What is heart failure?
By William Cicio
Heart failure, sometimes called congestive heart failure or CHF, is not a single disease. It is a medical condition, having many different causes, which can lead to symptoms such as shortness of breath, leg swelling, and/or fatigue. Heart failure is not a heart attack, although this is a very common cause of CHF. Other conditions, most commonly coronary heart disease, high blood pressure, and diabetes, place people at risk for heart failure. The symptoms of CHF come from the heart becoming too weak and not being able to pump enough blood, or from becoming too stiff and causing a “back up” of blood coming from the lungs.
Heart failure can affect one or both sides of the heart, and the symptoms can vary widely from person to person. Other causes of heart failure include problems with the heart valves, toxins such as alcohol or chemotherapy drugs, pregnancy, thyroid disease, viral infections, or Takotsubo Syndrome (a temporary weakness of the heart muscle due to severe stress). Serious complications of CHF include kidney damage, liver damage, and atrial fibrillation or more dangerous arrhythmias (electrical disturbance that can keep the heart from pumping) and stroke.
Five to six million Americans suffer from heart failure; this number is expected to rise as the population ages and as medical advances enable people with heart problems to live longer. People over age 65, African Americans, people who have had a heart attack or who are obese, and men are most likely to develop the condition. Heart failure affects less than 2-percent of people younger than 55 years of age and increases to a rate of 10-percent for persons older than 75 years of age. In addition to being the number one cause of hospitalization among Medicare patients, heart failure is also very costly. In 2010, the total cost of heart failure in the United States was $39.2 billion.
Learning the signs of heart failure can help you be proactive and seek treatment early. The most common signs include:
r Feeling tired or fatigued.
r Shortness of breath with exertion (in advanced stages there is shortness of breath at rest).
r Swelling in the legs.
r Racing heart.
r Distension of the abdomen.
r Weight gain due to retention of fluids.
r Weight loss in advanced stages.
r Distended neck veins.
r Bluish discoloration in the extremities.
Treatment for underlying conditions such as high blood pressure, coronary heart disease and diabetes can prevent or improve heart failure. When diagnosed in its earliest stages, you can often control it with lifestyle modifications such as:
r Getting regular exercise and weight control.
r Cutting sodium and fluid intake.
r Weighing yourself daily.
r Managing cholesterol, diabetes and high blood pressure.
r Stopping smoking and use of alcohol or illicit drugs.
Several medications can help control symptoms and aid your heart’s function to reduce symptoms and allow those with CHF live longer with less need for hospitalization. Structural problems, such as clogged arteries, damaged valves or birth defects, may be repaired or corrected surgically. Devices, such as a CRT (a pacemaker that paces the right and left sides of the heart) can be implanted to help your heart pump blood more efficiently. A defibrillator (ICD) can be implanted to activate during cardiac arrest and help to restore a normal heart rhythm.
People with severe heart failure symptoms at rest, despite other treatments, may need a mechanical heart pump to aid the heart’s function. Heart transplants are done for end-stage heart failure when other treatments have failed.
Heart failure is a chronic condition requiring careful maintenance to slow progression. Patients who are hospitalized and then re-hospitalized with heart failure have lower survival rates. You can prevent re-hospitalization by taking prescribed medications, keeping up with exercise and dietary recommendations, and having regular check-ups with your cardiologist to ensure that you understand and can manage your condition properly.
Healthy people need to see their family or primary care doctors on a regular basis, as screening for and managing the common causes of heart failure is the best way to prevent heart failure from occurring in the first place.
William Cicio, MD, of UPMC Susquehanna’s Heart & Vascular Institute, has nearly15 years of experience as a cardiologist and has experience in medical directorship in both diagnostic cardiac services and cardiac rehabilitation. Dr. Cicio is fellowship trained in cardiology and holds board certifications in both cardiovascular disease and echocardiography.