Patient Education: What is Heart Failure?
Dealing with heart failure
More people are surviving heart attacks than ever before. That’s the good news. The bad news is that heart attack survivors may have damaged heart muscles. In fact, the most common cause of heart failure is injury from a heart attack.
What is heart failure?
Heart failure doesn’t mean the heart stops beating. A failing heart simply doesn’t pump as well as it should. It can’t circulate enough blood to keep up with the body’s demand for oxygen and other nutrients. This poor circulation causes a person to fatigue easily, and also causes the lungs, legs, and other body parts to become congested with fluid.
There are two types of heart failure, depending on the heart’s pumping cycle:
¤ In systolic failure, the heart muscle is too flabby and weak to pump with enough force.
¤ In diastolic heart failure, the heart muscle is stiff and resists filling with blood.
These varieties can coexist.
The high stakes
Heart failure is a serious condition, both deadly and expensive. Medicare spends more on heart failure than on heart attacks and cancer combined. Meanwhile, the outcomes for people with heart failure continue to worsen, even though outcomes for other kinds of heart disease are improving.
Causes of heart failure:
There are other causes of heart failure besides heart attack. These common causes include:
¤ Coronary artery disease: Arteries that supply blood to the heart become narrowed or blocked.
¤ Hypertension: Pumping against persistent high blood pressure injures the heart muscle (diastolic heart failure).
¤ Chronic lung disease: Pumping blood through severely damaged lungs also damages the heart.
¤ Alcohol and street drugs: Cocaine and others can act like a poison on the heart muscle.
¤ Valve disease: Back flow from floppy heart valves or resistance from valves that are stiff or rigid can stretch and weaken the heart.
¤ Infection: Germs or a virus can infect and destroy the heart.
¤ Genetic or congenital heart disease: Defects are present in the heart at birth or can be passed on through generations of family members.
How do I know if I have heart failure?
Because heart failure can develop slowly over time, at first you may only find yourself getting tired more easily. As heart failure gets worse, even light activity may rob you of energy. Other symptoms depend on where the blood backs up. Swelling, known as edema, occurs when blood backs up in blood vessels. Your feet, ankles, and hands are puffy and tight with fluid. As you retain fluid, you may gain weight. When blood backs up in the lungs, you may feel short of breath. Doctors call this dyspnea. You may need to sit upright to breathe or prop yourself up on pillows to sleep. Sometimes, you may find yourself waking up at night feeling like you can’t get enough air. Since other conditions can cause shortness of breath, your doctor will want to do tests. People who have their heart function measured generally receive better management of their condition. Treatment is more carefully tailored to their individual needs.
What tests are needed to diagnose heart failure?
Every patient with heart failure needs to have a heart function measure taken. Heart function is expressed by a measure called ejection fraction, or EF — the percentage of the blood inside the heart that is pumped out with each heartbeat. Normally this is about 60%.
Three kinds of tests can be used to measure heart function:
¤ ECHO (echocardiogram): Sound waves (ultrasound) are used to look at the heart as it pumps.
¤ MUGA (Radionucleotide Ventriculogram or Multi-Gated Acquisition Scan): Some red blood cells are tagged with a radioisotope dye. As these cells flow through the heart, they show up as an image of the heart on a computer terminal.
¤ CATH (cardiac catheterization): X-ray dye is injected into the heart from a blood vessel. This test is more invasive and is used when more information is needed, such as checking for blockage in coronary arteries.
Play your cards right
Try to avoid behaviors that may lead to a heart attack. If you’ve had a heart attack, take care of yourself to avoid serious complications, troublesome symptoms, and costly unpleasant trips to the hospital:
¤ Check to see if your heart function has been measured.
¤ Know your EF.
¤ Take your medications regularly (ACE inhibitors, diuretics, digoxin, and others).
¤ Follow a heart-healthy diet and avoid sodium.
¤ Get a flu shot every year and make sure you get a pneumonia shot, too. You don’t need the flu and pneumonia on top of heart failure.
¤ Weigh yourself every morning. An increase of two pounds in a day can mean you are retaining fluid and may need more medicine.
¤ Avoid tobacco and alcohol.
¤ Stay active — follow your doctor’s advice about regular exercise. The better your other muscles work, the easier it is on your heart.
¤ Preserve your energy. Don’t stress and strain; pace yourself.
¤ Report signs of worsening heart failure early. Don’t wait to see your doctor in the emergency room.
How is heart failure treated?
Treatments for heart failure are chosen to ease the workload of your heart, to avoid complications, and to prevent further loss of heart function.
¤ ACE Inhibitors (angiotensin converting enzyme inhibitors): These are the mainstay of heart failure treatment. No other medication is as well proven to improve symptoms and reduce the risk of complications and death. Most everyone who has heart failure should be taking ACE inhibitors.
¤ Diuretics: Water pills remove excess fluid by prompting the kidneys to make more urine.
¤ Digoxin (lanoxin, digitalis): These drugs boost the pumping strength of your heart and controls the rate and rhythm of your heartbeat.
¤ Other medications: Those few people who are not suitable for ACE inhibitors can take other medications. Nitrates and hydralazine are alternatives. Angiotensin II receptor blockers (ARBs), certain beta-blockers (carvedilol and metoprolol), and spironolactone can be helpful when ACEs can’t be used or when more than one drug is needed. They may also provide further benefit when used along with ACE inhibitors.
Source: Adapted with permission from Medicare Talk, a publication of Arkansas Foundation for Medical Care, 2201 Brooken Hill Drive, P.O. 180001, Fort Smith, AR 72918-0001. Telephone: (501) 649-8501. Web site: www.afmc.org. The Medicare Beneficiary HelpLine number is 800-272-5528. Medicare Talk recently won the 1999 Banner Award for outstanding ongoing publications from the American Hospital Association.
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