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.
My son had a virus, it caused the Aortic valve to totally blow, which allowed one chamber of his heart to die. He had a Pace Maker and Defibulater emplanted. He is doing very well, exercising, keeping his weight and salt intake down. I’m not sure what his EJ factor is but at one time it was 35%. I wonder if he will need a Transplant or the pump would be needed at some time. We just lost a good friend with “A Widow Maker” These articles have helped me under stand these types of heart conditions.
Thank you for sharing your story and we are glad that you find our site useful. We wish your son the best and are glad he is doing well.
We are sorry to hear about your son’s heart condition. We appreciate your kind words and hope that the information provided on the site will help you better understand his condition.
thank you all for putting it in plain words and showing video of my condition I have 70 to 80 perc blockage of the left aorta in between 2 stents that are all ready in this part of the heart. I also have 50perc in other area of the left arteries of the heart I now know what LAD means and CAD thanks to this web site .It helps me to understand when they speak about these areas of the left hand side of the heart.
We appreciate your kind words and support. We hope that the site provides simple and clear explanations to common, but sometimes complex, heart conditions.
excellent reviews you make iy so easy to understand . i use to hear from my professor when he gives a lecture the acronym KISS keep it simple stupid .thats how you run your articles
What are the concerns with an E/F that’s too high (78%)? I have congenital valve disease and will require surgery in not so distant future. Echo in August estimated 55%, echo in November estimated 68%, then 3d TEE in March showed 78%. I was pleased when my cardiologist told me that, I have lost a significant amount of weight in an effort to ward off surgery as long as I can. But, he said no, it’s not good, thats too high for E/F, it’s a concern. He explained that he and the surgeons had reviewed the images and feel it may be associated with a small heart with small chambers requiring more force to pump blood causing a false high. They will be keeping an eye on it. It doesn’t make sense to me.
It depends on whether the thickness itself can predispose to obstruction. The other major problem is with the relaxation of the heart muscle. Do you have specific details of their concern?
I don’t know what the specific concerns are. I was expecting to hear that I required surgery for one valve and found out that 3 valves require surgical correction. I was in information over load mode. I asked no questions. I think I have a clear understanding of the rest, as much as I can. I can’t find much about a high E/F, I am not sure I clearly understand your comments.
High-output heart failure (HF) is an unusual cause of HF that has not been well-characterized. Some of the causes of high-output HF include, systemic arteriovenous shunts (congenital or acquired), hyperthyroidism, chronic anemia, thiamine deficiency (beriberi), advanced lung disease (COPD, etc.), renal disease, liver disease (cirrhosis), myeloproliferative disorders, hyperkinetic heart syndrome, and pregnancy. In the modern era, morbid obesity, cirrhosis, and arteriovenous shunts may be the most common causes of this form of HF. Without more specific information, especially with regards to your congenital valve disease, it is difficult to say what may be the issue in your case.
Wow, that was incredibly helpful. By process of elimination and looking those conditions I wasn’t familiar with I think I have narrowed it down. I had my thyroid removed because of cancer, but I have blood tests every 6 months and my medication never requires adjustment, so I don’t think that’s it. At 46 I better not be pregnant, I don’t drink alcohol, I am overweight, but bmi is not in the obese range. I do have vasculitis for 3 years now associated with an unknown autoimmune disease. I am thinking the arteriovenous stunts makes the most sense. Not sure. The vasculitis has only ever been treated with an aspirin a day. Makes me think I should talk to my rheumatologist about treatment. I am not even sure if there’s treatment for vasculitis. Makes me wonder if it may be associated with the degeneration of my heart valves, although I have had heart surgery before but only for 1 valve.
Is anesthesia for a gynecological surgery contraindicated in stage c heart failure from valve disease?
There are many variables that go into a pre-operative risk assessment for non-cardiovascular surgery. For high-risk heart patients having a high-risk surgery, there is always the option to have a dedicated heart team at a center of excellence perform the surgery with cardiovascular (CV) anesthesia utilizing a cardiovascular operating room (CVOR). I would discuss this further with your physician or surgeon, and a referral to a tertiary or quarternary healthcare center may be required.
Thank you very much for your reply and suggestions. I personally don’t think I am well enough for surgery. Although, not sick enough for heart surgery yet.
