Heart failure is a serious yet common health condition affecting millions of
people worldwide. The American Heart Association (www.aha.org) and the Heart
Failure Society of America (www.hfsa.org) estimate that about 5 million
Americans are living with heart failure. Most of the times heart failure
presents as the end stage of many heart diseases. The severity of your heart
failure is likely to progress and is a major cause of hospitalizations. In
many cases, there is no cure for heart failure but following your treatment
plan as recommended by your doctor and modifying your lifestyle can help you
control its progression. The aim of the content in this section is to help you understand your condition, what you can do to keep it under control, and how to follow your doctor's advice to help you live a longer and healthier life.
How the Normal Heart Works
Your heart is a specialized muscle about the size of your clenched fist and
its function is to pump blood to all parts of your body. Your heart is
divided into a right side and a left side. The heart and the lungs work very
closely. From the right side of the heart, the lungs receive blood poor in
oxygen and carrying waste. In the lungs the blood gets oxygen and deposits
waste products. After your blood gets oxygen it returns to the left side of
the heart where this oxygen rich blood is pumped to the arteries. The
arteries carry oxygen-rich blood to your body. Your body in turn, collects
oxygen and nutrients from the blood and deposits waste into the blood. The
oxygen depleted blood is carried out of the body by veins, and returns from
the body to the right side of the heart to re-start the process. Your body
depends on this process to maintain an adequate supply of oxygen and
nutrients for your body to work effectively [1].
This diagram from the National Heart Lung and Blood Institute
(www.NHLBI.nhi.gov) illustrates blood circulation in the heart.
What is Heart Failure?
Heart failure is a serious medical condition where your heart is weak and is
not pumping enough blood to meet your body needs or your heart cannot relax
properly to fill with blood. When your heart is not pumping enough blood
your body cannot receive as much oxygen and nutrients as needed which may
cause you , for example, to get tired easily. Also, your body is not able to
get rid of waste as effectively as before and fluid can back up in the lungs
and other parts of the body such as feet, ankles, legs, hands, and abdomen.
Heart failure usually develops gradually after diseases such as long
standing high blood pressure, a heart attack or another condition has
damaged or weakened the heart muscle. The majority of heart failure patients
are over 65 years of age and there is a strong connection between old age
and heart failure but it can develop at any age. It is also more common
among men and African American because of the high incidence of high blood
pressure in this population [2].
Causes of Heart Failure
There are many causes of heart failure; you can develop heart failure if you
had or currently have a medical condition which weakened your heart. In
United States the most common reason for heart failure is coronary artery
disease, a disease in which plaque builds up inside the arteries that supply
your heart with oxygen- rich blood. Other common causes of heart failure are
[1]:
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Heart attack |
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High blood pressure |
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Heart valve disease |
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Inflammation of the heart |
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Congenital heart defects |
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Lung conditions |
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Alcohol or drug abuse Infections, anemia, thyroid gland problems, lung,
diabetes and kidney diseases are some conditions that can trigger and worsen your
heart failure. |
What are the Symptoms of Heart Failure?
Common symptoms of heart failure are the result of fluid build up,
congestion in your lungs and less oxygen-rich blood circulating in your
body. Symptoms of heart failure include [2]:
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Difficulty breathing when lying down |
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Shortness of breath |
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Dry, hacking cough |
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Weight gain |
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Swelling |
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Fatigue |
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Weakness |
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Loss of appetite |
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Rapid heart beat |
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Confusion and/or impaired memory |
Diagnosing Heart Failure
Your doctor will ask you questions to complete your medical history and will
perform a physical exam. Routine diagnostic test for heart failure are [3]:
1
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Electrocardiogram- to record your heart's electrical impulses because heart
failure can cause changes that are shown on the electrocardiogram. |
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Blood tests to find out if you have anemia or problems with your kidneys or
liver. |
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BNP or brain natriuretic peptide- this is a blood test to measure BNP, a
substance produced by your heart in response to pressure due to excess
fluid. |
4 |
Chest x-ray- to show the size and shape of your heart. |
5
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Echocardiogram- it is the preferred test to assess your heart function. This
test can be done at the bedside and at your doctor's office. If your doctor
orders an echocardiogram find out what is your ejection fraction; this
number tells you how well your heart pumps with each beat. |
Heart Failure Treatment
Your doctor will talk to you about heart failure and the different ways to
manage your condition. The cause of your heart failure will determine your
treatment plan and it is likely to include medications, diet, exercise, and
other lifestyle changes. Your doctor may start one medication at a time and
then add others and increase the doses over a period of time. The following
medications are recommended for all patients with heart failure [4].
