Everything You Need to Know About Heart Failure

Medically reviewed by Rafle Fernandez, MD

Heart failure is when the heart does not effectively pump blood through the body. This can cause a series of symptoms that include swelling, weakness, and difficulty breathing.

It becomes a life-threatening condition when the heart continues to weaken and cannot provide the body with enough blood. Coronary artery disease, heart attacks, and high blood pressure most commonly cause it.

This article will discuss the types of heart failure, its symptoms, and treatment. It will also cover how heart failure is diagnosed and prevented.

Types of Heart Failure

Heart failure is either chronic or acute. Chronic heart failure develops slowly, whereas acute heart failure happens abruptly. From there, heart failure can be categorized into three types: right-sided heart failure, left-sided heart failure, and congestive heart failure.

To understand heart failure, knowing blood moves through the heart is important.

1. The right atrium receives deoxygenated blood from the body and sends it to the right ventricle.

2. Then the right ventricle sends the blood to the lungs to be oxygenated.

3. The oxygenated blood returns from the lungs and goes to the left atrium.

4. The blood then goes to the left ventricle, pumped out to the body.

Left-Sided Heart Failure

With left-sided heart failure, also called left ventricular heart failure, the heart is not effectively pumping blood to the body. It must work harder to get blood to all the organs and tissues.

Within left-sided heart failure, there are two subtypes:

• Heart failure with reduced ejection fraction (HFrEF): HFrEF is also known as systolic heart failure. With this type, the heart cannot squeeze well enough to get blood out of the body.

• Heart failure with preserved ejection fraction (HFpEF): HFpEF is also known as diastolic heart failure. With this type, the ventricular heart muscle is too stiff and does not allow the heart to fill up with enough blood between heartbeats.

Right-Sided Heart Failure

Right-sided heart failure, also called right ventricular heart failure, is when the right ventricle does not pump blood to the lungs effectively. It can result from left-sided heart failure or other conditions.

Congestive Heart Failure

Congestive heart failure (CHF) is an advanced stage of heart failure. It is when the heart is not pumping blood effectively, and the blood is backing up within the body. This causes fluid buildup within the lungs, tissues, organs, and many other places.

Heart Failure and COVID-19

When someone has COVID-19, it can worsen heart problems like heart failure. The inflammation from COVID-19 can damage the heart, making it more difficult to pump blood through the body.

Learn More: What to Know About Heart Failure and COVID-19

Heart Failure Symptoms

Each person will experience heart failure symptoms differently. The symptoms can suddenly come on or develop slowly over time. Most people will have shortness of breath and swelling. Heart failure symptoms can include:

• Shortness of breath

• Shortness of breath while lying down

• Coughing

• Decreased appetite

• Fatigue and weakness

• Swelling

• Abdominal distension

Late stages of heart failure can produce the following symptoms:

• Fast heartbeat

• Swelling in the feet

• Lung sound changes (crackles)

• Heart sound changes (gallops)
  

How It Feels to Have Heart Failure

When someone has heart failure, putting into words exactly how it feels can prove difficult. The buildup of fluids in the body and lungs can give someone a bad cough and a swollen stomach and make it hard to breathe.

They can feel like their heart is skipping a beat or beating quickly. If they develop high levels of certain blood byproducts like ammonia, they can feel confused. Each person will have a different experience, so sharing your symptoms with a healthcare provider is important.

Heart Failure Stages

There are two heart failure classification systems that a healthcare provider can use to classify the severity of a person's heart failure.

The New York Heart Association (NYHA) uses a staging system of stages 1 through stages 4. A person's stage can move forward or backward, based on their symptoms. The stages are:

• Stage 1: Heart failure has been diagnosed, but there are no symptoms or no limited activities.

• Stage 2: Mild symptoms with slight activity limitations.

• Stage 3: Activities are severely limited and the person is only comfortable when they are resting.

• Stage 4: There are significant activity limitations and symptoms at rest.

The American Heart Association (AHA) and American College of Cardiology (ACC) use a different staging system. In this system, when a person reaches a certain stage, they cannot move back to a lower stage.

• Stage A: There are no symptoms or evidence of heart failure. This stage is also known as pre-heart failure.

• Stage B: There are no symptoms, but heart function has decreased.

• Stage C: Heart failure has been diagnosed, and symptoms are present.

• Stage D: Heart failure symptoms are present when a person is slightly active or resting. The person does not see the benefit of treatment.

What Causes Heart Failure?

