Heart Failure

Causes

The leading causes of heart failure are:

• Coronary artery disease (CAD)
• Heart attack

Other common causes include:

• Problems with the heart's valves due to:
  • Rheumatic heart disease
  • Bacterial endocarditis
  • Congenital defects
  • Calcium deposits from atherosclerosis
• High blood pressure
• Diabetes

Other less common causes include:

• Cardiomyopathy—weakened, damaged heart muscle
• Certain medications
• Abnormal heartbeats—arrhythmias
• Hyperthyroidism—overactive thyroid
• Amyloidosis
• Kidney failure and/or liver failure
• Thiamine (vitamin B1) deficiency

Risk Factors

Heart failure is more common in older adults. Other things that increase the risk of heart failure include:

• Obesity
• Excess intake of salt and fat
• Excess alcohol intake
• Smoking
• Pregnancy
• High fever
• Severe infection, such as pneumonia
• Chronic lung disease—emphysema
• Chemotherapy
• Psychological disorders, such as depression or anxiety

Symptoms

Heart failure can cause:

• Shortness of breath—at first only with activity, then progressing to shortness of breath at rest
• Unexplained weight gain
• Swelling of feet, ankles, or legs
• Need to sleep propped up
• Fatigue, weakness
• Wheezing
• Cough—may be dry and hacking or wet sounding, may have a pink, frothy sputum
• Frequent urination, especially at night
• Abdominal pain

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The doctor may note changes caused by heart failure such as fluid build up in legs. They may also hear abnormal sounds when they listen to the heart. Blood tests may be done to look for certain markers of change in the heart.

Tests can help to show what areas of the heart are affected. They can also show changes in blood flow. This can be done with:

• ECG
• Echocardiogram
• Nuclear scanning
• Coronary angiography
• Exercise stress test

Doctors will use the test results to determine level of heart failure. This will help guide treatment plan.

Treatment

Heart failure will need lifelong care. The goal is to prevent worsening of symptoms. Treatment can ease symptoms and improve quality of life. Some may also have some improvement in heart strength.

Treatment will vary by person and over time. A care plan will require input from patient and care team. Tracking weight and symptoms everyday will help to catch changes early. Fast treatment of changes may reduce worsening and other problems.

Heart failure may be caused by another health issue. Treating this issue may improve heart failure or prevent it from getting worse. For any form of heart failure, treatment may include:

Medications

Medicine can help to ease workload on the heart. They may include:

• Angiotensin-converting enzyme (ACE) inhibitors—to widen blood vessels
• Digoxin (digitalis)—to help the heart pump
• Beta-blockers—to slow heart rate and lower blood pressure
• Diuretics—to remove excess fluid
• Nitrates—to dilate the blood vessels

Medicine may also be given to treat other heart issues like high blood pressure or high cholesterol.

Lifestyle Changes

Day-to-day habits can affect heart health. Some changes may help ease stress on the heart. Changes may include:

• Quitting smoking
• Eating a heart healthy diet; should be low in fat and high in fiber, vegetables, and fruits; salt intake may also need to be reduced.
• Regular physical activity
• Weight loss if needed
• Avoiding alcohol or recreational drugs that may stress the heart
• Manage and reduce stress

Heart Support and Surgery

Heart failure may cause or be worsened by rhythm problems of the heart. A defibrillator or pacemaker may be implanted. They give electrical shocks if the heart starts dangerous rhythms.

Other devices can help support the heart. They may be needed short term to help recover from an injury or illness. They may also support the heart in last stages of heart failure until a transplant can be done. These devices increase the amount of blood pumped to the body without increasing workload on the heart. Examples include:

• Intra-aortic balloon pump (IABP)
• Ventricular assist device

A heart transplant may be needed for severe heart failure, if all other treatment has failed.

Prevention

The best way to prevent heart failure is to reduce your risk of heart disease, high blood pressure, and diabetes. General steps include:

• Regular physical activity
• Quittin smoking
• Limiting alcohol
• Losing weight if needed, and maintaining a healthy weight.
• Eating a healthy diet