Medications
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Angiotensin converting enzyme (ACE) inhibitors
These medications widen blood vessels, reduce the work of your heart, and
control blood pressure. They are given to improve symptoms, to prevent
worsening of heart failure that may lead to hospital admission, and increase
survival. Symptoms improve within a few weeks to a few months of starting
treatment.
Adverse effects: dizziness, low blood pressure, dry cough, may affect your
kidneys. Rarely, swelling of your face, tongue, hands or feet (call your
doctor immediately if this happens). Take this medication at the same time
each day. To reduce the risk of dizziness, get up slowly from a sitting or
lying position and avoid stressful exercise. Avoid drinking alcohol, as it
may lead to dizziness.
Your doctor may prescribe any of the following ACE inhibitors: Captopril (Capoten),
Enalapril (Vasotec), Lisinopril, Quinapril (Accupril), Ramipril (Altace), or
Fosinopril
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Angiotensin receptor blockers (ARBs)
These medications have the same effect as the ACE inhibitors: widen blood
vessels, reduce the work of your heart, and control blood pressure. They are
given to improve symptoms, to prevent worsening of heart failure that may
lead to hospital admission, and increase survival. Symptoms improve within a
few weeks to a few months of starting treatment.
Adverse effects: dizziness, low blood pressure, dry cough, may affect your
kidneys. Take this medication at the same time each day. To reduce the risk
of dizziness, get up slowly from a sitting or lying position and avoid
stressful exercise. Avoid drinking alcohol, as it may lead to dizziness.
Your doctor may prescribed any of the following angiotensin receptor
blockers (ARBs): Candesartan (Atacand), Irbesartan (Avapro), Losartan (Cozaar),
Telmisartan (Micardis), or Valsartan (Diovan).
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Beta-blockers
These medications slow heart rate, improve heart function, and reduce the
work your heart does. Beta-blockers are given to improve symptoms, to
prevent worsening of heart failure leading to hospital admission, and to
improve survival. Improvement may develop slowly after starting treatment
with these medications; it may take from 3 to 6 months and sometimes longer.
Adverse effect: tiredness, dizziness, lightheadedness, temporary worsening
of shortness of breath or fluid retention, and slow heart rate. Take this
medication at the same time every day. Take this medication at least 2 hours
before you have taken your ACE inhibitor. Doses are often started very low,
and are gradually increased over a period of 1-3 months, so remember that
your dosage will change. In the morning, take this medication with food and
in the evening, take this medication right after dinner.
Your doctor may prescribe any of the following beta-blockers: Carvedilol (Coreg),
Metoprolol (Lopresor, Toprol XL), Atenolol (Tenormin), Bucindolol (Bextra),
or Bisoprolol (Monocor).
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Diuretics
Diuretics are given to patients with heart failure because they eliminate
water and salt (sodium) from your body, prevent or reduce shortness of
breath, swelling and bloating.
Adverse effects: frequent urination, weakness, dizziness, and loss of
potassium, which in turn may cause: dry mouth, increased thirst, irregular
heartbeat, muscle cramps, weakness, and fatigue. Take this medication with
meals to avoid stomach upset. Recommendations: take your last dose before
5:00 p.m., to prevent having to get up in the night to urinate.
Some commonly prescribed diuretics are: lasix (Furosemide), demadex (torsemide),
and Metolazone which is usually given with furosemide for maximum effect.
