Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen. Over time, heart failure leads to fatigue and shortness of breath with everyday activities. There are over 6 million people living with heart failure in the United States, and it is a leading cause of hospitalizations in people over 65. While there is no cure for heart failure, treatments can help manage symptoms and slow the progression of the disease. In this article, we will look at the causes of heart failure, risk factors, symptoms, and most importantly, steps you can take to prevent your heart failure from getting worse.
What causes heart failure?
Heart failure can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. The most common causes of heart failure include:
- Coronary artery disease and heart attack – Damage to the heart muscle from decreased blood flow
- High blood pressure – Increased workload on the heart over time
- Heart valve disease – Improper valve function leading to strain on the heart
- Cardiomyopathy – Weakness of the heart muscle
- Congenital heart defects – Abnormalities present at birth that affect heart function
- Diabetes – May contribute to coronary artery disease and high blood pressure
- Obesity – Increases risk of heart disease and diabetes
- Sleep apnea – Interrupted breathing during sleep that stresses the heart
Identifying and treating the underlying cause of heart failure is the first step in preventing it from worsening over time.
Who is at risk for heart failure?
Certain factors increase a person’s risk of developing heart failure. The major risk factors include:
- Age – Risk rises significantly after age 60
- Family history of heart disease
- Smoking
- Obesity
- Diabetes
- High blood pressure
- Previous heart attack
- Excessive alcohol use
- Sleep apnea
- Irregular heart rhythms such as atrial fibrillation
- Prolonged drug use, such as cocaine
- Radiation therapy to the chest
- Certain chemotherapy drugs
Knowing your personal risk factors allows you to focus on the lifestyle changes and medical management that can keep heart failure from progressing.
What are the symptoms of heart failure?
The most common symptoms of heart failure include:
- Shortness of breath with exertion or when lying down
- Fatigue and weakness
- Swelling (edema) in the legs, ankles, feet, or abdomen
- Rapid or irregular heartbeat
- Reduced ability to exercise
- Persistent cough or wheezing with white or pink phlegm
- Increased need to urinate at night
- Swelling of veins in the neck
- Confusion or impaired thinking
- Loss of appetite and nausea
Symptoms may develop slowly over time or come on suddenly. The severity depends on the degree of heart muscle dysfunction. Recognizing the signs of worsening heart failure is crucial for getting timely treatment.
How is heart failure diagnosed?
If heart failure is suspected based on symptoms and examination, the doctor will order several tests to confirm the diagnosis and determine the cause:
- Chest X-ray – Enlarged heart or fluid buildup in lungs
- Electrocardiogram (EKG) – Irregular heart rhythms
- Echocardiogram – Views structure and function of the heart
- Stress Test – Looks at blood flow to the heart with exertion
- Cardiac Catheterization – Visualizes coronary arteries and measures pressures in heart chambers
- Blood Tests – Levels of BNP (brain natriuretic peptide) are elevated
Based on the test results, the doctor will be able to determine the type of heart failure (reduced or preserved ejection fraction), underlying cause, and severity to guide appropriate treatment.
How is heart failure classified?
Heart failure is classified into different types based on the ejection fraction (EF), which is a measurement of how much blood the left ventricle pumps out with each contraction.
Heart Failure with Reduced Ejection Fraction (HFrEF)
Also called systolic heart failure, HFrEF means the heart muscle does not contract effectively and less than 40% of the blood is pumped out of the left ventricle with each beat. This type accounts for about 50% of heart failure cases.
Heart Failure with Preserved Ejection Fraction (HFpEF)
Also called diastolic heart failure, HFpEF means the left ventricle contracts normally but the ventricle does not relax as it should during the filling phase, limiting the amount of blood that can enter. The EF is 50% or higher. About 50% of heart failure cases are HFpEF.
Determining the type of heart failure guides the treatment approach for slowing progression of the disease.
What is the prognosis for heart failure patients?
The prognosis for heart failure depends on the underlying cause, ejection fraction, and how well the condition responds to treatment. Some general prognostic statistics include:
- 1 in 5 people diagnosed with heart failure die within one year
- 50% of people diagnosed will die within 5 years
- Prognosis is worse for heart failure with reduced ejection fraction
- Sudden cardiac death from arrhythmias accounts for about 50% of deaths in heart failure patients
With proper adherence to medications and lifestyle changes, many patients can manage symptoms for decades after initial diagnosis. Close monitoring and optimization of medications is key to slowing the progression of heart failure.
