Heart failure, also known as congestive heart failure (CHF), is a very common heart condition. As doctors, we understand exactly what we mean when this diagnosis is given, but for the patient it is often a different story. The words “heart failure” lead people to assume that their heart has “given up” and is actually failing or has already failed. This can lead to unnecessary panic about what lies for them in the future.
The goal of this article is to clear up the confusion about heart failure. I will provide a brief overview of heart failure including the different types, causes, symptoms, and treatments available.
What is heart failure?
Heart failure means that there is a weakening of the heart (due to age, damage, or abuse) and a decrease in its ability to pump as much blood as the body requires. Heart failure does not mean that the heart is failing to pump blood around the body; it means it simply cannot keep up with the demands put upon it. For example, if you are a normal sized male or female your body requires 4-8 liters (1-2 gallons) of blood to be circulated per minute. If your heart can only pump 2 liters (or ½ gallon) per minute, this can be classified as heart failure. So it’s not that the heart is not working, it’s that the heart is not working very well.
What are the types of heart failure?
There are two main types of heart failure – systolic and diastolic. Both are related to specific impairments of the heart’s left lower chamber (the left ventricle). To understand the difference between systolic and diastolic heart failure, it is helpful to be familiar with the term “ejection fraction (EF).” Ejection fraction is the fraction of blood pumped out of the heart and into the body with each heartbeat. A normal ejection fraction, or “pumping function” of the heart, is 55% and above.
- If the heart cannot pump as much blood as usual, it is called systolic heart failure (or heart failure with reduced ejection fraction).
- If the heart can pump well, but cannot relax as usual after pumping, it is called diastolic heart failure (or heart failure with preserved ejection fraction).
These are subtle but important differences. Don’t hesitate to ask your doctor what type of heart failure you have, as the treatment can vary tremendously!
What causes heart failure?
Anything that weakens the heart can reduce its ability to pump blood and then lead to heart failure. There are numerous different causes, but the most common include:
- heart disease (coronary artery disease)
- heart attack (myocardial infarction)
- abnormal heart valves
- high blood pressure (hypertension)
- obesity and diabetes
- smoking, excessive alcohol use, or illicit drug use
- some viral illnesses
- some genetic or inherited syndromes
What are the symptoms of heart failure?
Heart failure can develop suddenly or over several years before causing any symptoms. It really depends on the underlying cause. Most of the time, people are diagnosed once they begin to show the signs and symptoms of heart failure.
The most common symptoms include:
- shortness of breath or feeling short-winded (dyspnea)
- buildup of fluid, usually in the lungs, legs, or ankles (edema)
- feeling out of breath when lying down (orthopnea)
- waking in the night gasping for breath (paroxysmal nocturnal dyspnea)
- tiredness and fatigue, as the heart cannot keep up with physical activity
- lightheadedness and dizziness, brought on by low blood pressure
The symptoms can be of varying severity and can fluctuate throughout the day, especially buildup of fluid in the legs or ankles (edema). A very important symptom is feeling breathless specifically when lying flat (orthopnea). If the feeling of breathlessness is relieved by sitting up, the cause is most likely pooling of fluid in the lungs (a common sign of heart failure). Often you will find that as heart failure progresses, you unwittingly use more and more pillows at night in an effort to prevent feeling out of breath when lying flat.
What is the treatment for heart failure?
The ultimate goal of treating heart failure is to improve the ability of the heart to pump blood. In addition to improving the pumping function of the heart, it is also important to treat the symptoms. Depending on your type of heart failure, there are several prescription medications available to help achieve this goal. It is very important to strictly adhere to your medication schedule as prescribed by your doctor.
As well as taking the prescribed medications there are several other things that you can do to help, including:
- eating less salt and reducing fluid intake
- improving your diet and losing excess weight
- engaging in regular exercise
- eliminating alcohol and not smoking
Heart failure may progress over time, but with the right treatment plan this process can be slowed (or even reversed in some cases) leading to an improved length and quality of life.