Heart failure is a chronic, progressive condition in which the heart is no longer able to pump blood efficiently enough to meet the body’s demands. This impairment may stem from the heart muscle becoming too weak or too stiff to function properly. Despite its name, heart failure doesn't mean the heart has stopped working—it simply means it's functioning below optimal levels.
Although heart failure is a serious condition, many people with it lead productive and active lives, especially when it’s diagnosed early and managed effectively through lifestyle changes, medications, and other treatments. It is one of the most common cardiovascular conditions in the world, affecting over 6 million adults in the United States alone.
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Types of Heart Failure
Heart failure is classified according to which side of the heart is affected and how well it functions. Understanding the type of heart failure helps guide treatment.
Left-Sided Heart Failure This is the most common form and occurs when the left ventricle doesn't pump blood effectively. There are two subtypes:
- Heart Failure With Reduced Ejection Fraction (HFrEF): In this type, the heart muscle loses its ability to contract forcefully, leading to reduced blood output.
- Heart Failure With Preserved Ejection Fraction (HFpEF): Here, the heart contracts normally but is too stiff to fill properly with blood.
- Heart Failure With Mid-Range Ejection Fraction (HFmrEF): This occurs when the ejection fraction is between 41% and 49%, with characteristics of both HFrEF and HFpEF.
Right-Sided Heart Failure This occurs when the right side of the heart cannot effectively pump blood to the lungs. Often, it develops as a result of left-sided heart failure. It causes fluid retention in the lower limbs, liver, and abdomen.
Biventricular Heart Failure This involves both the left and right sides of the heart and is typically more severe. Symptoms of both left- and right-sided failure are present simultaneously.
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Common Signs and Symptoms
Heart failure symptoms can vary by individual and may evolve over time. Common signs include:
- Shortness of breath (dyspnea): Especially during exertion or while lying flat.
- Fatigue: A result of insufficient oxygen-rich blood reaching muscles.
- Edema: Swelling in the ankles, legs, and abdomen due to fluid buildup.
- Rapid or irregular heartbeat: The heart compensates for its decreased efficiency.
- Persistent cough or wheezing: Often due to fluid accumulation in the lungs.
- Weight gain: Caused by fluid retention.
- Nausea and appetite loss: Due to congestion in the gastrointestinal system.
- Confusion or memory issues: Especially in older adults.
- Decreased exercise tolerance: A hallmark of worsening heart failure.
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Causes and Risk Factors
Heart failure usually develops from conditions that damage or strain the heart. These include:
- Coronary artery disease (CAD): Narrowed arteries reduce blood supply to the heart.
- High blood pressure: Forces the heart to work harder.
- Heart attack: Can cause permanent heart muscle damage.
- Diabetes: Damages blood vessels and nerves.
- Cardiomyopathy: Disease of the heart muscle from various causes, including genetic factors.
- Valve disorders: Impair the flow of blood through the heart.
- Arrhythmias: Such as atrial fibrillation, which can impair cardiac output.
- Congenital heart defects: Structural issues present at birth.
- Chronic kidney disease, obesity, and sleep apnea also raise risk.
Lifestyle factors such as tobacco use, excessive alcohol, poor diet, and inactivity further contribute to developing heart failure.
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How Doctors Diagnose Heart Failure
Early and accurate diagnosis is crucial. Diagnosis may involve the following:
- Medical history and symptom review
- Physical examination to assess signs like swelling and lung fluid
- Blood tests: To check kidney/liver function, anemia, and BNP (a marker of heart failure)
- Chest X-ray: Reveals heart enlargement and lung congestion
- Electrocardiogram (EKG): Detects arrhythmias and heart damage
- Echocardiogram (Echo): The most important test to assess pumping function and ejection fraction
- Stress test: Measures how the heart performs during exertion
- Cardiac MRI or CT: Offers detailed imaging of heart structure
- Coronary angiography: Checks for blockages in the arteries
Ejection fraction (EF), the percentage of blood pumped out with each heartbeat, is a key measurement in evaluating heart failure severity.
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Available Treatments
Though heart failure cannot be cured, a variety of treatment strategies help manage symptoms and improve quality of life.
Medications
- ACE inhibitors and ARBs: Lower blood pressure and improve blood flow.
- ARNIs: Combine ARBs with neprilysin inhibitors for added benefit.
- Beta-blockers: Reduce heart rate and lower blood pressure.
- Diuretics: Help eliminate excess fluid.
- Potassium-sparing diuretics (aldosterone antagonists): Preserve potassium while reducing fluid.
- SGLT2 inhibitors: Originally for diabetes, now shown to improve heart failure outcomes.
- Digoxin: Helps the heart beat stronger and more regularly.
Surgical and Device Therapies
- Implantable cardioverter-defibrillators (ICDs): Prevent sudden cardiac death.
- Cardiac resynchronization therapy (CRT): Coordinates heart contractions.
- Left ventricular assist device (LVAD): A mechanical pump for advanced cases.
- Coronary bypass surgery or valve repair/replacement
- Heart transplantation for end-stage cases unresponsive to other therapies
Lifestyle and Self-Care
- Adhere to a low-sodium, heart-healthy diet
- Engage in regular exercise, as advised
- Monitor daily weight for fluid retention
- Avoid smoking and excessive alcohol
- Manage stress through relaxation techniques
Education and self-management are central to long-term success.
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Preventing Heart Failure
While not all causes are preventable, many lifestyle and medical interventions significantly reduce risk:
- Control blood pressure with medication and diet
- Manage cholesterol and blood sugar levels
- Exercise regularly (150 minutes of moderate-intensity activity/week)
- Quit smoking completely
- Limit alcohol to moderate levels
- Maintain a healthy weight
- Follow up regularly with healthcare providers for chronic conditions
Early intervention in at-risk individuals can delay or prevent heart failure altogether.
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Potential Complications
If unmanaged, heart failure can lead to life-threatening complications:
- Arrhythmias: Increased risk due to irregular heart rhythms
- Kidney failure: From decreased blood supply
- Liver congestion: Due to fluid buildup in veins
- Pulmonary hypertension: High pressure in lung arteries
- Cognitive decline: Poor brain perfusion may affect memory
- Thromboembolism: Blood clots due to sluggish circulation
Monitoring and treating these risks can extend life expectancy.
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Daily Life With Heart Failure
Living with heart failure involves more than medication. Daily decisions and support systems play a vital role.
Tips for Everyday Management:
- Stick to prescribed medications and diet
- Learn to recognize warning signs of worsening symptoms
- Weigh yourself every morning
- Keep hydration and salt intake in check
- Communicate with your care team regularly
- Use pill organizers or apps to track medication
Emotional Support Matters
- Join a heart failure support group
- Stay socially active with friends and family
- Seek help for anxiety or depression
Equity in Heart Failure Care
Research highlights disparities in treatment access, especially among Black communities. Advocacy and improved healthcare access are essential for equity in outcomes. Tailored health education, early screening, and access to advanced care are vital in underserved populations.