People diagnosed with heart failure typically have or had another heart condition. Having more than one condition can significantly increase the risk of developing heart failure. The conditions that most commonly cause heart failure are:

• Coronary artery disease: This condition causes the coronary arteries to narrow, making the heart work harder to pump. This can weaken the heart muscle and lead to heart failure.

• Heart attack: A heart attack causes injury to the heart muscle and causes scar tissue, which hinders the heart's ability to pump effectively.

• High blood pressure: The continuous high pressure on the heart can cause the heart to weaken.

Other conditions that can cause heart failure are:

• Heart arrhythmias

• Infections

• Lung disease

• Diabetes

• Cardiomyopathy

• Congenital heart disease
  

How Is Heart Failure Diagnosed?

Heart failure is diagnosed by using several diagnostic tools. A healthcare provider will determine the best combination based on the patient's needs.

Physical Exam

A physical exam is one of the first things a healthcare provider will perform during a heart failure evaluation. The exam will include listening to the heart, lungs, and abdomen. The healthcare provider will ask questions that may include health history, family history, and information about lifestyle choices like smoking, diet, and exercise.

Blood Test

Blood tests can detect changes in the body and may indicate if someone is in heart failure. A brain natriuretic peptide (BNP) blood test increases with heart failure.

Other blood tests may include electrolytes and creatinine levels.

Echocardiogram

An echocardiogram (or echo) is an ultrasound of the heart. It can see how well the heart works, look for thickening of the heart muscle, and measure the ejection fraction. The ejection fraction is a measurement to determine the percentage of blood that leaves the heart with each heartbeat. An average ejection fraction is 50–70%. An ejection fraction of 40% or lower is indicative of heart failure.

Other Testing

A healthcare provider may schedule other testing based on a person's symptoms and the results of previous tests. Other testing that may be used to diagnose heart failure include:

• Electrocardiogram (EKG)

• Cardiac catheterization

• Stress test

• Cardiac MRI
  

Heart Failure Treatment

Heart failure treatment will optimize the heart's ability to pump blood to the lungs and body. The treatment plan will vary from person to person based on the severity of their illness and other conditions they may have.

Lifestyle Changes

When someone has mild to moderate heart failure, lifestyle changes can make a real impact on their daily lives. Lifestyle changes that can slow down the progression of symptoms include:

• Quitting smoking

• Losing or maintaining weight

• Avoiding alcohol

• Tracking fluid intake

• Avoiding caffeine

• Stress reduction

• Exercise

Medications

Many medications can treat heart failure. Each medication will treat a different symptom (when taken as prescribed).

• Beta-blockers: This class of medications causes the heart to pump with less force and at a more regular rate. Examples include Coreg (carvedilol) and Toprol XL (metoprolol).

• Aldosterone antagonists: These medications block aldosterone and help the body release water and sodium. One example of this is Aldactone (spironolactone).

• ACE inhibitors: This type of medication relaxes the veins and arteries to decrease blood pressure. Examples include Capoten (captopril) and Vasotec (enalapril).

• Angiotensin receptor neprilysin inhibitor (ARNI): makes it easier for the heart to pump blood to the body by reducing fluid. The only available ARNI medication is sacubitril/valsartan.

• Diuretics: This class of medications pulls fluids out of the body, reducing blood pressure and swelling.
  

Left Ventricular Assist Device

A left ventricular assist device (LVAD) is a mechanical pump that is surgically placed inside the body and connected to the heart. An LVAD is implanted when the heart is weakened and cannot pump enough blood through the body. It supports the heart by pumping blood through the body.

An LVAD is typically reserved for people who do not respond to other treatments. It can serve as a "bridge to transplant," meaning it supports the person until they receive a heart transplant. Or it can work as "destination therapy," meaning that the person will not receive a heart transplant and will remain on the LVAD for the rest of their life. A person can go home with an LVAD and have a high quality of life.

Heart Transplant

A heart transplant is performed when someone has end-stage heart failure. It is a complex surgery by which the patient's heart is removed and replaced with a donor's heart. When someone has a heart transplant, they will need to take medications for the rest of their lives to prevent rejection. There are many risks with a heart transplant, but after recovery, the recipient can return to many of their activities and hobbies.

Can You Prevent Heart Failure?

While every case of heart failure cannot be prevented, many steps can be taken to reduce the likelihood of developing it. Ways to prevent heart failure include:

• Avoid smoking

• Eat a healthy diet

• Lose weight if needed

• Follow the healthcare provider's directions for any other heart-related conditions

Outlook for Heart Failure

Heart failure is a condition that has been and still is widely studied for better treatments and solutions. The current treatment options can improve life expectancy and quality of life. It's important to follow a healthcare provider's guidance and take medications as prescribed.