Severe fatigue and
or rapid heartbeat.
of breath and wheezing after limited physical exertion. In advanced
cases shortness of breath occurs even at rest, and attacks of
severe breathlessness disturb sleep (left-sided failure).
or cough that produces frothy or bloody sputum (left-sided failure).
urination during the night (right-sided failure).
of the ankles and feet, or swelling in the lower back if the
patient is bedridden (right-sided failure).
gain due to fluid retention (right-sided failure).
pain and a feeling of fullness (right-sided failure).
neck veins (right-sided failure).
appetite (anorexia); nausea and/or vomiting.
feeling of poor health.
in severe cases irritability, restlessness, and mental confusion
When To Call Your Doctor
an ambulance immediately if you experience severe breathlessness.
an ambulance if you experience crushing chest pain with or without
nausea, vomiting, profuse sweating, breathlessness, weakness,
or intense feelings of dread. Such symptoms may indicate a heart
an appointment with a doctor if you regularly experience fatigue
and shortness of breath after mild physical activity.
a doctor if you experience any of the following during treatment
for heart failure: fever, rapid or irregular heartbeat, wheezing,
severe shortness of breath, or any worsening of the other symptoms
of heart failure.
What Is It?
Heart failure is a serious condition marked by
the inability of the heart to pump enough blood to meet the bodys
oxygen demands. Heart failure can result from either a reduced
ability of the heart muscle to contract or from a mechanical
problem that limits the ability of the hearts chambers
to fill with blood. When weakened, the heart is unable to keep
up with the demands placed upon it; blood returns to the heart
faster than it can be pumped out so that it gets backed up or
congestedhence the name of the disorder.
The heart attempts to compensate in a number of
ways. It beats faster and expands somewhat more than usual as
it fills with blood, so that when it contracts, more blood is
forced out to the body. In addition, the decreased volume of
blood reaching the kidneys causes them to stimulate a hormonal
cascade called the renin-angiotensin system, which results in
the retention of sodium and water. These efforts help meet the
bodys demands in the short term, but they ultimately have
deleterious long-term effects. Faster beating allows less time
for the heart to refill after each contraction, and less blood
ends up being circulated. Also, the extra effort increases the
heart muscles demand for oxygen; if this need is not met
adequately, heart rhythm can become dangerously erratic and ultimately
Heart failure can occur in the left side of the
heart, the right side, or both sides. Left-sided failure is most
common. It leads to increased pressure in the pulmonary veins
in the lungs, which forces fluid into the surrounding alveoli,
the microscopic air sacs that transfer oxygen to the blood. As
the alveoli fill with fluid, they no longer function properly,
which limits the amount of oxygen available to the body and produces
the most characteristic symptoms of heart failure: fatigue and
shortness of breath. In right-sided failure, the increased pressure
in the veins returning blood to the heart from the rest of the
body combined with the compensatory retention of sodium and water
leads to fluid accumulation and swelling in the abdomen, liver,
Heart failure should not be confused with a heart
attack, which involves sudden death of the heart muscle. Although
heart failure may occur suddenly in some cases, gradual loss
of function is more common. Fatigue, shortness of breath on exertion,
and increased frequency of nighttime urination develop and worsen
over time. Shortness of breath is often worse when lying downa
condition known as orthopneaas fluid from the legs pools
in the lungs. Elevating the head with pillows eases chest congestion,
but in advanced stages the patient may be unable to recline at
all without severe breathlessness, and may need to sleep upright
in a chair.
Heart failure occurs most frequently in those over
age 60 and is the leading cause of hospitalization and death
in that age group. In over 50 percent of cases, sudden death
occurs due to an arrhythmia, an irregular heartbeat. Unfortunately,
antiarrhythmic medications may not be effective in controlling
arrhythmias caused by heart failure.
There is no cure for heart failure, although measures
are taken to treat the underlying cause, if possible. Restricted
salt intake and medication are used to ease the strain on the
heart and to relieve symptoms. Heart failure is a serious health
risk; for many patients the outlook is uncertain and depends
on the extent of the disease and the patients response
to therapy. However, with proper treatment it is possible for
many patients to live with heart failure and to manage many symptoms
effectively. It is important that patients adhere to prescribed
treatment regimens; noncompliance with a doctors recommendations
regarding diet or medication increases the risk that the disease
What Causes It?
disease (obstruction of the coronary arteries by atherosclerotic
plaque) often leads to a heart attack, which damages the heart
muscle and causes heart failure.
injury due to viral infections or long-term drug or alcohol use
may result in heart failure.
o Conditions that overwork the heart may lead to heart failure. Such conditions
include heart valve defects, high blood pressure, increased levels of thyroid
hormones, and anemia.
of the heart muscle by other tissue, as occurs in a disorder
called amyloidosis (accumulation of a waxy substance), may cause
the development of heart failure in a weakened heart include
pulmonary embolism (a blood clot in the lungs), severe bacterial
or viral infections, pregnancy or childbirth, and physical overexertion.
heart failure commonly results from left-sided heart failure.
may result from restricted entry of blood into the heart due
to thickening of the tissue surrounding the heart or to accumulation
of excessive fibrous tissue in the heart muscle.
more than two alcoholic beverages a day.
Eat a healthy,
balanced diet low in salt and fat, exercise regularly, and lose
weight if you are overweight.
Adhere to a
prescribed treatment program for other forms of heart disease
that you have been diagnosed with.
and physical examination.
Blood and urine
(ECG) may be performed to measure the electrical activity of
the heart. ECG abnormalities can indicate rhythm disturbances,
heart muscle damage, inadequate blood flow to segments of the
heart, and enlargement of the heart muscle. You may be given
a portable ECG device, known as a Holter monitor, to measure
the hearts electrical activity over a 24-hour period.
testing, in which blood pressure, heart rate, ECG, and oxygen
consumption rates are measured while you walk on a treadmill.
which uses sound waves to produce images of the heart, may be
may be performed to evaluate narrowings of the coronary arteries.
In this procedure a tiny catheter is inserted into an artery
in the groin and threaded up to the coronary arteries. A contrast
material is then injected, which provides a clear image of the
blood vessels when x-rays are taken.
will advise you to reduce your salt intake (salt contributes
to fluid retention and swelling) and to eat smaller, more frequent
meals (less effort is required to digest smaller portions).
may exacerbate heartbeat irregularities, should be avoided.
such as hydralazine and ACE inhibitors (for example, captopril
and enalapril), may be prescribed to dilate blood vessels, thus
reducing blood pressure and easing blood flow.
of diuretics, such as hydrochlorothiazide, metolazone, furosemide,
or bumetanide, are prescribed to help eliminate excess fluid
from body tissues.
may be prescribed to strengthen contractions of the heart muscle.
(In the United States digoxin is the most commonly prescribed
type of digitalis.)
including anticoagulants such as warfarin, beta-blockers such
as carvedilol, calcium channel blockers such as amlodipine, and
tranquilizers such as diazepam, may be prescribed to improve
blood flow, ease breathing, and relieve anxiety.
support stockings that reduce swelling in the legs may be prescribed.
In severe cases
it may be necessary to administer oxygen through a nasal tube.
Mechanical devices for administration of oxygen are available
for home use after the condition has stabilized in the hospital.
be required to repair or replace heart valves or bypass blocked
transluminal coronary angioplasty (PTCA; insertion and then inflation
of a small balloon in an obstructed coronary artery via a catheter)
may be performed to widen the artery and improve blood flow.
A heart transplant
may be advised if the heart muscle has been badly damaged. The
survival rate for this surgery is 85 percent after one year and
65 percent after five years.
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