How is heart failure treated?
Treatment focuses on relieving symptoms, improving quality of life, slowing the progression of heart failure, and reducing the risk of sudden death from arrhythmias. Treatment options include:
Medications
- Diuretics – Reduces fluid buildup in lungs and swelling
- ACE inhibitors – Lowers blood pressure, reduces strain on heart
- Beta blockers – Reduces blood pressure, helps heart beat slower
- Aldosterone antagonists – Improves heart’s pumping ability
- Digoxin – Helps strengthen heart contractions
- Anticoagulants/antiplatelets – Prevents blood clots in heart
Medical Devices
- Implantable cardioverter defibrillator (ICD) – Shocks heart back into normal rhythm if dangerous arrhythmias detected
- Cardiac resynchronization therapy (CRT) – Device to coordinate pumping between ventricles
- Ventricular assist device (VAD) – Mechanical pump to support heart function
- Heart transplant – For end-stage heart failure when other options fail
Lifestyle Changes
- Following a low-sodium diet
- Exercise and activity within tolerable limits
- Quitting smoking and avoiding secondhand smoke
- Limiting alcohol intake
- Losing weight if overweight or obese
- Managing stress levels
- Taking medications correctly and monitoring for changes in symptoms
The most effective treatment is a combination of medications, devices if needed, and lifestyle changes tailored to each patient. Treatment is adjusted continually based on the progression of symptoms.
What can you do to prevent heart failure from getting worse?
The key steps you can take to prevent your heart failure from worsening include:
Follow All Medical Therapy
Take all medications prescribed by your doctor exactly as directed. Diuretics, ACE inhibitors, beta blockers, and other heart failure medications can significantly improve symptoms, quality of life, and prognosis when taken properly. Report any new side effects or changes in symptoms to your doctor.
Monitor for Warning Signs
Weigh yourself daily and watch for sudden increases in weight from fluid retention. Look for swelling, especially in the abdomen and legs. Pay attention to any change in the severity of shortness of breath or fatigue. Worsening symptoms are a sign that heart failure may be advancing and needs closer management.
Adopt Heart-Healthy Lifestyles
Follow a low-sodium diet, exercise within recommended limits, achieve and maintain a healthy weight, and quit smoking. Controlling blood pressure and cholesterol also help protect the heart. Limit alcohol intake as well. Developing good lifestyle habits reduces strain on the heart.
Visit Your Doctor Regularly
See your doctor for scheduled follow-up appointments to monitor your heart failure. You will need frequent testing to detect any worsening of heart function. Your medications may need adjustment over time as well. Ongoing medical management is imperative.
Get Immunized
Stay current on immunizations like the flu vaccine and COVID-19 vaccines to prevent respiratory infections than can worsen heart failure. Ask your doctor if you need immunizations for pneumonia as well. Preventing illnesses helps take strain off the heart.
Check for Sleep Apnea
Sleep apnea stresses the heart at night. If you have symptoms like snoring or daytime fatigue, get evaluated for sleep apnea. Using CPAP at night may improve your heart failure.
Consider Cardiac Rehab
Ask your doctor about enrolling in a cardiac rehabilitation program tailored to your needs. This can help safely increase physical activity, improve lifestyle habits, and monitor your heart function.
Reduce Stress
Finding healthy ways to cope with stress through meditation, yoga, tai chi, or other methods may benefit your heart. Use your support system and communicate your feelings. Relaxation techniques promote well-being.
Consider Advanced Treatments
For severe heart failure that continues to worsen despite optimal medical therapy, ask your doctor about advanced treatment options like implantable defibrillators, ventricular assist devices, or heart pumps that support heart function and circulation.
Conclusion
Heart failure is a serious condition, but the prognosis can be improved through active participation in your care. Following doctor’s orders for medication and lifestyle changes, monitoring for symptom changes, staying current on immunizations, reducing stress, considering advanced treatments when appropriate, and keeping up with regular visits can help prevent your heart failure from progressing. Work closely with your healthcare team and be vigilant about your symptoms and overall health. There are many steps you can take to live better with heart failure and slow the worsening of your condition. Don’t give up hope – with proper management, heart failure can be maintained for many years. The keys are education, commitment to a healthy lifestyle, and working closely with your doctor.