On a personal level, as a life long heart patient I just want to express how frustrating it is to try to get or find the medical care needed. I work in a large, privately owned dental office. There are dentists there who won’t even do a filling for me because of medical history. They have known me for years and years. At the age of 25 and in need of some form of birth control I found myself without a gynocologist for several years, she decided she was no longer comfortable treating me due to medical history. I had to take care of things on my own. Good thing, because once we decided we wanted a baby, my cardiologist wasnt able to find a high risk group to take my case. These are just a few examples of how many doctors have flat out refused to treat me. I have had the same high risk gynocologist for several years now. Every once in a while I find the doctor that embraces a challenge. He is even leary of a surgery for me, even after years of not hesitating to treat me for whatever I needed. This was before I knew the complexity of my heart issues and that I was in heart failure. This has made me very concerned and hesitant regardless of how much I may want/need this surgery. I sincerely wish there was a better system in place for heart patients, especially young heart patients to get even basic medical care.
I will let my doctors decide if this can be done safely. Thank you again.
Based on what you are describing, it seems you have congenital heart disease. I would recommend finding an Adult Congenital Heart Disease specialist (https://www.achaheart.org) and having them follow you for your heart-related issues. I think you would find their expertise and services very beneficial.
Thank you so much. I apologize for venting. Yes, I have very complex congenital heart disease. I was non compliant with cardiology follow up for 8ish years and things have become very complicated. I am at the only hospital with an ACHD specialist in our area. I used your helpful link to check. I am not sure if ACHD is involved, but I know there are several surgeons, and research is ongoing trying to find a similar case for guidance on how to procede. It’s just very scarey. Thanks for your input.
Husband has heart failure, have had very real problems with Dr’s, even ER Dr’s, have got into some furious arguments with ignorant junior Dr’s, I now carry his initial diagnoses with me at all times, from specialist heart clinic, that makes them sit up and take notice.
Initially, I knew something was wrong with my husband, after 40 yrs of marriage I knew him well enough to say with confidence there is something wrong with him, ECG done, declared normal by GP, I still insisted he see a cardiologist, her opinion, she was shocked GP had missed what to her was screaming out at her from same ECG. he had 23%EF, that seems to be the main reading they are interested in, admitted to hospital the following day in congestive heart failure. Discharged 18 hrs later, no swollen ankles, by physician, who didn’t know what he was looking at, blood pressure normal, I was still not happy, soo drove him across city to specialist heart hospital, they I believe saved his life, he stills see them, but even there I have to watch him like a hawk. Has since developed left arm weakness and pain, heart jnr’s said, arthritis, rota-tor cuff injury, torn muscle, all checked out with various tests, x-rays, cat scans, eventually collapsed at home, Omron, said 30BPM, blood pressure still normal for him. Took him to heart hospital, jnr staff Dr said pinched nerve in his neck, I nearly punched his lights out. Told him I knew more about heart failure than he did in no uncertain terms, put him in bed to monitor him 23BPM during the night, consultant came the following day, and in front of us growled at jnr Dr’s, pacemaker installed. In the last couple of weeks, husband seems to have caught something unknown, admitted to hospital, put on drip, and given jug of fluid which he was drinking, I arrived about midday to find him looking bloated, I checked with the nurses, no everything OK. Again I questioned them about fluid overload, and asked them to weight him, NO I was told, no matter how many times I have told them he does not get swollen ankles, does not seem to penetrate nurses and Dr’s heads, demanded to see a Dr, eventually a duty Dr came, I explained to him as best I could and asked him to weight him 3 kilos different from morning weigh in, alarm bells then sounded loudly, by WHY OH WHY do I have to be the one ringing the alarm bells. I have educated myself with library books, GP’s (different) books, and papers I can find on the internet about heart failure, nothing quite fits husband though.
Thank you very much for your story, it sounds like it has been a frustrating time for you.
I am a 60 yr old male. I began exercising and correcting my diet by limiting calories and eliminating as much sugar and carbs as I can on Aug 1 of this year. At the time I weighed 260 lbs. I have since lost 40 lbs. I also went from walking 3 miles in an hour 4 days a week to running 4.25 miles in an hour every day. My resting heart rate was mid 70’s prior to changes. It has been steadily declining to the mid 50’s now. I’m still considered overweight and smoke about a pack a day. Should I be concerned about my heart rate?
No, that heart rate change can be normal especially since you are able to exercise without any issues. Congratulations on your exercise regimen and weight loss.