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. The term “heart failure” doesn’t mean that the heart has literally failed or stopped working. Rather, it means the heart can’t keep up with its workload.
Heart failure develops over time as the heart’s pumping action grows weaker. It can affect the right side of the heart only, or it can affect both sides of the heart. Other terms used for heart failure are congestive heart failure (CHF), left-sided heart failure, and right-sided heart failure.
Common Symptoms of Heart Failure
Some common symptoms of heart failure include:
- Shortness of breath during activity or when lying down
- Fatigue and weakness
- Swelling (edema) in your legs, ankles, feet, and sometimes in your abdomen, arms, and hands
- Rapid or irregular heartbeat
- Reduced ability to exercise
- Persistent cough or wheezing with white or pink blood-tinged mucus
- Increased need to urinate at night
- Swelling of your abdomen (ascites)
- Sudden weight gain from fluid retention
- Lack of appetite and nausea
- Difficulty concentrating or decreased alertness
- Sudden, severe shortness of breath and coughing up pink, foamy mucus
- Chest pain if your heart failure is caused by a heart attack
Symptoms may develop slowly over time as heart failure progresses. In advanced stages, even everyday activities may cause dizziness, weakness, and shortness of breath. Severe heart failure can result in a reduced quality of life and require hospitalization.
Conditions that Mimic Heart Failure Symptoms
There are various conditions that can mimic the signs and symptoms of heart failure. Some examples include:
Chronic Obstructive Pulmonary Disease (COPD)
COPD is a progressive lung disease that makes it difficult to breathe due to damage to the airways and air sacs in the lungs. The symptoms of COPD can be similar to heart failure, including:
- Shortness of breath, especially during physical activity
- Fatigue
- Wheezing or whistling sound when breathing
- Chest tightness
- Chronic cough, sometimes producing mucus
However, COPD does not cause swelling in the legs and feet seen with heart failure. Also, COPD symptoms are often worse in the morning, while heart failure symptoms worsen during physical activity.
Obesity
Carrying excess weight puts additional strain on the heart. Obesity can cause symptoms including:
- Shortness of breath with exertion
- Fatigue
- Swelling in the legs and feet
- Irregular heartbeat
However, obesity does not typically cause the coughing or buildup of fluid in the lungs that can accompany heart failure.
Anemia
Anemia reduces the oxygen-carrying capacity of the blood, which can lead to shortness of breath, irregular heartbeat, fatigue, dizziness, and chest pain. However, anemia itself does not directly affect heart function like heart failure.
Pneumonia
Symptoms of pneumonia including chest pain, cough, fever, and shortness of breath may resemble a heart failure flare-up. However, pneumonia is an infection of the lungs, not a chronic disease of heart function like heart failure.
Asthma
Asthma is a condition in which the airways narrow and swell, causing wheezing, chest tightness, coughing, and shortness of breath. These symptoms can mimic heart failure. However, asthma attacks are usually triggered by allergens or respiratory infections and are reversible with treatment.
Pulmonary Hypertension
Pulmonary hypertension is increased blood pressure in the arteries of the lungs. Symptoms include shortness of breath, dizziness, chest pain, and ankle swelling. While the symptoms overlap with heart failure, the underlying problem is in the pulmonary arteries rather than the heart itself.
Lung Cancer
Some types of lung cancer can cause swelling in the face and arms, fatigue, wheezing, and shortness of breath. However, lung cancer does not directly impair heart function like heart failure. Other key differences are unexplained weight loss and coughing up blood-tinged sputum associated with lung cancer.
Hypothyroidism
An underactive thyroid gland slows metabolism, which can lead to fatigue, weakness, shortness of breath, and swelling in the limbs. However, hypothyroidism does not directly affect heart muscle function.
When to See a Doctor
See your doctor promptly if you develop any symptoms of heart failure, especially shortness of breath, fatigue, swelling in the legs, or sudden weight gain. Because many conditions can mimic heart failure, it’s important to get an accurate diagnosis. Call 911 immediately for severe shortness of breath or chest pain.
Diagnostic Tests for Heart Failure
To diagnose heart failure, doctors use several different types of tests to evaluate how well the heart is pumping.
Physical Exam
During a physical exam, the doctor will listen to the lungs with a stethoscope to check for crackling sounds that suggest fluid buildup. The doctor will also check for swelling, tenderness, and engorgement in the neck veins and liver.
Blood Tests
Blood tests measure levels of certain biomarkers that tend to be elevated when heart failure is present, such as:
- B-type natriuretic peptide (BNP)
- N-terminal pro-BNP (NT-proBNP)
Other lab tests check kidney function, electrolytes, and blood cell counts.
