Heart Failure: Symptoms, Causes, and Types
What Is Heart Failure?
Heart failure occurs when your heart is unable to pump an adequate supply of blood to the body. It may require ongoing treatment to keep your body's major functions working properly.
Approximately 6.2 million people have heart failure in the United States, according to the Centers for Disease Control and Prevention (CDC).
Heart failure often happens when there is a problem with the ventricles, which are two chambers located in the lower part of your heart. They're responsible for pumping blood out of your heart.
Heart failure can be classified by the side of the heart that's affected (left or right). Both sides are often affected.
Congestive heart failure (CHF) is sometimes used synonymously with heart failure since the symptoms of both right- and left-sided heart failure include congestion.
In right-sided heart failure, there is congestion with fluid buildup in the abdomen and lower extremities. In left-sided heart failure, fluid builds up in the lungs.
Heart failure is a serious health condition that requires immediate medical treatment. Early treatment decreases your risk of complications over time.
The most common symptoms of heart failure include:
Other symptoms of heart failure may include:
Heart failure is a chronic condition. This type of condition requires ongoing, lifelong management.
However, you may experience acute heart failure, which is when symptoms come on suddenly. This is sometimes referred to as heart failure exacerbation or flares.
It may happen as an initial symptom when heart failure is diagnosed for the first time. Or, it may happen on top of chronic heart failure when your symptoms worsen.
Since heart failure may affect either side of the heart, the types of heart failure are right-sided heart failure and left-sided heart failure. Both types lead to the activation of hormones and the nervous system, which causes the body to retain fluid, leading to symptoms of congestion.
Left-sided heart failureLeft-sided heart failure occurs when the left ventricle in the bottom left of your heart doesn't pump blood out efficiently. Heart failure in this ventricle prevents your body from getting enough oxygen-rich blood.
There are two types of left-sided heart failure:
Systolic heart failure is more common in males. Diastolic heart failure is more common in females.
Right-sided heart failureThe right ventricle is located in the bottom right side of your heart. It's responsible for pumping blood to your lungs to collect oxygen.
Left-sided heart failure usually triggers right-sided heart failure. The accumulation of blood in the lungs makes the right ventricle work harder. This can stress the right side of the heart and cause it to fail.
Heart failure happens when your heart muscle gets weak or stiff. This may then block or reduce blood flow to the heart.
The most common cause of heart failure is coronary artery disease (CAD). It happens when fatty deposits build up in your arteries, reducing the supply of blood and oxygen to the heart.
Other conditions that may increase your risk of developing heart failure include:
Certain behaviors may also increase your risk of developing heart failure, including:
A will doctor start by performing a physical exam and assessing your medical history to check for signs of heart failure.
They may also use an echocardiogram. This test is the most effective way to diagnose heart failure. It uses sound waves to create detailed pictures of your heart. An echocardiogram can help a doctor evaluate the damage to your heart and how it's functioning.
Other tests to help diagnose heart failure or its underlying causes include:
Treating heart failure depends on the severity of your condition and the type of heart failure you have.
Early treatment can improve symptoms fairly quickly. However, you should still get regular testing and follow up with a healthcare professional at least every 6 months.
The main goal of treatment is to increase your life span, prevent complications, and improve your quality of life.
MedicationMedications may treat early stages of heart failure. They can help relieve your symptoms and prevent your condition from worsening.
Certain medications are prescribed to:
These medications can include:
Speak with a doctor before taking new medications. People with heart failure should avoid some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve, Naprosyn) and ibuprofen (Advil, Motrin). These can worsen fluid retention in heart failure.
SurgeryYou may require surgery if you have heart failure. Options include:
You may require surgery to implant a device to help monitor your heart rhythm.
PacemakersThese small devices are placed into the chest to help control heart rhythms. They may slow your heart rate when the heart is beating too quickly or increase your heart rate if it's beating too slowly.
Biventricular pacemakers are sometimes used for cardiac resynchronization therapy. These may help your heart chambers pump in sync.
Left ventricular assist device (LVAD)An LVAD helps your left ventricle pump blood out to the rest of your body.
Implantable cardioverter defibrillator (ICD)This battery-powered device keeps track of your heart rate. It shocks your heart if it detects an abnormal heart rhythm. This restores the heart rate to a normal rhythm.
