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Heart Failure

What Is Heart Failure?

Despite its name, "heart failure" also known as "congestive heart failure" doesn't refer to a condition in which the heart suddenly fails or stops. Instead, it refers to a more gradual decline in the heart's ability to pump blood efficiently. While the heart continues to pump, the blood flow out of the heart slows, causing blood to back up in the veins and fluid to build up (congest) in tissues throughout the body.

Heart failure often results from cardiomyopathy, a group of diseases that can affect the myocardium (heart muscle). There are three types of cardiomyopathy:

  • Dilated cardiomyopathy - an overall enlargement of the heart chambers in response to weakening heart muscles
  • Hypertrophic cardiomyopathy - an overgrowth of heart muscle that can impair blood flow into and out of the heart
  • Restrictive cardiomyopathy - a stiffening of the heart muscle that restricts the hearts ability to pump blood

Whether mild or severe, congestive heart failure is a serious health problem, requiring careful monitoring and treatment.

Are You At Risk?

Hypertension (high blood pressure) is the single greatest risk factor for congestive heart failure. The second greatest risk factor is a previous heart attack that resulted in heart-muscle damage. Additional risk factors include smoking, high cholesterol, diabetes, obesity and physical inactivity.

Any disease that affects the myocardium can eventually lead to heart failure.

Diagnosis

Heart failure usually develops gradually, over many years. It often begins as a mild condition and becomes more severe as the heart becomes less and less efficient. 

If you are experiencing any of the following symptoms, talk to your doctor:

  • Shortness of breath
  • Fatigue or tiring easily
  • Swelling of feet, ankles, legs or abdomen
  • Persistent coughing, raspy breathing or wheezing

Your physician may recommend any or all of the following diagnostic tests:

  • BNP blood test - This test checks the level of a hormone called BNP (B-type natriuretic peptide) that rises in heart failure
  • Cardiac blood pool scan - Using a "dye" injected into a vein, this test shows how well the heart is pumping blood.
  • Cardiac catheterization and angiography - A thin flexible tube called a catheter is passed into the coronary arteries to monitor blood flow and to capture images of the arteries.
  • Chest x-ray - This test can indicate an enlarged heart or fluid in the lungs
  • Echocardiogram - This test uses sound waves to show how well the heart walls are moving, the valves are opening and closing, and the heart is filling with blood and pumping it to the rest of the body
  • Electrocardiogram (EKG or ECG) - This test involves attaching (with adhesive material) small electrodes to the arm, leg and chest to measure the rate and regularity of a heartbeat and to check for heart muscle damage.
  • Exercise stress test - The patient is asked to perform exercise, such as walking on a treadmill, and EKG and blood pressure readings are taken before, during and after exercise to measure changes in heartbeat and blood pressure.
  • Holter monitor - Worn for 24 hours, this test provides a continuous recording of heart rhythm during normal activity
  • Thyroid function test - Test for an overactive or underactive thyroid, which can cause or contribute to heart failure.

Treatment

There is no cure for the most common forms of congestive heart failure, but depending on causes and severity of your condition, the following treatment options may help reduce your symptoms and improve your quality of life:

  • Quitting smoking
  • Losing excess weight
  • Abstaining from alcohol
  • Eating a heart-healthy diet
  • Regular, modest exercise

Management

To assist patients with chronic heart failure management, MidMichigan Health has developed a comprehensive Heart Failure Clinic to help patients monitor responses to treatment, modify behaviors, adjust medications and to coordinate care with their cardiologist and primary care provider.

Medications

  • Beta-blockers to keep the heart rhythm regular by reducing heart rate and blood output
  • Diuretics to reduce fluid retention
  • Digitalis to increase the force of the heart's contractions
  • Angiotensin converting enzyme (ACE) inhibitor to decrease the pressure inside blood vessels, reducing stress on the heart
  • Nitrate and/or hydralazine to relax tension in blood vessels and improve blood flow

MidMichigan offers cardiac rehabilitation services, including supervised, prescribed aerobic training on exercise machines, to help you safely build a stronger cardiovascular system.

If medicines and lifestyle changes do not control your congestive heart failure, your physician may recommend additional measures, including surgery.