Heart Failure: What Does It Mean?

“Heart Failure?  What does that mean,” she asked.  “Does is mean my heart is going to stop beating?” 

Janet was an Italian woman in her mid-fifties.  She had slowly been developing shortness of breath after a prolonged illness.  Soon her legs began to swell. Now she was in the office to review the echocardiogram (a sound wave test that evaluated the function of her heart.)  The test revealed that her heart muscle was moderately weakened. 

“No, your heart isn’t going to stop beating,” I said emphatically.  “And having heart failure isn’t the end of the world,” I replied.

I explained that when a cardiologist tells a person they have heart failure it mean that the heart is failing to pump blood in an effective manner. Heart failure can be mild.  It may be moderate, or it can be severe.  Many different causes of heart failure exist.  In Janet’s case the heart muscle had become weakened due to damage of the muscle fibers.   Muscle damage is one of the chief causes of Congestive Heart Failure. 

The human heart has two distinct phases- contraction and relaxation.  The medical term for contraction is systole.  Relaxation is called diastole.  Heart failure can be caused by abnormal systolic function or abnormal diastolic function.  Systolic heart failure accounts for about 80% of heart failure.  Abnormal relaxation causes the other 20% .  The approach and appropriate treatment for each of the types of heart failure is different. 

For example, in Janet’s case her sound wave test of the heart revealed that the heart’s pumping function was reduced. Because she had only been seen in the office and we didn’t know the exact cause, she was going to need further tests to determine why her heart’s systolic function was abnormal. 

The most common cause of systolic heart failure is coronary artery disease.   Coronary artery disease is an illness where the blood flow to the heart is reduced or stopped because of cholesterol buildup inside the arteries. Coronary Artery Disease or CAD is what causes a heart attack.  CAD is a treatable and even preventable illness.  It is diagnosed with the use of stress tests of various varieties and an invasive test called a cardiac catheterization.

Because the fraction of blood that was being ejected from Janet’s heart (the Ejection Fraction) was moderately reduced I had recommended that she undergo a special imaging stress test called a nuclear stress exam.  Janet’s nuclear stress examination showed that she was suffering from a blocked artery of the heart.

After discussing this with her further, she agreed to have a cardiac catheterization. 
Other causes of systolic heart failure include: high blood pressure, Valvular abnormalities, and a vast number of cardiomyopathies.  Cardiomyopathies are weakening of the heart muscle from infections, toxins, medications, and various illnesses.