When the Heart Fails
Understanding the basics of heart failure can help you feel more in control—and less afraid. Find out more about the different types, how they’re diagnosed, and what the best treatment options are. by Andrea Peirce Senior Editor
Heart failure (HF) is one of those conditions that sounds absolutely terrifying. If your heart fails you, then what’s next, right? But despite its ominous name, heart failure actually means the heart isn’t pumping blood as well as it should. While it can’t be cured, HF can be treated and well-managed. And that’s great news given that as many as one in five Americans get this diagnosis, according to the American Heart Association.
There are several potential reasons the heart may weaken, including coronary-artery disease, high blood pressure, or diabetes. Other risk factors include being overweight or obese, smoking, and getting little or no exercise. And sometimes, it can develop after an infection.
Three Types of Heart Failure
The heart has awesome responsibilities. It’s a critical muscle that moves oxygenated blood from the lungs to the left atrium (one of the four chambers of the heart) to the left ventricle (one of the two lower chambers of the heart). The left ventricle pumps this blood to the rest of the body.
Heart failure can happen when there’s weakness on one or both sides of the heart. Most people have left-sided heart failure, which makes sense if you think of the particularly hard job the left side has in delivering blood to the body. In fact, because of the hard work it does 24/7, the left ventricle tends to be the largest of the four chambers of the heart. The right atrium and ventricle do the opposite: They take the used blood from the veins and pump it to the lungs, which release fresh oxygen. When the heart begins to weaken, it usually occurs in one of these three ways:
Left-sided or left-ventricle HF In this case, the left side of the heart tries to compensate for poor performance by the rest of the muscle, and it can start to fail in two ways:
Systolic failure or heart failure with reduced-ejection fraction The left ventricle is unable to contract normally due to some muscle injury. This results in the heart’s inability to push enough blood into circulation.
Diastolic failure or heart failure with preserved ejection fraction In this case, the left ventricle doesn’t relax normally between beats because part of the muscle has become stiff. This inflexibility increases pressure within the heart, leading to shortness of breath. It also prevents the heart from completely filling during the rest periods, thereby reducing blood flow.
Right-sided heart failure With this type, there’s a weakening in the chambers responsible for pumping old blood back to the lungs for oxygenation. In many cases, the right side of the heart is unable to pump efficiently because the left side is weak.
Congestive heart failure Although the terms “heart failure” and “congestive heart failure” are sometimes used interchangeably, they’re not quite the same. Congestive heart failure is a more urgent and dangerous development because of the pressure it puts on the organs, warns the American Heart Association.
Congestive heart failure refers to an excessive build-up of fluids in the body, sometimes referred to as “edema.” This can occur with left- or right-sided heart problems. Because the heart isn't pumping well, blood inevitably backs up into the body, leading to fluid buildup or “congestion” in the lungs, legs or feet. It can also pool in the abdomen, affecting the functioning of the gastrointestinal tract and the liver. Too much abdominal fluid in this area is known as “ascites.”
With congestive heart failure, you may notice swelling in your legs and ankles. Fluid can also build up in your lungs and cause shortness of breath, especially if you’re lying down. Congestive heart failure can, at a certain point, interfere with the kidneys as well.
Warning Signs of Heart Failure
See a doctor to get evaluated if you develop more than one of the following signs or symptoms:
Shortness of breath
Chronic coughing or wheezing
Swelling in the legs and feet
Fatigue or light-headedness for unknown reasons
Nausea or lack of appetite for unknown reasons
Confusion or impaired thinking
Fast heart rate
How Heart Failure Is Diagnosed
After learning about your medical history and symptoms and completing a physical exam, the doctor may order some tests to determine if you’ve developed heart failure. They include:
Blood tests that measure levels of sodium in the blood; low levels (known as hyponatremia) can mean there’s too much water in your blood—which affects your heart’s ability to function normally. The amount of potassium in the blood is measured as well, since low levels have been linked to stroke, high blood pressure, and heart disease. Doctors also check the blood for levels of albumin, creatinine, and other biomarkers that can indicate heart damage.
Chest x-ray to see if there is fluid in the lungs, or enlargement of the heart, which can indicate that parts of the muscle are working overtime to keep things going
Electrocardiogram (EKG or ECG) to see if there are abnormal heart rhythms, signs of a heart attack, or if the heart is enlarged, a sign that it’s working overtime to keep up
Echocardiogram, which is an ultrasound test that allows doctors to examine the heart’s structure, motion, and contraction
Exercise stress test to see how your heart responds to the demands of exercise as well as to check for blockages in the arteries
Multiple-Gated Acquisition Scanning (MUGA scan) is a type of nuclear-imaging scan that shows how well the chambers of the heart are working, how complete the blood supply to the heart is, and whether there are signs of heart attack
Cardiac catheterization, in which a thin tube is inserted in an artery or vein in your neck groin, or arm, and up into your heart with the goal of finding and possibly open blockages in blood vessels to the heart
Magnetic Resonance Imaging (MRI) to see the structure of the heart and assess how well blood is flowing through major vessels, as well as within the heart itself
Treatments for Heart Failure
There are several ways to treat heart failure, but the best approach is to avoid heart failure by eating a healthy diet, exercising, and not smoking. Even then, some people develop heart failure and based on results from your evaluation, your doctor may recommend:
Making changes in the way you live (diet, exercise, stress reduction, healthier sleep patterns)
Starting medications such as beta blockers to lower blood pressure, diuretics (“water pills”) to lessen fluid buildup and lessen strain on the heart, and blood thinners to reduce the risk of clots, among many others. Various drugs can treat different symptoms and factors that contribute to heart failure. It’s important to understand the purpose of each medication and commit to taking them as prescribed.
Having surgery to correct issues that might be contributing to the heart failure, such as implanting a cardiac defibrillator (and/or a pacemaker) or left-ventricular assist device (LAVD), undergoing or heart-valve replacement, angioplasty, or coronary artery bypass.
This is all to say that if you’re diagnosed with heart failure, you have options. How long you live with ultimately depends on many factors, including how sick you are when you get the diagnosis. According to the Heart Failure Society of America, about half of people with heart failure will live at least five years. But remember, each person is unique. People who are careful about taking their medicines, have good kidney function, healthy blood-sugar levels—and who live a healthy lifestyle—typically have a much better outcome. And that’s worth fighting for.