Chest X-Ray
A chest x-ray image allows the doctor to check the heart size and view the lungs for fluid buildup or other abnormalities. Enlarged heart size suggests enlarged or thickened heart muscle.
Electrocardiogram (EKG)
An EKG records the heart’s electrical activity. Abnormal EKG findings may include arrhythmias, evidence of prior heart attacks, and abnormal heart rhythms associated with heart failure.
Echocardiogram
An echocardiogram uses ultrasound waves to produce images of the heart’s structures. It shows how well the heart chambers and valves are working and can identify areas of impaired heart muscle function.
Stress Testing
Stress testing tracks heart rate, blood pressure, and EKG changes while walking on a treadmill or undergoing medication-induced stress. Decreased exercise capacity helps confirm the diagnosis.
Cardiac Catheterization
Cardiac catheterization with coronary angiography allows visualization of the heart arteries. It helps determine if coronary artery disease or heart valve problems are contributing to heart failure.
MRI and CT Scans
Cardiac CT and MRI scans create 3-dimensional images of the beating heart’s structure and function. These specialized scans help measure ejection fraction and assess for structural abnormalities.
How is Heart Failure Treated?
Treatment for heart failure aims to relieve symptoms and improve quality of life through a combination of lifestyle changes and medications. The main goals include:
- Treating the underlying cause of heart failure, such as coronary artery disease, hypertension, or valve disorders
- Reducing fluid buildup in the lungs and swelling in the limbs
- Preventing hospitalizations
- Improving exercise tolerance and daily energy
- Preventing disease progression and worsening heart failure
Lifestyle Changes
Recommended lifestyle changes for managing heart failure include:
- Following a low-sodium diet
- Restricting fluid intake
- Getting regular physical activity
- Achieving and maintaining a healthy body weight
- Quitting smoking and avoiding secondhand smoke
- Limiting alcohol
- Managing other conditions, like diabetes, high cholesterol, and high blood pressure
Medications
Medications used to treat heart failure include:
| Medication | Purpose |
|---|---|
| ACE inhibitors | Lower blood pressure, reduce strain on the heart |
| Angiotensin II receptor blockers | Lower blood pressure, reduce strain on the heart |
| Beta-blockers | Slow heart rate, lower blood pressure, reduce strain on heart |
| Aldosterone antagonists | Remove excess fluid and sodium from the body |
| Diuretics | Remove excess fluid from the body |
| Digoxin | Help strengthen heart muscle contractions |
| Anticoagulants | Prevent dangerous blood clots in those with heart failure |
| Statins | Lower cholesterol, prevent additional heart damage |
For people with severe heart failure, specialized pacemakers and implantable cardioverter defibrillators may be recommended.
Surgery and Procedures
Surgical or interventional procedures that may help treat heart failure include:
- Coronary artery bypass grafting (CABG) to improve blood flow to the heart
- Heart valve repair or replacement
- Implanting ventricular assist devices to boost heart function
- Heart transplant in severe, end-stage heart failure
What is the Prognosis for Heart Failure?
With modern treatments, many people with heart failure are able to effectively manage their condition. However, heart failure is a chronic, generally progressive disease. It’s important to take medications as prescribed and adopt lifestyle changes to help preserve heart function.
The prognosis for an individual patient depends on multiple factors, including:
- Underlying cause of heart failure
- Presence of other medical conditions
- Severity of heart failure symptoms
- Response to treatment
- Age and overall health status
Mild heart failure may have no effect on life expectancy if properly managed. However, approximately 50% of people with congestive heart failure die within 5 years of diagnosis if the condition is left untreated. Severe heart failure can lead to critical organ failure and death without prompt treatment and supportive care.
Preventing Heart Failure
Steps to help prevent heart failure include:
- Living an active lifestyle
- Eating a heart-healthy diet low in sodium, sugar, and saturated fat
- Maintaining a healthy weight
- Controlling blood pressure and cholesterol
- Not smoking
- Limiting alcohol intake
- Managing conditions like coronary artery disease, diabetes, and obesity
The Takeaway
Heart failure causes debilitating symptoms including fatigue, shortness of breath, coughing, and swelling in the legs and abdomen. While several conditions like COPD, asthma, and pulmonary hypertension can mimic heart failure symptoms, they are separate diagnoses involving different mechanisms.
Accurate diagnosis through physical examination, imaging tests, and cardiac workup allows proper treatment. Lifestyle changes, medications, devices, and sometimes surgery help manage heart failure symptoms and improve prognosis.