10 Questions About Heart Failure—Answered

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We asked doctors to explain what heart failure actually is (hint: it's probably not what you're imagining), the signs to watch for, and most important, what it means to live with this chronic condition.


Does heart failure mean my heart is no longer working?

Actually, while the term heart failure (HF) sounds dire, what it means is that your heart isn’t pumping as well as it should be. HF is a chronic, progressive condition in which the heart muscle can’t pump enough blood and oxygen to adequately meet the body’s needs. It can involve the heart’s left side, right side, or both sides. However, it usually affects the left side first, says Robert Greenfield, M.D., cardiologist and medical director of Non-Invasive Cardiology & Cardiac Rehabilitation at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA.


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What causes heart failure?

Generally, heart failure is caused by uncontrolled high blood pressure, coronary artery disease, a heart attack, and/or hardening of the arteries. Chemotherapy, especially the chemotherapy used for breast cancer, can also prompt the heart muscles to deteriorate. “The risk factors are the same as the risk factors for a heart attack: Smoking, uncontrolled diabetes and obesity,” says Hal Skopicki, M.D., chief of cardiology and director of the Heart Failure and Cardiomyopathy Program at the Stony Brook University Heart Institute in Stony Brook, New York. In rare cases, HF can be caused by a virus or develop after pregnancy.


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Is HF genetic?

While scientists are still working on the answer to this question, there is some evidence that suggests having a family history of HF increases your risk. “If one of your family members has HF, sometimes we can figure out the genetic defect and see if you share it,” says Dr. Skopicki. “There are different types that cause weak or stiffened heart muscles. Every year we’re finding more genes that are involved.”


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Is there a cure for heart failure?

There isn’t a cure, but HF patients can live a full life with proper treatment and making healthy changes to their lifestyle. In fact, the therapies available today have cut the risk of dying from heart failure by 85%, says Dr. Skopicki. Depending on the underlying cause, treatment may involve medication (more on this soon), surgery (for a blocked artery or damaged heart valve), as well as establishing an fitness routine, quitting smoking, and avoiding alcohol and high-sodium foods, which can contribute to fluid retention.


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What are the most common symptoms of heart failure?

Fatigue, swelling in the belly or legs, dizziness, lethargy, and shortness of breath. “You’ll be able to detect the signs,” Dr. Skopicki says. For instance, if you've never had trouble breathing while walking and suddenly find yourself struggling, or if you wake up in the middle of the night short of breath, HF could be to blame.


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How do doctors diagnose heart failure?

Your doctor will do a battery of tests, including a physical exam, an echocardiogram (ECG), which is an ultrasound of the heart, blood tests, which can measure certain hormones and biomarkers that indicate heart damage, a chest X-Ray, and a stress test, says Dr. Skopicki.


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What’s the most important thing to do after an HF diagnosis?

The first goal for your doctor is to figure out why the heart is damaged. “The most common cause is blockages and damage from a heart attack, but HF could be caused by rhythm problems or due to genetic reasons," says John A. Osborne, M.D., Ph.D., director of State of the Heart Cardiology in Dallas and a volunteer expert at the American Heart Association. "And, while the general therapies are going to be similar, if we understand the cause, we can better understand the prognosis.”


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What are the medications people take for heart failure?

There are three classes of drugs that have been shown to help you feel better, restore heart function, and dramatically reduce mortality, Dr. Osborne says.

ACE inhibitors dilate the blood vessels and improve blood flow. They also can lower blood pressure and lessen heart strain.

Beta blockers reduce the workload on the heart, and numerous studies have shown that they can significantly reduce the risk of death.

Diuretics help you maintain a healthy fluid level.


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How often will my doctor want to see me?

Your goal: To have a good relationship with your physician in which you communicate all your concerns as soon as possible. “Early on we’ll usually want to see you every week or two as we adjust your medications,” Dr. Osborne says. “After that phase, we’ll see you every three months and, if you’re doing well, are having no issues, are tolerating the medicines and your symptoms are controlled, we’ll then start to see you every six months.”


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What’s congestive heart failure (CHF)?

Congestive heart failure means that excess fluid is beginning to build in the body, which is also a sign that the heart is weakening even more. Patients may notice a rapid weight gain, shortness of breath, as well as swelling in the abdomen, legs, or feet. If you notice any of these signs, it's important to contact your doctor immediately. “CHF can sound daunting but with the right medications on board and when you watch your diet, your symptoms can be mild to maybe not even detectable,” says Dr. Osborne.