Heart Failure

When the heart muscle does not pump blood, the heart failure occurs. As a result, the blood may back up and fluid can build up in the lungs frequently, leading to breathing problems. There are some health problems that cause gradual weakness and stiffness of the heart that make it not pump blood properly. For example, narrowed arteries in the heart and hypertension (high blood pressure).

People who receive treatment can get rid of symptoms. Furthermore, certain lifestyle changes can help to improve the quality of life. These include reducing stress, eating foods with reduced amounts of salt and cholesterol, regular exercise, and trying to get and maintain a healthy weight.

However, this is a life-threatening condition and some people may experience severe symptoms. In such cases, the only way to treat this health problem is a heart transplant or a device that helps to pump blood. Doctors sometimes call this heart condition congestive heart failure.

Symptoms

In people with heart failure, the heart muscle cannot pump enough blood needed for the entire body. In most cases, the symptoms appear slowly. However, sometimes, the symptoms appear suddenly without any warning signs. Check below some heart failure symptoms:

Breathing problems when you are lying down or during an activity
Weakness
Extreme tiredness (fatigue)
Swollen ankles, legs, and feet
Fast or irregular heartbeats
Decreased ability to perform physical exercises
Wheezing
Persistent cough that could bring up pink or white mucus with spots of blood
Unusual weight gain from fluid buildup
Nausea
Lack of appetite
Problems with concentrating or reduced alertness
Chest pain (commonly happens when heart failure is caused by a myocardial infarction)

Immediately seek medical care if you think you have heart failure or have any of the following symptoms. Examples include:

Sudden shortness of breath along with cough
Severe weakness
Chest pain
Fainting
Abnormal heartbeats along with chest pain, breathing problems, or fainting

Sometimes, previous symptoms may occur due to other health problems. However, you should go to the nearest emergency room if a recurrence of heart failure happens and the symptoms worsen suddenly, appear new symptoms, and you gain 5 pounds or 2.3 kilograms within several days. In case previous changes happen, it may mean the treatment does not work or that heart failure gets worse.

Causes

The main cause of heart failure is a stiff, damaged, or weakened heart muscle.

The heart is not able to pump enough blood when the heart is weakened or damaged and its chambers may stretch and become bigger.
Sometimes, the ventricles become stiff which also leads to less blood flow.

Damage to the heart can occur due to different causes. For instance, misuse of alcoholic drinks and recreational drugs, infections, and certain chemotherapy drugs. Moreover, some experts suggest that genes also play a role. Check below some health conditions that can damage or weaken the heart muscle and lead to heart failure:

Coronary Artery Disease and Myocardial Infarction

One of the most common causes of heart failure is coronary artery disease and it occurs when fat builds up in the arteries. As a result, arteries become narrow, which decreases blood flow and may lead to a myocardial infarction. In most cases, a heart attack occurs suddenly when an artery that supplies the heart with blood becomes thoroughly blocked. Damage to the heart caused by myocardial infarctions leads to reduced ability of the heart muscle to pump blood enough for body needs.

Hypertension

This is a condition that makes the heart muscle work harder than normally should to pump enough blood. Without treatment, high blood pressure may put extra strain on the heart, and the heart muscle can become weakened.

Heart Valve Disease

The valves of the heart help to keep blood flowing in the right way and if even one valve does not work properly, it may lead to extra strain on the heart muscle. Over time, it may weaken the heart muscle.

Myocarditis

A health condition in which the heart muscle becomes inflamed. It commonly happens due to a virus (including the COVID-19 virus).

Congenital Heart Defect

Sometimes, people are born with heart problems. For instance, if the heart chambers or valves do not work properly, other parts of the heart should work harder to pump enough blood for the body. As a result, heart failure may occur.

Arrhythmia

This is a heart condition in which irregular heartbeats occur. Therefore, an increased strain on the heart happens which also can lead to heart failure. However, if you treat abnormal heart rhythms it may help to reverse heart failure.

Other Health Conditions

There are some long-term (chronic) diseases that contribute to chronic heart failure. For example diabetes, HIV infection, hypo or hyperthyroidism, or a build-up of protein or iron.

Check also some causes of sudden heart failure below:

Severe infections
Certain medicines
Viruses that attack the heart muscle
Diseases that negatively affect the entire body
Allergic reactions
Blood clots (especially in the lungs)

In most cases, heart failure starts in the lower left heart chamber (known as the ventricle). This ventricle is the primary heart’s pumping chamber. However, this heart condition can impact the right side too. In rare cases, heart failure negatively affects both ventricles at the same time.

