What is heart failure?

What causes heart failure?

• heart valve disease - caused by past rheumatic fever or other infections
• high blood pressure (hypertension)
• infections of the heart valves and/or heart muscle (i.e., endocarditis)
• previous heart attack(s) (myocardial infarction) - scar tissue from previous attacks may interfere with the heart muscle's ability to work normally
• coronary artery disease - narrowed arteries that supply blood to the heart muscle
• cardiomyopathy - or another primary disease of the heart muscle
• congenital heart disease/defects (present at birth)
• cardiac arrhythmias (irregular heartbeats)
• chronic lung disease and pulmonary embolism
• drug-induced heart failure
• excessive sodium intake
• hemorrhage and anemia
• diabetes

How does heart failure affect the body?

Heart failure interferes with the kidney's normal function of eliminating excess sodium and waste from the body. In heart failure, the body retains more fluid - resulting in swelling of the ankles and legs. Fluid also collects in the lungs - resulting in shortness of breath.

What are the symptoms of heart failure?

The following are the most common symptoms of heart failure. However, each individual may experience symptoms differently.

Symptoms may include:

• shortness of breath during rest, exercise, or lying flat
• weight gain
• visible swelling of the legs and ankles (due to a build-up of fluid), and, occasionally, the abdomen
• fatigue and weakness
• loss of appetite and nausea
• persistent cough - often produces mucus or blood-tinged sputum
• reduced urination

The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been lost.

The symptoms of heart failure may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is heart failure diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for heart failure may include any, or a combination of, the following:

• chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• echocardiogram (Also called echo.) - a noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.
• electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
• BNP testing - B-type natriuretic peptide (BNP) is a hormone released from the ventricles in response to increased wall tension (stress) that occurs with heart failure. BNP levels rise as wall stress increases. BNP levels are useful in the rapid evaluation of heart failure.

Treatment for heart failure

Specific treatment for heart failure will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

The cause of the heart failure will dictate the treatment protocol established. If the heart failure is caused by a valve disorder, then surgery is usually performed. If the heart failure is caused by a disease, such as anemia, then the disease is treated.

And, although there is no cure for heart failure due to a damaged heart muscle, many forms of treatment have proven to be successful.

The goal of treatment is to improve a person's quality of life by making the appropriate lifestyle changes and implementing drug therapy.

Treatment of heart failure may include:

• controlling risk factors
  • losing weight (if overweight)
  • restricting salt and fat from the diet
  • stop smoking
  • abstaining from alcohol
  • proper rest
  • controlling blood sugar if diabetic
• medication, such as:
  • angiotensin converting enzyme (ACE) inhibitors - to decrease the pressure inside the blood vessels, or angiotensin II receptor blockers if ACE inhibitors are not tolerated
  • diuretics - to reduce the amount of fluid in the body
  • vasodilators - to dilate the blood vessels and reduce workload on the heart
  • digitalis - to increase heart strength and control rhythm problems
  • inotropes -  increase the pumping action of the heart
  • antiarrhythmia medications -  keep the rhythm regular and prevent sudden cardiac death
  • beta-blockers -  reduce the heart's tendency to beat faster by blocking specific receptors on the cells that make up the heart
  • aldosterone blockers - block the effects of aldosterone which causes sodium and water retention
• biventricular pacing/cardiac resynchronization therapy - a new type of pacemaker that paces both sides of the heart simultaneously to coordinate contractions and improve pumping ability. Heart failure patients are potential candidates for this therapy
• heart transplantation

What is cardiomyopathy?
 

Cardiomyopathy is any disease of the heart muscle in which the heart loses its ability to pump blood effectively.

In some instances, heart rhythm is disturbed and leads to arrhythmias (irregular heartbeats). There may be multiple causes of cardiomyopathy, including viral infections. Sometimes, the exact cause of the muscle disease is never found.

 
How does cardiomyopathy differ from other heart disorders?
 

Cardiomyopathy differs from many of the other disorders of the heart in several ways, including the following:

• Cardiomyopathy can, and often does, occur in the young.
• The condition affects about 50,000 Americans (adults and children).
• The condition tends to be progressive and sometimes worsens fairly quickly.
• It may be associated with diseases involving other organs, as well as the heart.
• Cardiomyopathy is a leading cause for heart transplantation.

 
What causes cardiomyopathy?
 

Viral infections that infect the heart are a major cause of cardiomyopathy. In some instances, cardiomyopathy is a result of another disease or its treatment, such as complex congenital (present at birth) heart disease, nutritional deficiencies, uncontrollable, fast heart rhythms, or certain types of chemotherapy for childhood cancers.

Sometimes, cardiomyopathy can be linked to a genetic abnormality. Other times, the cause is unknown. Three types of cardiomyopathy affect adults.

 
What is hypertrophic cardiomyopathy?
 

Hypertrophic cardiomyopathy occurs when the muscle mass of the left ventricle of the heart is larger than normal, or the wall between the two ventricles (septum) becomes enlarged and obstructs the blood flow from the left ventricle.

Because it prevents the heart from properly relaxing between beats, it fills with blood, which eventually limits the pumping action. A heart murmur may be heard.

• This is a rare disease and in most cases it is inherited.
• It can affect men and women of all ages, and symptoms can appear in childhood or adulthood
• Symptoms include shortness of breath on exertion, dizziness, fainting, and angina pectoris.
• Some patients experience cardiac arrhythmias, which may lead to sudden death.

 
What is dilated cardiomyopathy?
 

Dilated cardiomyopathy is the most frequent form of non-ischemic cardiomyopathy. The cavity of the heart is enlarged and stretched (cardiac dilation) causing the heart to become weak and not pump normally.

• This occurs most often in middle-aged people and more often in men than women, but has been diagnosed in people of all ages, including children.
• Most patients develop congestive heart failure.
• Dilated cardiomyopathy can be caused by chronic, excessive consumption of alcohol along with dietary deficiencies.
• It occasionally occurs as a complication of pregnancy and childbirth.
• Other suggested causes are: various infections (mostly viral, which lead to an inflammation of the heart muscle, called myocarditis), toxins, and (rarely) heredity.

Sometimes drugs used to treat a different medical condition can damage the heart and produce dilated cardiomyopathy. However, in most cases, a specific cause for the damage is never identified.
 
What is restrictive cardiomyopathy?
 

Restrictive cardiomyopathy, the least common type of cardiomyopathy in the US, occurs when the myocardium of the ventricles becomes excessively rigid, and the filling of the ventricles with blood between heart beats is impaired.

• It usually results from another disease, which occurs elsewhere in the body.
• Restrictive cardiomyopathy does not appear to be inherited, but some of the diseases that lead to the condition are genetically transmitted.
• Symptoms may include fatigue, swelling of the extremities, and difficulty breathing on exertion.