Heart Failure Part 1: What Is Heart Failure?

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One of the most common misunderstandings about heart failure is that the heart suddenly stops beating. The reality is that it happens over a period of time. Early diagnosis of heart failure is critical to managing the disease and extending a patient’s life.

I had the pleasure of discussing heart failure with Eileen Hsich, M.D., director of the Women’s Heart Failure Clinic at the Cleveland Clinic and chair of the WomenHeart Scientific Advisory Council. Dr. Hsich has devoted her medical career to treating, educating, and researching cardiovascular disease in women. In this first part of our talk, we discuss what happens when heart failure occurs, as well common symptoms.

Lisa Nelson, R.D.: One of the most common misunderstandings about heart failure is that the heart suddenly stops beating. What is it that actually occurs during heart failure?

Dr. Hsich: What happens during heart failure is that the heart fails to pump the blood forward properly. The fluid backs up and goes into your lungs. That could be due to a weak heart or a stiff heart. The heart can be strong but stiff and not able to relax. That is what causes the backup of fluid into the lungs.

Lisa: So it is not a sudden stop, but a gradual slowdown of heart function. What are other misconceptions around heart failure?

Dr. Hsich: There are three that I want to discuss. The first misconception is that patients often think that they’re dying. I think that’s very unfortunate. They get that idea because heart failure has the word “failure” in there. I hear that all the time.

They think that it’s a disease that they’re going to die from. In fact, most patients improve on medical therapy. One out of every four fully recovers. I think that’s one misconception. I want people to know that there’s hope.

The second misconception is the fact that women feel that they are alone. And yet, 55 percent of patients with heart failure are women. This affects women and men nearly equally.

The third misconception is the fact that patients and doctors refer to this as one disease, like sometimes we refer to cancer as one disease. With cancer, we know that there are many different types.

With heart failure, we often forget that there are many different causes. High blood pressure, valvular disease, diabetes, as well as heart attacks are common causes. You can have heart failure with a weak heart or a strong heart. All of these factors affect how you do.

Lisa: What is the reason someone with a strong heart might experience heart failure?

Dr. Hsich: It seems like it doesn’t make sense. If the heart is strong, why would you get heart failure? It’s because the heart isn’t relaxing properly. The muscle is pretty stiff. You want it to be like a balloon, when you blow into it, for it to expand and be able to hold more air. In this case, it would be blood. In reality, when you have a stiff heart, it’s more like it’s a glass vase. If you pour too much fluid in there, it spills over. That’s the problem with a stiff heart.

Lisa: Thank you for expanding on why someone with a strong heart may still be at risk for heart failure. What are symptoms of heart failure that people should watch for?

Dr. Hsich: The most common thing that patients complain about when they come to my office is shortness of breath. They will have a cough. Their symptoms persist for weeks. In fact, it can last for months.

Many times, they’ve sought medical attention. They thought they had pneumonia. They’ve tried antibiotics and they don’t get better. They have often gotten steroids for what they thought was asthma, and they don’t get better. If you have a cough and shortness of breath that does not go away, that persists, especially if you sought medical attention and it’s not getting better, then tell your medical provider that it’s not getting better. They will look for other causes. That’s the most common complaint I hear.

You’ll have some patients with swelling of their legs. Swelling of the legs alone may be different things. If it’s swelling with shortness of breath, that’s likely to be due to a heart condition. Some patients, if they have been experiencing this for a long time, can have belly discomfort because the fluid can build up in their belly. If belly discomfort occurs with shortness of breath, then someone needs to seek medical attention.

Editors’ Note: Read the second part of Lisa and Dr. Hsich’s talk  for more crucial information on heart failure, including who is at risk.