Heart Failure

Heart failure is a term for describing a heart that is not pumping as well as it should. Your heart is a muscular pump that pumps necessary oxygen-rich blood to your arms, legs, kidneys and other organs in your body. In cases of heart failure, the heart is failing to pump enough blood to the rest of the body, or to pump as efficiently as it should. This means that your body isn't getting the oxygen it needs. This may also cause a build-up of body fluid in your system.

More than 3.5 million people in the United States have heart failure. It is now the number one reason people over the age 65 are admitted to the hospital.

Causes of Heart Failure
Heart failure commonly results from heart damage caused by one or more of the following:

• Coronary artery disease (narrowed or blocked arteries leading to the muscle of your heart)
• High blood pressure
• Heart valve disease (leaky or stiff heart valves due to past rheumatic fever, birth defect, or infected valves)
• Myocarditis (an inflammation of the heart muscle)
• Idiopathic disease (no clear reason why the heart is damaged)
• Excess alcohol

Signs and Symptoms
What you may notice if your heart is not pumping enough blood to the rest of your body is the following:

• Swelling in your ankles and legs
• Needing two or more pillows to sleep or needing to sit in a chair to sleep
• Waking up suddenly in the middle of the night, short of breath
• Becoming short of breath during regular activities such as making beds, vacuuming, walking to the end of the block or walking to your car at the shopping center
• Weight gain
• Clothes, waistbands, belts getting tighter around the waist
• Loss of appetite
• Fatigue

Diagram of heart failure symptoms

How Is Heart Failure Diagnosed?
Your doctor may use a variety of tests to determine:

• the cause of your heart failure
• the degree of your heart failure
• how much you are able to do

Some of the tests your doctor may use are:

• Echocardiogram (the use of sound waves to take a picture of the heart)
• Angiogram of your heart (insertion of a small thin catheter into the left side of your heart, where dye is injected and pictures taken to check for narrow or blocked arteries)
• MUGA Scan (measures how well your heart is pumping blood)
• Blood tests
• Exercise test (to check your heart's reaction to exercise)

Occasionally, these tests will be used:

• Right heart catheterization - insertion of a small thin catheter into the right side of your heart to determine how the right side of your heart is working by measuring the pressure in the different chambers
• Heart biopsy to look at very small samples of the heart muscle under a microscope, to determine possible causes of heart failure
• CPX (cardiopulmonary stress test) to determine how well the heart is pumping blood to the muscles in your body, and evaluate how your heart and lungs are working together

Treatment of Heart Failure

General measures in the treatment of heart failure include:

• A 2 gram (2000 milligram) sodium diet restriction too much salt (sodium) in your system tricks the kidneys into retaining fluid in your body. This excess fluid can cause added stress on your heart, causing extra fluid to back up in your lungs (making you short of breath), or swelling in your ankles or abdomen. Some foods in particular that are high in salt are: canned soups, lunch meats, dairy products, canned vegetables, salty snacks like pretzels, or potato chips.
• Fluid restriction most people should limit themselves to 6-8 glasses of fluid a day. Remember to count the water you take with your pills, soups, ice, sherbet, and popsicles as fluids also.
• TED stockings these elastic stockings are used to get the fluid out of your legs and back to your heart.
• Daily weighs weight gain is often one of the first signs that you are retaining fluid. Weigh yourself daily. If you gain 2-3 pounds in a day, or if it continues for two or more days, call your doctor. You may need some adjustments made in your medications or a visit to the doctor.
• Avoidance of alcohol many people have heard that 1-2 drinks a day is good for your heart. This is not the case in heart failure, since alcohol can weaken the heart further. You should abstain from the use of alcohol.

Medications frequently used in heart failure:

