What is Heart Failure?

Heart failure means the heart isn't able to pump enough blood to meet the needs of the body, either because the heart muscle is weakened or stiff or because a defect is present that prevents proper circulation. When the heart does not circulate blood normally, the kidneys receive less blood and filter less fluid into urine – causing this fluid to build up in the lungs, liver, around the eyes, or in in the legs. This is known as fluid congestion.

Types of Heart Failure

Baptist Health treats the following heart failure conditions:

• Congestive Heart Failure: a progressive disease with four stages where the heart cannot pump blood through the ventricles properly and blood remains in the ventricles. Fluid retention is common as the blood is not pumping toxins through the kidneys at an acceptable rate to filter them out.
• Diastolic Heart Failure: the lower left chamber of the heart (left ventricle) is not able to fill properly with blood during the diastolic phase, reducing the amount of blood pumped out to the body. The diastolic phase is when the heart relaxes and fills with blood.
• Left Sided Heart Failure: the heart’s main pumping power comes from the left ventricle, that is gradually weakened in left-sided heart failure.
• Right Sided Heart Failure: often occurs due to left-sided heart failure, when the weakened and/or stiff left ventricle loses power to efficiently pump blood to the rest of the body. As a result, fluid is forced back through the lungs, weakening the heart’s right side, causing right-sided heart failure.
• Systolic Heart Failure: how the heart pumps blood to the rest of the body effectively or how it improperly fills with blood.

Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of heart failure. The American Heart Association awarded us with the Get With the Guidelines® Bronze Award in 2016 for consistent application of quality measures in treating heart failure. 

You will appreciate timely appointments and respectful attention to your concerns, all in a positive and friendly atmosphere. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Heart Failure Stages

There are four stages of heart failure: A,B,C and D, along with four different classes indicating how active or limited a patient is by their condition. The four stages and classes include:

Stages

• Stage A: No structural disorder of the heart but there is a high risk for developing congestive heart failure based on high risk factors like family history or lifestyle.
• Stage B: Structural disorder of the heart is present but no know symptoms of congestive heart failure have been detected.
• Stage C: Current or past symptoms of congestive heart failure have been detected as well as symptoms of underlying heart disease.
• Stage D: End stage of heart failure that requires special treatment strategies.

Classes

• Class I: No physical limitations on activity due to heart failure.
• Class II: Some physical activity limitations and generally comfortable while at rest.
• Class III: Significant limitations in physical activity and generally comfortable while are rest.
• Class IV: Unable to carry on daily activities without physical discomfort and symptoms are still present in periods of rest.

Heart Attack vs. Heart Failure

Both heart attack and heart failure involve the same organ, but the two conditions vary by their symptoms and how the heart is affected. Heart failure occurs when the heart is working too hard while a heart attack occurs when blood flow is restricted to part of the heart and causes some muscle to die. 

Traditional heart attack symptoms include pain in the chest, arm, shoulders or abdomen while heart failure symptoms include pain in the chest, shortness of breath, palpitations or swelling in the extremities. Women tend to experience non-traditional heart attack symptoms more often than men. If you think you or someone you know is experiencing a heart attack, dial 9-11. 

Heart Disease vs. Heart Failure

 Heart disease, often referred to as coronary artery disease (CAD), is a condition of the heart where blood vessels become diseased, have structural problems or blood clots. Heart failure occurs when the heart works too hard. 

Typical heart attack symptoms are pain in the chest, arm, shoulder or abdomen while heart disease can have no symptoms at all. Heart disease symptoms, when present, can be similar to a heart attack with pain in the chest. If you think you or someone you know is experiencing a heart attack, dial 9-11.

Signs and Symptoms

Some people with heart failure have no symptoms. For others, symptoms can range from mild to severe and include:

• Awakening at night with shortness of breath 
• Coughing or wheezing, sometimes with white or pink phlegm
• Difficulty concentrating
• Dizziness, fatigue and weakness
• Fluid retention causing swelling in the ankles, legs, feet and/or abdomen
• Increased urge to urinate
• Lack of appetite and nausea
• Rapid or irregular heartbeat
• Shortness of breath during exercise or when lying flat
• Sudden weight gain

Diagnosis

To diagnose heart failure, we ask questions about your medical history and do a physical exam. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Common diagnostic procedures can include:

Blood test: Blood tests check the levels of certain fats, cholesterol, sugar and protein in the blood that could indicate heart conditions.

Contrast-enhanced CT scan: A thin tube (catheter) is inserted into a blood vessel and dye is injected to make the aorta visible to X-rays. Computers capture the images and produce a highly detailed view of the aorta.

Chest X-ray: A common imaging test of the lungs, heart and aorta.