Other medications used in the medical treatment of heart failure are:
Aldosterone ,digitales, and antiarrhythmics
To keep track of your medications download the medication log here link to
medication log |
Living with Heart Failure
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To reduce symptoms of heart failure and help you feel better doctors
recommend a combination of both medications and lifestyle changes [4]. There
are many things that you can do to help yourself including changes to your
diet, exercise, alcohol and smoking habits.
Weight Monitoring, Diet and Alcohol
Maintain a healthy weight and monitor
sudden weight changes. If you are overweight, lose weight because excess
weight puts extra strain on your heart. Weigh yourself daily before having
breakfast and after emptying your bladder and keep track of your weight.
Click here to download a daily weight chart you can use to track your
weight.
Lower your salt intake; heart failure causes your body to retain water and
salt. When you limit the amount of salt that you eat you can get rid off
extra fluid and reduce swelling of your ankles, feet, or stomach. Avoid
products high in salt such as cheese, cold cuts, sausages, hams, canned
soups, frozen meals, and ketchup. Read the food labels to check for sodium
(salt) content. Remove the salt shaker from your table and use herbs and
other seasonings instead of salt. If your heart failure is worsening your
doctor may ask you to limit your fluid intake and you should not drink more
than 1.5 to 2 liters per day.
Click here for balanced, heart healthy recipes.
Illegal drugs use and excessive alcohol intake can damage your heart. Try to
limit alcohol consumption to one drink per day or stop drinking it and avoid
drugs.
Exercise and rest
Mild physical activity is beneficial for most patients with heart failure;
it improves symptoms and the functional capacity of your heart. Remember to
have periods of rest between activities or when exercising. Talk to your
doctor before starting a regular exercise program.
Smoking
Smoking causes narrowing of your blood vessels; it also increases your heart
rate and blood pressure making your heart work harder. Nicotine worsens your
heart failure, if you smoke, stop now. If you need help to quit smoking
follow the link
www.smokefree.org
Vaccines
Make sure that your vaccines are up to date. Respiratory problems are more
dangerous for people who have heart failure. To quote Michael Brescia, MD
"The heart and the lungs are anatomically and physiologically intimately
related. Usually, when either system develops a problem, the other is sure
to develop one as well". Get a pneumonia vaccine if you did not get it
before and every year get a flu shot; both vaccines are usually safe and
rarely cause severe reactions. Tell your health care provider if you have
any allergies.
It is very important for you to keep your doctor's appointments! Click here for a form you can download to keep track of your scheduled
appointments. |
When to Call your Doctor
You should pay attention to changes in your condition and watch for the
following signs and symptoms [1].
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Weight gain of more than 2 lbs overnight or 5 lbs in one week |
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Increased shortness of breath |
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Increased swelling in your feet, legs, hands, or stomach |
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Dry cough |
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Difficulty breathing when lying down |
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Nausea and vomiting |
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Sudden weakness or dizziness, even if it is temporary |
If you experience any of these worsening symptoms call your doctor.
Community Resources
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CHF Help Line 908-994-5251 English/Spanish
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Dolis Lebreault, RN-BC, BSN |
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CHF Program Coordinator 908-994-8916 English/Spanish |
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Prescription Assistance Program 908-994-5423 |
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Fitness Center www.trinitashospital.org/fitness_center.htm |
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Cardiac Rehabilitation 1-908-994-5695 |
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Educational resources
For additional information on heart failure and smoking cessation visit the
following sites.
References
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1. |
American Heart Association www.americanheart.org |
2.
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Heart Failure Society of America www.hfsa.org |
3.
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Hess, O. & Carroll, J. (2008). Clinical Assessment of Heart Failure. In
P. Libby, R. Bonow, D. Mann & D. Zipes (Eds.), Brawnwald's Heart Disease a
textbook of cardiovascular medicine 8th ed. (561-581). Philadelphia, PA:
Saunders. |
4.
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McMurray, J. & Pfeffer, M. (2008). Heart Failure: Management and
Prognosis. In L. Goldman & D. Ausiello (Eds.), Cecil Medicine 23rd edition
(354-372). Philadelphia, PA: Saunders
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