Heart Failure

Heart failure means that the heart is weak and the pumping power is reduced. 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. Basically, the heart can't keep up with its workload. It is often the result of damage or injury to your heart caused by other heart problems and high blood pressure. Heart failure is a long-term condition that tends to get worse over time. It is important to manage your health to improve your quality of life.

Causes and risk factors

• High blood pressure: Your heart works harder than it has to if your blood pressure is high.
• Coronary artery disease: Narrowed arteries may limit your heart's supply of oxygen, resulting in heart attacks and a weakened heart muscle.
• Diabetes: Having diabetes increases your risk of coronary artery disease.
• Tobacco use: Causes coronary artery disease.
• Sleep apnea: The inability to breathe properly at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.
• Congenital heart defects: Some people who develop heart failure were born with structural heart defects.
• Viruses: A viral infection may damage the heart muscle.
• Alcohol use: Drinking too much alcohol can weaken the heart muscle and lead to heart failure.
• Irregular heart rhythm: Abnormal rhythms, especially if they are frequent and fast, can weaken the heart muscle and cause heart failure.
• Obesity
• Heart valve disease: The heart muscle may be damaged from blood backing up in the chambers due to the valves not opening and closing properly.
• Family history and genetics: People with a family history of cardiomyopathies (diseases that damage the heart muscle) have an increased risk of developing heart failure.

Signs and symptoms

• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Fatigue and weakness
• Swelling (edema) in your legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged sputum
• 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

Diagnosis

1. Physical Assessment

The following physical signs, along with medical history, strongly suggest heart failure:

• Enlarged heart
• Abnormal heart sounds
• Abnormal sounds in the lungs
• Swelling or tenderness of the liver
• Fluid retention in legs and abdomen
• Elevation of pressure in the veins of the neck

2. Blood Test

Blood tests are used to evaluate kidney and thyroid functions as well as to check cholesterol levels and the presence of anemia.

3. Chest X-ray

A chest X-ray shows the size of your heart and whether there is fluid build-up around the heart and lungs.

4. Electrocardiogram (EKG or ECG)

An EKG records the electrical impulses traveling through the heart.

5. Echocardiogram

This test is an ultrasound, which shows the heart's movement, structure, and function. The Ejection Fraction (EF) is used to measure how well your heart pumps with each beat.

6. Exercise Stress Test

A stress test, sometimes called a treadmill test or exercise test, helps a physician find out how well your heart handles work. As your body works harder during the test, it requires more oxygen, so the heart must pump more blood. The test can show if the blood supply is reduced in the arteries that supply the heart. It also helps physicians know the kind and level of exercise appropriate for a patient.

7. Cardiopulmonary Exercise Testing (CPET)

Cardiopulmonary exercise testing has become an important clinical tool to evaluate exercise capacity and predict outcome in patients with heart failure and other cardiac conditions. It provides an assessment of the integrative exercise responses involving the pulmonary, cardiovascular and skeletal muscle systems.

8. Cardiac Catheterization

This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure. Right heart catheterization enables your physician to evaluate the pressures in the right side of your heart, your lungs, overall fluid status and cardiac output.