Coronary angiography: This procedure often is done with cardiac catheterization. During the procedure, dye that can be seen on an X-ray is injected into the heart chambers or coronary arteries. The dye lets a physician study blood flow through the heart and blood vessels to detect any blockages.

Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves. 

Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.

Electrophysiology study: This test records the heart’s electrical activities and pathways. It can help find what’s causing heart rhythm problems and identify the best treatment. 

Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.

Myocardial biopsy: For this procedure, the physician removes a piece of heart muscle, often during cardiac catheterization. The heart muscle is studied under a microscope to see whether changes in cells have occurred. These changes may suggest cardiomyopathy.

Stress testing: This test is conducted during exercise. If a person can't exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the heart’s rate, rhythm or electrical activity as well as blood pressure. Exercise makes the heart work hard and beat fast while heart tests are administered.

Causes

The following can lead to heart failure:

• Cardiomyopathy
• Coronary artery disease
• Diabetes
• Heavy alcohol use
• High blood pressure
• Obesity
• Sleep apnea
• Smoking

Risk Factors 

Risk factors that could contribute to heart failure include:

Chronic diseases: Type 1 diabetes, HIV, hyperthyroidism, hypothyroidism, a buildup of iron (hemochromatosis) or a buildup of protein (amyloidosis) may contribute to heart failure.

Congenital heart defects: Structural heart defects may prevent proper blood circulation from the heart.

Irregular heartbeats: Abnormal heart rhythms, especially if they are very frequent and fast, can weaken the heart muscle.

Previous heart attack: Damage to the heart muscle may affect its ability to pump blood effectively.

Some diabetes and chemotherapy medications: Certain drugs have been found to increase the risk of heart failure.

Valvular heart disease: Damage or a defect in one of the four heart valves can prevent the heart from pumping blood effectively.

Viral infection: Certain viral infections can damage the heart muscle.

Prevention

While you cannot prevent all types of heart failure, you can take steps to lower your risks for diseases or conditions that can lead to or complicate the condition.

Balance your blood sugar: If you have diabetes, watch what you eat and check your blood glucose regularly. Talk to your physician about medications that control blood sugar spikes.

Be active: Moderate exercise helps circulation and decreases stress on your heart muscle.

Eat a healthy diet: Limit sugar, saturated fat, cholesterol and salt, and eat plenty of fruit, vegetables, whole grains and low-fat dairy products.

Get regular checkups: And, if you experience new or changing symptoms or side effects from medications, see your physician.

Maintain a healthy weight: Losing weight and maintaining a healthy weight puts less stress on the heart.

Reduce stress: Stress can contribute to a fast or irregular heartbeat.

Reduce your alcohol intake: In some cases, you may need to stop drinking entirely. If you can drink, keep your intake low.

Stop smoking: Smoking damages blood vessels, raises blood pressure, reduces the amount of oxygen in the blood and makes the heart beat faster.

Take your medications as prescribed: If you’ve been prescribed a medication for heart failure or a causative condition, be sure to take it as prescribed. 

Prognosis

Prognosis varies depending on the cause of heart failure, the severity a person’s symptoms and impairment, the degree to which other organ systems are involved, and his or her response to medications.

Treatment and Recovery

Treatment for heart failure may include: 

Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors) and Angiotensin Receptor Blockers (ARBs): These medications relax blood vessels to improve blood flow. 

Beta-Blockers: These drugs can reduce blood pressure and slow a rapid heart rhythm.

Diuretics: Heart failure causes the body to retain fluid. These drugs reduce your body’s fluid content by promoting urination.

 Surgery and Other Procedures: If medications are not effective, your physician may recommend an angioplasty to open a blocked artery or surgery to repair a heart valve.

Vasodilators: These medications are another option for opening blood vessels if you cannot tolerate ACE inhibitors.

Complications

Congestive heart failure can lead to other conditions, including:

Anemia: This condition that develops when your blood lacks enough healthy red blood cells or hemoglobin can cause weakness and fatigue. 

Atrial fibrillation: This irregular heart rhythm can increase the risk of stroke and blood clots.

Cardia cachexia: This unintentional weight loss can be life-threatening without supplemental nutrition.

Impaired kidney function: Decreased kidney function is common in patients with heart failure, and it increases the risks for heart complications, hospitalization and death.

Leg venous stasis and ulcers: Poor circulation can cause skin to thicken, change color and look shiny. Hair may fall out and ulcers can develop if you sustain an injury.

Liver disease: People with heart failure are at risk for developing liver disease.

Stroke: If the blood supply to the brain is decreased or cut off, the brain can be deprived of oxygen, causing cells to die.