Heart failure - overview

Definition

Heart failure is a condition in which the heart is no longer able to pump out enough oxygen-rich blood to the body. This causes symptoms to occur throughout the body.

Alternative Names

CHF; Congestive heart failure; Left-sided heart failure; Right-sided heart failure - Cor pulmonale; Cardiomyopathy - heart failure

Causes

Heart failure is often a long-term (chronic) condition, but it may come on suddenly. It can be caused by many different heart problems.

The condition may affect only the right side or only the left side of the heart. More often, both sides of the heart are involved.

Heart failure is present when:

As the heart's pumping becomes less effective, blood may back up in other areas of the body. Fluid may build up in the lungs, liver, gastrointestinal tract, and the arms and legs. This is called congestive heart failure.

The most common causes of heart failure are:

Other heart problems that may cause heart failure are:

Other diseases that can cause or contribute to heart failure:

Symptoms

Symptoms of heart failure often begin slowly. At first, they may only occur when you are very active. Over time, you may notice breathing problems and other symptoms even when you are resting. Symptoms may also appear suddenly after the heart is damaged from a heart attack or other problem.

Common symptoms are:

Exams and Tests

Your health care provider will examine you for signs of heart failure:

Many tests are used to diagnose and monitor heart failure.

An echocardiogram (echo) is often the best test for heart failure. Your doctor will use it to guide your treatment.

Other imaging tests can look at how well your heart is able to pump blood, and how much the heart muscle is damaged.

Many blood tests may also be used to:

Treatment

MONITORING AND SELF CARE

If you have heart failure, your doctor will monitor you closely. You will have follow-up visits at least every 3 to 6 months, but sometimes much more often. You will also have tests to check your heart function.

Knowing your body and the symptoms that your heart failure is getting worse will help you stay healthier and out of the hospital. At home, watch for changes in your heart rate, pulse, blood pressure, and weight.

Weight gain, especially over a day or two, can be a sign that your body is holding on to extra fluid and your heart failure is getting worse. Talk to your doctor about what you should do if your weight goes up or you develop more symptoms.

Limit how much salt you eat. Your doctor may also ask you to limit how much fluid you drink during the day.

Other important changes to make in your lifestyle:

MEDICINES, SURGERY, AND DEVICES

Your doctor will ask you to take medicines to treat your heart failure. Medicines treat the symptoms, prevent your heart failure from getting worse, and help you live longer. It is very important that you take your medicine as your health care team directed.

These medicines:

It is very important that you take your medicine as you have been told. Tell your health care provider right away if you think you are having side effects or want to stop or change any of your medications. Do not take any other drugs or herbs without first asking your provider about them. Drugs that may make your heart failure worse include:

The following surgeries and devices may be recommended for some people with heart failure:

END-STAGE HEART FAILURE

Severe heart failure occurs when treatments no longer work. Certain treatments may be used when a person is waiting for a heart transplant:

At a certain point, the health care provider will decide whether it is best to keep treating heart failure aggressively. The patient, along with his or her family and doctors, may want to discuss palliative or comfort care at this time.

Outlook (Prognosis)

Often, you can control heart failure by taking medicine, changing your lifestyle, and treating the condition that caused it.

Heart failure can suddenly get worse due to:

Most of the time, heart failure is a chronic illness that gets worse over time. Some people develop severe heart failure. Medicines, other treatments, and surgery no longer help at this stage.

People with heart failure may be at risk for dangerous heart rhythms. These people often receive an implanted defibrillator.

When to Contact a Medical Professional

Call your health care provider if you develop:

Go to the emergency room or call the local emergency number (such as 911) if:

Prevention

Most cases of heart failure can be prevented by living a healthy lifestyle and taking steps aimed at reducing your risk for heart disease.

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References

Goodlin SJ,, Bonow RO. Care of patients with end-stage heart disease. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 31.

Mann DL Management of Patients with Heart Failur with Reduced Ejection Fraction. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 25.

Mant J, Al-Mohammad A, Swain S, Laramee P. Guideline Development Group. Management of chronic heart failure in adults: synopsis of the National Institute For Health and Clinical Excellence guideline. Ann Intern Med. 2011;155(4):252-259. PMID: 21844551. Available at: http://www.ncbi.nlm.nih.gov/pubmed/?term=Ann+Intern+Med.+2011%3B155(4)%3A252-259

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, 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. Circulation. 2013 Oct 15;128(16):e240-327. Epub 2013 Jun 5. PMID: 23741058. Available at: http://www.ncbi.nlm.nih.gov/pubmed?term=%22Circulation%22%5BJour%5D+AND+2013%5Bpdat%5D+AND+Yancy%5Bauthor%5D&cmd=detailssearch



Review Date: 8/12/2014
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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