Doctors suggest an ICD for people with an ejection fraction of less than 30–35%. An ejection fraction refers to how much blood your heart pumps out of the left ventricle with each contraction. A normal range is 55–70%.
Some lifestyle measures can help treat heart failure and prevent the condition from developing.
These may include:
Untreated heart failure can eventually lead to CHF, which could be life threatening. This is when blood builds up in other areas of your body. You may experience fluid retention in your limbs and organs, such as the liver and lungs.
Additional complications of heart failure include:
Yes, and early diagnosis gives your doctor more time to find the best treatment for you and gives you time to treat the condition before it becomes critical. Early diagnosis involves recognizing the sometimes subtle signs and the main symptoms of heart failure:
Other signs and symptoms may include:
Yes. A B-type natriuretic peptide (BNP) blood test measures the levels of a hormone called the BNP hormone in your blood.
BNP helps keep your veins and arteries dilated and has a role in keeping salt and fluid balance in the body. If you have heart failure, your heart produces more BNP, and it's visible on a BNP blood test.
What's the most accurate test for congestive heart failure?Congestive heart failure is diagnosed using a combination of history and physical examination, blood testing, and imaging tests. Imaging tests provide details about the type and cause of heart failure.
An echocardiogram is performed to look at the heart's structure and function. This test uses sound waves to produce pictures of the heart. Cardiologists can look at the heart's structure, including heart muscle, chambers, and valves, along with the heart's pumping and filling.
Other tests that cardiologists may use to investigate heart failure include stress echocardiogram, nuclear imaging, cardiac magnetic resonance imaging (MRI), and cardiac computed tomography (CT).
What are possible signs your heart is quietly failing?Heart failure may not cause obvious signs or symptoms initially. Some people may have vague or quiet signs and symptoms that come on slowly, making it hard to recognize a problem.
Some of these subtle signs include:
If you notice these, contact a doctor for a checkup.
What are the 4 stages of heart failure?The four stages of heart failure are A, B, C, and D. These refer to the severity of symptoms and how your heart is functioning as your condition progresses:
The authors of a 2019 review of studies found that approximately 60% of people were alive 5 years after their chronic heart failure diagnosis. After 10 years, approximately 1 in 3 people were still alive.
Survival rates are just estimates. Your outlook depends on several factors, such as age, lifestyle habits, other medical conditions, and stage at diagnosis.
What are the serious signs of heart failure?The most common signs of heart failure include:
For someone with heart failure, any progression of symptoms is serious. Contact your cardiologist if you notice worsening symptoms. Some particularly concerning symptoms include:
Congestive heart failure (CHF) is another term used for heart failure. It emphasizes the congestion that occurs due to a backup of blood flow, which causes fluid retention, swelling, and pulmonary edema (fluid in the lungs).
Heart failure happens when your heart is unable to pump enough blood throughout your body.
It's typically a chronic condition that requires ongoing treatment to prevent complications and increase your quality of life.
Your outlook and treatment of heart failure varies depending on the type of heart failure you have. Early treatment is key in preventing the most serious cases of heart failure.
Ejection Fraction: How Is It Measured?
Ejection fraction (EF) measures the amount of blood pumped out of your heart's lower chambers, or ventricles. It's the percentage of blood that leaves your ventricle when your heart contracts. The term usually refers to just the left ventricle.
Measuring your ejection fraction can help doctors figure out whether you have certain heart problems, especially one type of heart failure. Despite the scary-sounding name, heart failure doesn't mean your heart stops; it just means it can't pump as much blood as your body needs. Your ejection fraction will also help the doctor decide which treatments are best for you and whether your treatment is working.
Left Ventricular Ejection Fraction (LVEF)
Your left ventricle pumps blood that's been enriched with oxygen through your aorta to the rest of your body. The LVEF can show the extent of damage from a heart attack, long-term high blood pressure, left-sided heart failure, or chemotherapy.
Right Ventricular Ejection Fraction (RVEF)
Your right ventricle takes blood that's come back to your heart and pumps it into your lungs where it picks up oxygen. Your doctor will measure RVEF if you have right-sided heart failure, which is less common.
