomyopathy, hypertrophic cardiomyopathy) or inflammation (myocarditis)
• Heart defects present at birth (congenital heart disease)
• Severe lung disease
• Diabetes
• Chronic kidney disease
• Sleep Apnea

You cannot change your heredity, but you can take simple steps to improve your lifestyle and lower other your risks of developing heart failure. Lifestyle changes have enabled many heart failure patients live a full enjoyable life.

Prevention and Treatment of Heart Failure

Heart failure is an irreversible disease. However, treatments can slow down progression of heart failure and improve symptoms. Depending on the underlying causes of heart failure, doctors may recommend pharmacological, surgical, and/or device therapies. Heart transplantation is another option for heart failure treatment, but is limited by the availability of donor hearts.  In addition to medications, you can prevent/delay worsening of heart failure by improving lifestyle.  National Institutes of Health, the American Heart Association, and the American College of Cardiology recommend the following approaches:

• Monitor blood pressure. High blood pressure is a major risk factor for heart failure. Monitoring blood pressure at home can be helpful for controlling high blood pressure. Read High Blood Pressure to find out more about how lifestyle changes can lower your blood pressure.
• Eat a better diet: Consider the Dietary Approaches to Stop Hypertension (DASH) for an overall eating plan. The DASH diet plan emphasizes fruits, vegetables, and low fat dairy foods. It includes whole grains, poultry, fish, and nuts, but has reduced amounts of fats, red meats, sweets, and sugared beverages. Studies indicate that eating DASH diet can help decrease high blood pressure and reduce risk of developing heart failure.
• Reduce sodium intake: Another key to healthy eating is choosing foods lower in sodium. The current recommendation for healthy individuals is to consume less than 2.4 grams (2,400 milligrams) of sodium a day. Heart failure patients may need to restrict sodium intake to an even lower level, since too much sodium contributes to water retention, which makes the heart work harder and causes shortness of breath and swollen legs, ankles and feet.  Consult your doctor for the amount of daily sodium intake.
• Be physically active: Even moderate physical activity is beneficial for your overall health. For prevention of heart failure, exercise frequently and stay physically active. If you have heart failure, consult your doctor for the physical activities best fit your condition.  
• Maintain a healthy weight: Overweight puts your heart with extra workload. If you are overweight, your dietitian can help you work toward your ideal weight.Even a small weight loss can reduce blood pressure and/or prevent high blood pressure in many overweight people (those with a Body Mass Index of 25 or greater).
• Track daily fluid intake. Heart failure is often associated with excessive fluid retention. Diuretics (water pills) are prescribed to help many heart failure patients get rid of extra water and sodium, and reduce the workload for the heart. Consult your doctor for how much liquid to drink every day.
• Limit caffeine. Heart failure patients should consume no more than a cup or two of coffee a day.
• Stop smoking. Smoking can damage blood vessels, raise blood pressure, and make the heart beat faster. If you smoke, your doctor may recommend a quit smoking program for you.
• Limit alcohol: The American Heart Association recommends limiting alcohol consumption to no more than two drinks per day for men and no more than one drink per day for women.
• Select appropriate clothing. Avoid tight socks and stockings, which slow blood flow to the legs and may cause clot.

• There are about 23 million heart failure patients worldwide. About 6 million American adults have heart failure. It is estimated by American Heart Association that there will be 9 million people in the US will have heart failure in 2030, a 25% increase from 2010.
• High blood pressure is a major contributor for heart failure. About 75% of heart failure patients have high blood pressure before diagnosis of heart failure.  The lifetime risk for people with blood pressure greater than 160/90 mm Hg is double that of those with blood pressure less than 140/90 mm Hg.
• Advanced age is another major risk factor for heart failure (Table). 
• Healthy lifestyle factors, including normal body weight, not smoking, regular exercise, moderate alcohol intake, consumption of cereals/fruits/vegetables, are related to lower risk of heart failure.

Table. Annual Rate of Heart Failure in Different Age Groups in the US (per 1000 population)