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Heart Failure

Heart failure is a medical condition where the heart muscle doesn’t pump blood as it should, so your body’s need for blood and oxygen isn’t being easily met. Heart failure is usually caused by damage to the main pumping chamber of the heart (the left ventricle).

It is usually a chronic condition, which means it continues over a long period of time.

Most people with heart failure can live comfortably for many years if they take steps to manage the condition.

When the heart doesn’t pump enough blood, hormones (body chemicals) are sent to increase the amount of work the heart does.

Some hormones make the heart grow larger. Others tell the heart to pump faster. These hormones may help the heart pump more blood at first, but it can’t keep up with the ongoing demands. As a result, the heart muscle becomes more damaged. Over time, even less blood is pumped through the heart. This leads to problems throughout the body.

What happens once you have heart failure?

If you have heart failure, your heart pumps less blood than normal to the lungs and to the rest of the body. As a result, the kidneys and other organs don’t get the oxygen-rich blood they need. When the kidneys don’t work right, fluid backs up in the lungs and throughout the body. This results in the symptoms:

  • Shortness of breath
  • Swelling

Types of Heart Failure

There are two basic types of heart failure:

  • Systolic heart failure
  • Diastolic heart failure

Systolic Heart Failure (“Pumping problem”): The heart muscle becomes weak and enlarged. It can’t pump enough blood forward when the ventricles (or the main chambers of your heart) contract. With each heartbeat, the system pumps out only a fraction of the total amount of blood in the ventricle (the ejection fraction). Systolic heart failure is also called heart failure with reduced ejection fraction (HFrEF).

Diastolic Heart Failure (“Filling problem”): The heart muscle becomes stiff. It doesn’t relax normally between contractions. This keeps the ventricles from filling with blood, even though the ejection fraction is often in the normal range. Diastolic heart failure is also called heart failure with preserved ejection fraction (HFpEF).

The amount of blood a normal heart pumps out with each beat (known as the ejection fraction or EF) is 55% or greater.

What Causes Heart Failure?

People of any age can have heart failure, but it is much more common in people over 65. Causes of heart failure include:

  • Weakening of or damage to the heart muscle itself, called cardiomyopathy. The heart muscle can become weakened by a previous heart attack, severe coronary artery disease, many years of high blood pressure, many years of drinking too much alcohol, or an infection. Sometimes the cause of a weakened heart cannot be found.
  • Diseases of the heart valves. These diseases may cause the valves to become too narrow or to “leak.” A narrowed valve, which is also called stenosis, makes it hard for the heart muscle to pump blood forward. A leaky valve, which is also called regurgitation, allows the blood to flow backward. As a result, the heart must work harder since blood is going back and forth instead of going forward.
  • Heart defects present since birth. These defects, which are also called congenital defects, may or may not cause problems during childhood. Over time, however, the heart becomes weakened because most defects cause the heart to work harder.
  • High blood pressure (hypertension). If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
  • Myocarditis is an inflammation of the heart muscle. It’s most commonly caused by a virus and can lead to left-sided heart failure.
  • Abnormal heart rhythms (heart arrhythmias) may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken, leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
  • Other diseases. Chronic diseases such as diabetes, hyperthyroidism, hypothyroidism, emphysema, or a buildup of iron (hemochromatosis) or protein (amyloidosis) also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications, or any illness that affects the whole body.

What types of tests and treatments are used for heart failure?

Certain tests and treatments are done in the hospital. Some may be done after you are discharged from the hospital.

  • Blood tests check your kidney and thyroid function and to look for signsof other diseases that affect the heart.
  • Cardiac computerized tomography (CT) scan or magnetic resonance imaging (MRI) can be used to diagnose heart problems, including causes of heart failure. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart.
  • Chest X-rays look at the condition of your lungs and heart. Your heart may appear enlarged and fluid buildup may be visible in your lungs.
  • Coronary catheterization (angiogram) is performed by using a thin, flexible tube (catheter) inserted into a blood vessel through your groin or in your arm and guided through the aorta into your coronary arteries. A dye injected through the catheter makes the arteries supplying your heart visible on an X-ray. This test helps doctors identify narrowed arteries to your heart (coronary artery disease) that can be a cause of heart failure. The test may include a ventriculogram—a procedure to determine the strength of the heart’s main pumping chamber (left ventricle) and the health of the heart valves.
  • Echocardiogram helps distinguish systolic heart failure from diastolic heart failure. An echocardiogram uses sound waves to produce a video image of your heart. This image can help doctors determine how well your heart is pumping. This test can also look for valve problems or evidence of previous heart attacks, as well as some unusual causes of heart failure.
  • Electrocardiogram (ECG) records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.
  • Myocardial biopsy diagnoses certain types of heart muscle disease causing heart failure. In this test, your doctor inserts a small flexible biopsy tool into a vein in your neck or groin, and small pieces of the heart muscle are taken.
  • Stress tests measure how your heart and blood vessels respond to exertion. Stress tests help doctors see if you have coronary artery disease. Stress tests also determine how well your body is responding to your heart’s decreased pumping effectiveness and can help guide long-term treatment decisions.

Why choose Presbyterian for heart failure treatment?

Our heart and vascular team has many different options to manage your heart failure. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans for your heart health needs. Depending on the type of heart failure you have and its underlying cause, the team can recommend a wide variety of treatment options. These may include lifestyle modifications, medications and procedures. Our cardiologists and cardiovascular surgeons work closely together for cases in which surgery is the best treatment option. We also offer a customized cardiac rehabilitation program at our Healthplex which can improve your endurance and exercise tolerance, as well as improve heart-related symptoms. Your cardiologist will work with the rehabilitation team to create a plan that will be tailored to your individual health needs.