Heart Failure Types

Right and left-sided heart failure – These types of heart failure negatively affect the lower right and left chambers (right and left ventricles). As a result, it may lead to swelling in the legs, feet, and abdomen, shortness of breath, and other symptoms.
Heart failure with decreased ejection fraction (HFrEF) and preserved ejection (HFpEF) – These heart failure types are also known as systolic heart failure and diastolic heart failure. Both types lead to reduced ability of the heart muscle to pump enough blood required for the entire body.

Risk Factors

Check below some health problems that may elevate your risk of developing heart failure:

Coronary artery disease – A health condition in which the arteries that supply the heart with blood become narrowed.
Myocardial infarction – This is a type of coronary artery disease that happens suddenly. It causes damage to the heart muscle that leads to a decreased heart’s ability to pump enough blood.
Heart valve disease – This condition occurs when even one valve does not work properly.
Congenital heart disease – These are certain heart defects that happen during pregnancy and present at birth.
Diabetes – The risk of hypertension and coronary artery disease elevates if you have diabetes.
Sleep apnea – Poor breathing during nighttime may cause reduced oxygen in the blood, which may lead to abnormal heartbeats.
Obesity – Overweight people have a higher risk of developing heart failure.
Viral infections – There are some viruses that could cause damage to the heart muscle.

There are some medications that also could elevate the risk of heart failure. Examples include:

Diabetes medications – Medicines such as Rosiglitazone and Pioglitazone may elevate the risk of heart failure sometimes. You should not administer previous medications without a doctor’s recommendation. Otherwise, it may lead to some serious health problems.
Other medicines – These include nonsteroidal anti-inflammatory drugs (NSAIDs) and medications used to treat hypertension, cancer, blood diseases, arrhythmia, nervous system disorders, mental diseases, lung and urinary issues, and infections.

Other Risk Factors

Age – The risk of heart failure increases once a person becomes older.
Misuse of alcoholic beverages – Heavy alcohol drinking can weaken the heart muscle and cause heart failure.
Tobacco products – Smoking is a serious risk factor for heart disease and heart failure. If you cannot quit smoking, discuss it with your healthcare professional.

What Are The Possible Complications of Heart Failure?

Heart failure complications happen differently among people because depends on the severity of the condition, your age, and other factors. Check below some of them:

Kidney damage or failure – Reduced blood flow that often happens due to heart failure can lead to kidney failure that sometimes requires dialysis for treatment.
Liver damage – A fluid buildup also can occur due to this heart condition. As a result, increased pressure on the liver occurs, which can lead to scarring of the liver as well as reduced function.
Other heart diseases – The size and function of the heart are changed due to heart failure. Therefore, previous changes may lead to heart valve disease and arrhythmia.
Sudden cardiac death – An increased risk of death have people with weakened heart muscle.

Prevention

Controlling health conditions that cause heart failure can help to prevent it. For example hypertension (high blood pressure), obesity, diabetes, and coronary artery disease. Furthermore, certain lifestyle changes also can help to prevent and manage heart failure. Examples include:

Quit smoking or never start
Regular exercise
Adopt a diet with healthy foods including fresh fruits, vegetables, and whole grains
Reduce and manage stress
Administer medications prescribed by doctors regularly. Never change the dose or take another medicine without a doctor’s recommendation because it may lead to unpleasant outcomes.

Diagnosis

Physicians will ask you some questions about symptoms and medical history and will perform a physical examination before diagnosing heart failure. They should also check you for heart failure risk factors including hypertension, coronary artery disease, diabetes, or others. They also use a stethoscope to listen to your heart and lungs. However, to confirm the condition physicians may perform several tests. For example:

Tests

Blood tests – These tests help doctors determine the level of a certain protein that usually increases when a person has heart failure.
Chest X-ray – This test produces images of the lungs and heart.
Electrocardiogram (ECG or EKG) – ECG is a test that records the heart’s electrical activity and can show how your heart is beating.
Echocardiogram – This test uses sound waves to make images of the beating heart. It helps to determine the size and structure of the heart muscle and its valves.
Ejection fraction – This is a special test used to measure the percentage of the blood leaving your heart every time it squeezes. For instance, an ejection fraction of 50% or higher is considered ideal but you can still have heart failure despite this good result.
Stress or exercise tests – During these tests doctors check the heart while you are riding on a stationary bike or walking on a treadmill.
CT and MRI scans – These tests are used to get detailed images of the heart and blood vessels. They help to determine whether you have blockages in the arteries of the heart or not.
Coronary angiogram – This test involves a long and flexible tube (catheter) that is inserted into a blood vessel (in most cases in the groin of the wrist). Thereafter, it is guided to the heart. This test uses also a contract dye that helps to get clearer images.
Biopsy – During this test, physicians will get a small sample of the heart and send it to the laboratory for testing. Myocardial biopsy is often done to determine if a person has heart muscle disease that could cause heart failure.