• Digitalis this drug slows your heart rate down and helps your heart pump stronger and more efficiently. Your doctor will decide the best dose for you and will monitor the level of digitalis in your blood to maintain the correct level in your system. Be sure to let your doctor know if any of the following occur: nausea or vomiting, loss of appetite, bad taste in your mouth, sudden heart palpitations, rapid beating or a "pounding" in your chest, changes in your vision such as a yellow-green halo around images or blurred vision. These symptoms do not mean you are allergic; they may mean you need a change in the dosage.
• Diuretics these medications are often called water pills. They help the kidneys take sodium (salt) and water out of the blood. This decreases any extra fluid in your blood vessels, making it easier for your heart to pump. You will notice that these medications will make you urinate more frequently.
• ACE-Inhibitors (also known as Angiotensin-Converting Enzyme Inhibition medications) these drugs prevent the production of Angiotensin II in your body. Angiotensin II causes your arteries to constrict, making it hard for your heart to pump the blood into the rest of your body. It also stimulates your kidneys to retain sodium (salt) and water. ACE-Inhibitors produce an increase in exercise tolerance, increase the amount of blood your heart pumps to the rest of your body, and reduces your symptoms of heart failure. They may cause some drop in blood pressure. Your doctor will monitor your blood pressure and kidney function while on these medications.
• Vasodilators These medications help to widen or relax the walls of your blood vessels. Widening the walls of the blood vessels increases the amount of space the heart has to pump blood into. This makes it easier for the heart to pump and easier for the blood to flow through your heart.
  When taking vasodilators, move slowly when changing positions. Standing up too quickly or getting out of bed too fast may make you feel dizzy. Take your time to give your blood vessels a chance to adjust. Let your doctor know if you have any of the following symptoms: dizziness or lightheadedness, nausea or vomiting, headache, fever, muscle and joint aching or skin rash.
• Potassium Along with sodium and water, diuretics also cause your kidneys to remove potassium. Potassium is a mineral your body needs to help control your heart rhythm. Your doctor may prescribe potassium supplements for you to replace the potassium that is lost.
  If you are losing too much potassium, you may experience muscle cramps, muscle weakness, or fatigue.
  If you have too much potassium in your body, you may feel weakness and heaviness in your legs, nausea, vomiting or abdominal pain. Let your doctor know if you experience any of these symptoms. Your doctor will check the level of potassium in your blood to determine the amount of potassium supplements you need.
  Some foods are high in potassium. Your doctor may recommend that you eat foods high in potassium, such as bananas, orange juice, baked potatoes, prunes, cantaloupe and tomato juice.

Medications play an important part in treating heart failure. The medications your physician prescribes for you may help your limitations on your lifestyle. One of the most common reasons people are readmitted to the hospital with heart failure is because they have not taken their medications properly. It is important to take your medications, follow the instructions you were given, and to communicate to your doctor any reason why you were not able to take them as directed.

Activity
Your doctor will encourage you to remain as active as possible. Activity is important in heart failure to:

• assess how you are doing and whether your medications are working
• determine the need for other medications, treatments or the consideration of experimental medications available at research centers
• improve the function of your heart and your muscles

You are always the best judge of how much you can do. Use your common sense when planning your activities, (i.e. coordinate your activities so you only make one trip to the basement instead of 4 or 5, make one trip to the store, etc.) If you get tired, or short of breath, stop, rest and then go on. Your doctor may use the CPX (cardiopulmonary stress test) to help guide you to find the best exercise program for you.

Discuss with your doctor activities such as trips you are taking or sexual activity.

Prognosis of Heart Failure in the 90s
Unfortunately, we do not have a crystal ball. While there have been major advances in diagnosis and treatment of heart failure, there is still no cure. Survival is variable dependent on different factors. Your doctor may use certain indicators/tests to help gauge what your prognosis may be. These indicators are:

• Your functional class of heart failure (how much you can do without getting short of breath)
• MUGA test (shows how well your heart is pumping blood to the rest of your body)
• CPX (the cardiopulmonary stress test that tells how much blood is getting to your muscles)
• Blood tests

Much research is being done in the area of heart failure. In the near future you may be hearing about new, exciting and hopeful treatments for heart failure patients.

Where You Can Get Help
Keep in close contact with your doctor, be sure to tell your doctor of sudden weight gains and changes in your symptoms.

Know your other support systems:

• call the nurse at your local hospital that specializes in heart failure for information or questions
• your doctor may send a nurse to visit you in the home to monitor your progress
• dietitians can help guide you in your sodium (salt) and fluid restrictions
• ask about local support groups

Other places to get information are:

• specialized heart failure centers
• the American Heart Association

It is important to remember the role you play in treating your heart failure. Things you have control over are whether or not you keep your doctor appointments, your fluid and sodium (salt) intake, whether or not you get weighed each morning and whether or not you take your medications. The actions you take to take care of yourself will help you feel much better and get you back to doing the activities you enjoy.