With heart failure, the heart is unable to pump the right amount of blood throughout the body. This causes blood to back up in the veins. It can lead to a buildup of excess fluid in the lungs, feet, and elsewhere. Heart failure can worsen with time. Vital organs can be damaged from low blood flow. Doctors are often aggressive in treating heart failure to try to prevent worsening and damage to other organs.

Blood Flow through the Heart

Causes

The leading causes of heart failure are:

Coronary artery disease (CAD)
Heart attack

Other common causes include:

Problems with the heart's valves due to:
- Rheumatic heart disease
- Bacterial endocarditis
- Congenital defects
- Calcium deposits from atherosclerosis
High blood pressure
Diabetes

Other less common causes include:

Cardiomyopathy—weakened, damaged heart muscle
Certain medications
Abnormal heartbeats—arrhythmias
Hyperthyroidism—overactive thyroid
Amyloidosis
Kidney failure and/or liver failure
Thiamine (vitamin B1) deficiency

Risk Factors

Heart failure is more common in older adults. Other things that increase the risk of heart failure include:

Obesity
Excess intake of salt and fat
Excess alcohol intake
Smoking
Pregnancy
High fever
Severe infection, such as pneumonia
Chronic lung disease—emphysema
Chemotherapy
Psychological disorders, such as depression or anxiety

Symptoms

Heart failure can cause:

Shortness of breath—at first only with activity, then progressing to shortness of breath at rest
Unexplained weight gain
Swelling of feet, ankles, or legs
Need to sleep propped up
Fatigue, weakness
Wheezing
Cough—may be dry and hacking or wet sounding, may have a pink, frothy sputum
Frequent urination, especially at night
Abdominal pain

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The doctor may note changes caused by heart failure such as fluid build up in legs. They may also hear abnormal sounds when they listen to the heart. Blood tests may be done to look for certain markers of change in the heart.

Tests can help to show what areas of the heart are affected. They can also show changes in blood flow. This can be done with:

Doctors will use the test results to determine level of heart failure. This will help guide treatment plan.

Treatment

Heart failure will need lifelong care. The goal is to prevent worsening of symptoms. Treatment can ease symptoms and improve quality of life. Some may also have some improvement in heart strength.

Treatment will vary by person and over time. A care plan will require input from patient and care team. Tracking weight and symptoms everyday will help to catch changes early. Fast treatment of changes may reduce worsening and other problems.

Heart failure may be caused by another health issue. Treating this issue may improve heart failure or prevent it from getting worse. For any form of heart failure, treatment may include:

Medications

Medicine can help to ease workload on the heart. They may include:

Angiotensin-converting enzyme (ACE) inhibitors—to widen blood vessels
Digoxin (digitalis)—to help the heart pump
Beta-blockers—to slow heart rate and lower blood pressure
Diuretics—to remove excess fluid
Nitrates—to dilate the blood vessels

Medicine may also be give to treat other heart issues like high blood pressure or high cholesterol.

Lifestyle Changes

Day to day habits can affect heart health. Some changes may help ease stress on the heart. Changes may include:

Quit smoking.
Eating a heart healthy diet. Should be low in fat and high in fiber, vegetables and fruits. Salt intake may also need to be reduced.
Regular physical activity.
Weight loss if needed.
Avoiding alcohol or recreational drugs that may stress the heart.
Manage and reduce stress.

Heart Support and Surgery

Heart failure may cause or be worsened by rhythm problems of the heart. A defibrillator or pacemaker may be implanted. They give electrical shocks if the heart starts dangerous rhythms.

Other devices can help support the heart. They may be needed short term to help recover from an injury or illness. They may also support the heart in last stages of heart failure until a transplant can be done. These devices increase the amount of blood pumped to the body without increasing workload on the heart. Examples include:

Intra-aortic balloon pump (IABP)
Ventricular assist device

A heart transplant may be needed for severe heart failure, if all other treatment has failed.

Prevention

The best way to prevent heart failure is to reduce your risk of heart disease, high blood pressure, and diabetes. General steps include:

Regular physical activity.
Quit smoking.
Limit alcohol.
Lose weight if needed. Maintain a healthy weight.
Eat a healthy diet.

RESOURCES:

American Heart Association
http://www.heart.org

Heart Failure Association of America
http://www.hfsa.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

References:

Congestive heart failure and congenital defects. American Heart Association website. Available at:
...(Click grey area to select URL)
Accessed September 14, 2020.

Explore heart failure. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/hf. Accessed September 14, 2020.

Heart failure with reduced ejection fraction. EBSCO DynaMed website. Available at: http://www.dynamed.... Accessed September 14, 2020.

Lifestyle changes for heart failure. American Heart Association website. Available at:
...(Click grey area to select URL)
Accessed September 14, 2020.

Paterna S, Parrinello G, et al. Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart failure. Am J Cardiol. 2009;103(1):93-102.

Physical changes to report. American Heart Association website. Available at:
...(Click grey area to select URL)
Accessed September 14, 2020.

Yancy CW, Jessup M, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-e239.

4/2/2014 DynaMed Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T905359/Choosing-Wisely: Updated July 23, 2015.

1/18/2017 DynaMed Systematic Literature Surveillance http://www.dynamed...: Emdin CA, Odutayo A, et al. Meta-analysis of anxiety as a risk factor for cardiovascular disease. Am J Cardiol. 2016;118(4):511-519.

Last reviewed September 2020 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 9/15/2020

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