Heart failure, is it All the Same?

Health Professional

Not really. In fact, heart failure is newly diagnosed in more than half a million Americans per year and may be somewhat different for men and women. Most of the time, a physician can make the diagnosis on the basis of symptoms given by the patient. On some occasions, however, it is more difficult to make this diagnosis if there are other problems such as lung disease (asthma, emphysema) present.

First, the symptoms:

- Fatigue - Shortness of breath on exertion - Diminished capacity to exercise - Heavy, swollen legs

Second, the signs:

  • Abnormal heart sounds or heart rhythms
  • Abnormal lung sounds
  • Evidence for fluid in the ankles

Third, the tests:

  • Electrocardiogram or ECG
  • Echocardiogram (ultrasound)
  • Chest X-ray
  • In rare cases: chest CT or MRI
  • Blood work such as "cardiac enzymes" or hormones associated with heart failure

The term "heart failure" makes it sound like the heart is no longer working at all and there's nothing that can be done. Actually, heart failure means that the heart isn't pumping as well as it should be. Your body depends on the heart's pumping action to deliver oxygen and nutrient-rich blood to the body's cells. When the cells are nourished properly, the body can function normally.

With heart failure, the weakened heart can't supply the cells with enough blood and as a result you don't feel as well, or have as much "energy" as you should.

Heart failure is a serious condition; it can certainly limit how long you live and there's usually no cure. But many people with heart failure lead a full, enjoyable life when the condition is managed with medications and healthy lifestyle changes. It's also helpful to have the support of family and friends who understand your condition.

Heart failure can involve the heart's left side, right side or both sides, but it usually affects the left side first. Each side is made up of two chambers: the atrium, or upper chamber; and the ventricle, or lower chamber. The atrium receives blood into the heart, and the ventricle pumps it where it needs to go. Heart failure occurs when any of these chambers lose their ability to keep up with the amount of blood flow.

"Left-Sided" Heart Failure

"Left-sided" or left ventricular failure involves the heart's left ventricle (lower chamber). Oxygen-rich blood travels from the lungs to the left atrium, then to the left ventricle, which pumps it to the rest of the body. Because this chamber supplies most of the heart's pumping power, it's larger than the others and essential for normal function.

When the left ventricle does not contract normally (called systolic failure), it doesn't pump enough blood into circulation. If the ventricle loses its ability to relax normally (diastolic failure) because the muscle has become stiff (diabetes and hypertension are often the cause), it can't properly fill with blood during the resting period between each beat.

In either case, blood coming into the left chamber from the lungs may "back up," causing fluid to leak into the lungs (the technical term for this is pulmonary edema). Also, as the heart's ability to pump decreases, blood flow slows down, causing fluid to build up in tissues throughout the body (edema). This excess fluid or congestion explains the term congestive heart failure, which you've probably heard before.

Right-Sided" Heart Failure

The right atrium receives the "used" blood that returns to the heart through the veins; then the right ventricle pumps it into the lungs to be replenished with oxygen. Right-sided or right ventricular (RV) failure usually occurs as a result of left-sided failure (but may also be seen with blood clots to the lungs, heart attacks and pulmonary hypertension).

When the left ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, damaging the heart's right side. When the right side loses pumping power, blood backs up in the body's veins. This usually causes swelling in the legs and ankles.