Heart Failure
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Heart failure is a condition where the heart cannot
pump enough blood throughout the body.
Heart failure does
not mean that your heart has stopped or is about to stop
working. It means that your heart is not able to pump
blood the way that it should. The heart cannot fill with
enough blood or pump with enough force or both. Heart failure
develops over time as the pumping action of the heart grows
weaker. It can affect the left side, the right side, or both
sides of the heart. Most cases involve the left side where
the
heart cannot pump enough oxygen-rich blood to the rest of the
body. With right-sided failure, the heart cannot effectively
pump blood to the lungs where the blood picks up oxygen.
The weakening of the pumping ability of the heart
causes:
- Blood and fluid to "back up" into the lungs
- The buildup of fluid in the feet, ankles, and legs
- Tiredness and shortness of breath
Heart failure
is a serious condition. About 5 million people in the U. S.
have heart failure and the number is growing. Each year,
another 550,000 people are diagnosed for the first time. It
contributes to or causes about 300,000 deaths each year.
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Heart failure is caused by other diseases or
conditions that damage or overwork the heart muscle. Over time
the heart muscle weakens and is not able to pump blood as well
as it should. The leading causes of heart failure are:
- Coronary
artery disease (CAD)
- High
blood pressure
- Diabetes.
CAD, including angina
and heart
attack, is the most common underlying cause of heart
failure. Persons who have a heart attack are at high risk of
developing heart failure. Most people with heart
failure also have high blood pressure and about 1 in 3 has
diabetes.
Other Causes of Heart Failure
Other heart diseases and conditions that can lead to
heart failure are:
- Cardiomyopathy (a disease of the heart
muscle)
- Diseases of the heart valves
- Abnormal heartbeats or arrhythmias
- Congenital heart disease (a heart defect or
problem you are born with).
Other conditions that
may injure the heart muscle and lead to heart failure include:
- Treatments for cancer such as radiation and certain
chemotherapy drugs
- Thyroid disorders-having either too much or too little
thyroid hormone in the body
- Alcohol abuse
- HIV/AIDS
- Cocaine and other illegal drugs use.
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Heart failure can happen to anyone, but it is more common
in:
- People 65 years of age and older
- African Americans.
Heart failure is very common in persons 65 years of age and
older. It is the number one reason for a hospital visit in
this group.
Blacks are more likely to have heart failure and suffer
more severely from it. Blacks are more likely to:
- Develop symptoms at an earlier age
- Have their heart failure get worse faster
- Have more hospital visits
- Die from heart failure.
Men also have a higher rate of heart failure than women.
But in actual numbers, more women have heart failure because
many more women live into their 70s and 80s when heart failure
is common.
Children with congenital heart disease can also get heart
failure. Congenital heart disease happens when the heart,
heart valves, and/or blood vessels near the heart do not
develop correctly in babies when they are in the womb. This
can weaken the heart muscle and lead to heart failure.
Children do not have the same symptoms or get the same
treatment for heart failure as adults and will not be
discussed here.
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The most common signs and
symptom are:
- Shortness of breath or difficulty breathing
- Feeling tired
- Swelling in the ankles, feet, legs, and sometimes the
abdomen.
Shortness of breath and feeling tired
are caused by the buildup of fluid in the lungs and around
the lung (pleural effusions). When
symptoms start, you may feel tired and short of breath after
routine physical exertion. Climbing two flights of stairs
makes you feel winded. As heart failure progresses, the
symptoms get worse. You may begin to feel tired and short of
breath after simple activities, like getting dressed or
walking across the room. Some people have shortness of breath
when lying flat.
Fluid buildup in the lungs can
also cause a cough. The cough is worse at night and when
you are lying down. Excessive fluid in the lungs can cause a
life-threatening condition called
acute pulmonary edema. This condition requires
emergency treatment.
The swelling is from the
buildup of fluid in your body (edema). Other signs of
fluid buildup are:
- Weight gain
- Frequent urination.
Limitation on Physical
Activity Doctors also classify your symptoms based
on how much they limit your daily activity. By class of
symptom, your doctor means:
- Class 1: No limits--ordinary physical activity does not
cause undue tiredness or shortness of breath.
- Class 2: Slight or mild limits--comfortable at rest,
but ordinary physical activity results in tiredness or shortness of breath.
- Class 3: Marked or noticeable limits--comfortable at
rest, but less than ordinary physical activity causes tiredness or shortness
of breath.
- Class 4: Severe limits--unable to carry on any physical
activity without discomfort. Symptoms are also present at rest. If any physical
activity is undertaken, discomfort increases.
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The goals of treatment are to:
- Treat the underlying cause of your heart failure
- Improve your symptoms and quality of life
- Stop your heart failure from getting worse.
- Prolong your life span
Your doctor will continue
to treat the underlying diseases or conditions (such as CAD,
high blood pressure, or diabetes) that caused heart failure.
The treatment for heart failure includes:
- Lifestyle changes
- Medications
- Specialized care for those in the most advanced stage.
Lifestyle Changes There are things
that you can do to help with your treatment. Your doctor will
recommend that you:
- Follow a diet low in salt. Salt can cause extra fluid to
build up in your body making your heart failure worse.
- Limit the amount of fluids that you drink.
- Weigh yourself every day and let your doctor know right
away if you have a sudden weight gain. This could mean you
have extra fluid building up in your body.
- Exercise as directed to help build up your fitness level
and ability to be more active.
Your doctor will also
tell you to:
- Lose weight if you are overweight
- Quit smoking if you smoke
- Limit the amount of alcohol that you drink.
Medications Your doctor will
prescribe medicines to help improve your heart function and
symptoms. The main medicines are:
- Diuretics (water or fluid pills) to help
reduce fluid buildup in your lungs and swelling in your feet
and ankles.
- ACE inhibitors to lower blood pressure and
reduce the strain on your heart. These medications also may
reduce the risk of a future heart attack.
- Beta blockers to slow your heart rate and
lower your blood pressure to decrease the workload on your
heart.
- Digoxin to make the heart beat stronger and
pump more blood.
Specialized Care for Severe
Disease As the disease progresses, lifestyle
changes and regular medications may not be enough to control
worsening symptoms. Many people with severe heart failure must
be put in the hospital from time to time for treatment. In the
hospital, your doctor may prescribe new or special medicines.
You continue to take your regular medicines during this
treatment. Your doctor will also order extra oxygen if
you continue to have trouble breathing. The extra oxygen can
be given in the hospital and at home. Persons with
very severe heart failure may be considered for a:
- Mechanical heart pump
- Heart transplant.
A
heart pump is a
special device placed inside the body to help pump blood to
the rest of the body. There are different kinds of heart
pumps. Some stay in the body for a short period of time, while
others can stay in the body for a long time. Many people with
a heart pump will also be considered for a heart transplant.
A
heart transplant is surgery to replace the
heart of a patient with heart failure with a healthy heart
from someone who has recently died. A transplant is indicated
in some people when all other treatments fail to control
symptoms.
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The major underlying causes of heart failure are CAD
(including angina and heart attack), high blood pressure, and
diabetes. The
section "What Causes Heart Failure?" lists all the likely
causes. Getting treatment and staying in treatment for any
underlying condition that you have can greatly reduce your
risk. Other things you can do reduce your risk
include:
- Eating a heart-healthy diet low in salt, saturated fat,
and cholesterol.
- Quitting smoking if you smoke.
- Losing weight if you are overweight.
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