If your heart is healthy, your EF should be between 55% and 70%. Below 50% is a sign of a problem. Below 40% could indicate heart failure. (Photo Credit: Claus Lunau/Science Source)
There are a few ways your doctor can find out your EF percentage. You'll probably have one of these tests:
Your ejection fraction is a percentage. It's calculated by dividing the volume of blood pumped out of the ventricle each time your heat beats (called stroke volume, or SV), by the total amount of blood in the ventricle (called end-diastolic volume, or EDV). Then you multiply the result by 100.
The formula looks like this: EF = (SV/EDV) x 100.
Many doctors consider a normal ejection fraction to be 55%-75%. If yours is 50% or lower, it's a sign that your heart--usually your left ventricle--may not pump out enough blood.
There's a gray area when your EF is between 50% and 55%. Some experts call this borderline.
A normal EF doesn't always mean your heart is healthy. You could have heart failure with preserved ejection fraction (HFpEF). It happens when your heart muscle thickens to the point that the left ventricle holds less than the usual amount of blood. Even if that chamber pumps the way it should, it doesn't release as much oxygen-rich blood as your body needs.
HFpEF Causes
The health conditions that can lead to HFpEF include:
It's more common in women, smokers, and older people.
HFpEF Treatment
Medication options include diuretics and other medicines that lower your blood pressure.
If your doctor says your ejection fraction is too low, under 50%, it means there may be a problem with your heart.
With a low ejection fraction, you might have symptoms like:
A low ejection fraction could be a sign of a condition such as:
Medications can raise your ejection fraction and make you feel better. Your doctor may suggest:
You might also need to make lifestyle changes such as:
A device like an implantable biventricular pacemaker or cardiac defibrillator can help your heart work better. It may also help some people who have a low EF live longer.
What to ask your doctorTake an active role in your health, especially if you have a low EF. Keep up with your appointments. Have your doctor explain your condition and treatment options. Here's a list of questions you may want to ask:
If your ejection fraction is higher than 75%, it could be a sign of a condition called hypertrophic cardiomyopathy. It causes the walls of your heart to beat harder. They become thick and stiff, and your heart doesn't take in or pump out as much blood as usual.
Can ejection fraction improve in 3 months?
Yes. If you get treatment, like medication and exercise, for the problem that's causing your injection fraction to be low, you can see improvement within 3 months.
What is the lowest ejection fraction you can live with?
According to experts, you can survive if your ejection fraction is as low as 5%. But your life expectancy at that point is quite low.
How serious is a 25 ejection fraction?
It's very serious. With an EF of 25% or lower, your heart function is considered seriously impaired.
Calculator Can Help Tailor Treatment During, After Heart Pump Placement
MONDAY, Feb. 5, 2024 (HealthDay News) — The right ventricular failure (RVF) risk score, STOP-RVF calculator, can predict RVF after durable left ventricular assist device (LVAD) placement, according to a study published online Jan. 31 in JAMA Cardiology.
Iosif Taleb, M.D., from the University of Utah Health and School of Medicine in Salt Lake City, and colleagues derived and validated a risk model to predict RVF after LVAD implantation. Patients with advanced heart failure enrolled at five institutions were included in the derivation cohort (798 patients); patients enrolled at a sixth institution were included as the external validation cohort (327 patients). Several techniques were used to derive a predictive model; the RVF risk calculator (STOP-RVF) was developed and validated externally.
The researchers found that RVF developed in 24.2 and 32.7 percent of patients in the derivation and validation cohorts, respectively. Preimplant variables associated with postoperative RVF included nonischemic cardiomyopathy, intra-aortic balloon pump, microaxial percutaneous left ventricular assist device/venoarterial extracorporeal membrane oxygenation, and LVAD configuration. Model performance was not improved with inclusion of intraoperative variables. The C-statistic for the calculator was 0.75 and 0.73 in the derivation and validation cohorts, respectively. Patients comprising the low-risk group (estimated <20 percent RVF risk) had higher cumulative survival than those in the high-risk group. The STOP-RVF risk score exhibited significantly better performance than commonly used risk scores.
"The calculator could impact the selection of patients with both acute and chronic advanced heart failure undergoing advanced therapies evaluation, as well as assist in their perioperative optimization to reduce RVF-related morbidity and mortality," the authors write.
Several authors disclosed ties to the pharmaceutical and medical device industries.
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