Treatment

The treatment for heart failure can be different among people because it depends on the cause and severity of the heart failure and other existing health conditions. The primary treatment options for people with heart failure include medications and lifestyle changes. Sometimes, people require surgery that helps to open blocked arteries or to place a device to improve the work of the heart.

Medicines

In most cases, physicians prescribe a combination of medicines to treat heart failure. Check below some examples:

Angiotensin-converting enzyme (ACE) inhibitors – This group of medicines is used to relax blood vessels, reduce blood pressure, and improve blood flow. Doctors usually prescribe Enalapril, Lisinopril, and Captopril.
Angiotensin II receptor blockers (ARBs) – These medications provide similar benefits as ACE inhibitors. However, sometimes, people cannot use ACE inhibitors and doctors recommend this category of medicines. For example Losartan, Valsartan, Candesartan.
Angiotensin receptor plus neprilysin inhibitors (ARNIs) – This medicine group includes two active ingredients (such as Sacubitril-Valsartan) to treat heart failure.
Beta-Blockers – These medications are prescribed by doctors to reduce high blood pressure and lessen heart failure symptoms. For example Carvedilol, Metoprolol, and Bisoprolol.
Diuretics – This group of medicines is also called water pills because they make you urinate more frequently. Water pills are effective in removing extra fluids from the body. Physicians usually prescribe Furosemide.
Potassium-sparing diuretics – These medicines are also called Aldosterone antagonists and include Spironolactone and Eplerenone. Sometimes, these medicines can increase potassium levels in the blood to dangerous levels. Discuss with your doctor before using them.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors – These medications are usually prescribed by doctors to reduce blood sugar along with exercise and diet for people with type 2 diabetes. These include Canagliflozin, Dapagliflozin, and Empagliflozin.
Digoxin – It is used to help the heart squeeze better to pump blood.
Hydralazine and Isosorbide dinitrate (BiDil) – This combination of medicines helps to relax blood vessels and reduce heart failure symptoms.
Vericiguat – This medicine is intended for people with chronic heart failure. It is taken once daily by mouth with a glass of water.
Positive inotropes – This group of drugs is given intravenously (IV) to patients with severe forms of heart failure who usually stay in the hospital.

Other Medications

Sometimes, your doctor may recommend other medications to prevent or treat other symptoms. These include nitrates (for angina), statins (for high cholesterol), and blood thinners (for blood clots).

Surgery and Other Procedures

Coronary bypass surgery – This treatment option involves surgery to open blocked arteries that cause heart failure.
Heart valve repair or replacement – Some people experience heart failure due to a damaged heart valve. In such cases, doctors recommend this procedure to repair the heart valve.
Implantable cardioverter-defibrillator (ICD) – This is a special device that helps to prevent heart failure complications. It also monitors heartbeats and can help to correct them if irregular ones begin.
Cardiac resynchronization therapy (CRT) – CRT is also known as biventricular pacing which is a treatment for people with heart failure. This device sends small electrical signals to the heart that help to improve the heart’s ability to pump blood out. It is usually recommended by doctors if heart failure is caused by lower heart chambers.
Ventricular assist device (VAD) – This is another device used in patients with heart failure and it is recommended by doctors as a permanent damage or if you are waiting for a heart transplant.
Heart transplant – Some people require this treatment option because medicines and surgery do not help them. However, this procedure is not for everyone and you should consult with healthcare providers from a transplant center.

Frequently Asked Questions

Can heart failure be cured?

Generally, it is not possible to cure this health problem but sometimes people can reverse heart failure with early diagnosis and proper treatment.

How to understand the heart failure gets worse?

If you experience the following symptoms, it may be a sign that your condition is getting worse. Examples include:

Fast heart rate
Persistent cough and wheezing
Decreased exercise tolerance
Abnormal weight gain
Chest discomfort or pain
Extreme tiredness
Swelling that occurs in the ankles, legs, abdomen, or other body parts
Severe shortness of breath

Immediately, seek emergency care if any of the previous symptoms happen.

What are the potential complications of heart failure?

Arrhythmias (irregular heart rhythm)
Impaired kidney or liver function
Loss of muscle tissue
Trouble breathing
Pulmonary edema
Blood clots (this complication can lead to stroke or pulmonary embolism)

Ask your doctor if you have additional questions.