Heart Failure

What Is Heart Failure?

Heart failure happens when the heart cannot perform one or both of its critical roles: pumping blood to meet the body's needs and relaxing to fill with blood. When the heart cannot keep up, fluid can back up into the lungs and body, causing shortness of breath, swelling and fatigue.

This could be due to a congenital heart condition (one you are born with) or a condition you developed later in life, like coronary artery disease. Heart failure causes symptoms like shortness of breath, fatigue and irregular heartbeat.

Heart failure is very common in the U.S. About 1 in 4 people will develop heart failure in their lifetime. University Health offers innovative heart failure treatment options, like LVAD, to eligible patients.

What Are the Types of Heart Failure?

Congestive Heart Failure

Heart failure is also called congestive heart failure. This is the most common type of heart failure. It may be referred to as “congestive” because heart failure results in fluid and blood buildup in the lungs (called pulmonary congestion) and body (systemic congestion). Where the fluid builds up depends on whether the left or right side of the heart is impacted.

Ejection Fraction

Doctors often classify heart failure by ejection fraction, which is the percentage of blood the left ventricle pumps out with each heartbeat. This classification helps guide treatment decisions.

• Heart failure with reduced ejection fraction (HFrEF): 40% or less
• Heart failure with mildly reduced ejection fraction (HFmrEF): 41% to 49%
• Heart failure with preserved ejection fraction (HFpEF): 50% or higher

Heart Failure Causes and Risk Factors

Heart failure can happen if your heart is damaged, stiff or weak.

Conditions that may contribute to heart failure include:

• Coronary artery disease
• High blood pressure
• Type 2 diabetes
• Past heart attack(s)
• Irregular heartbeats
• Sleep apnea
• Hyperthyroidism
• Hypothyroidism

Risk factors include:

• Smoking
• Obesity
• Excessive alcohol or recreational drug use
• Some radiation and chemotherapy treatments
• Being 65 or older

Heart failure is also more common within some races and ethnicities, like the Black and Hispanic communities. This is largely because of differences in access to care and higher rates of conditions like high blood pressure and diabetes, not because of race itself.

Treatment Options

There are many misconceptions about heart failure, one of them being that it is a death sentence, which it isn’t.

While there is no cure for heart failure, many people live full lives by following their doctor’s advice and utilizing treatment options, such as medications and implanted devices.

Medications

Your doctor may prescribe medications that help improve heart function and help you live longer.

For HFrEF, treatment often includes four foundational medication classes: an ARNI or ACE inhibitor, an evidence-based beta-blocker, a mineralocorticoid receptor antagonist (MRA) and an SGLT2 inhibitor.

These medications are considered lifesaving because they can reduce hospitalizations and improve survival when taken as prescribed.

Ask your pharmacist if you need help understanding or managing multiple medications.

Procedures

If your condition does not improve with lifestyle changes and medications, your healthcare team may recommend a procedure. University Health offers a range of procedures, including minimally invasive and surgical options.

Catheter Ablation

Catheter ablation is a minimally invasive procedure that uses catheters (thin, flexible tubes) to create scar tissue in the heart. This prevents the electrical impulses that cause irregular heartbeats. A catheter ablation treats conditions that cause or worsen heart failure.

Implanted Device

Your doctor may recommend an implanted device, such as a cardiac resynchronization therapy device, pacemaker or defibrillator in your heart. These devices are implanted during a minor surgery and monitor and treat irregular heartbeats.

Angioplasty

During an angioplasty, your interventional cardiologist inflates a balloon inside a narrowed artery to improve blood flow. This is a minimally invasive procedure.

Coronary Artery Bypass

Coronary artery bypass surgery is a common heart surgery that connects a healthy blood vessel to the heart to bypass the blocked artery.

Left Ventricular Assist Device (LVAD)

An LVAD is an option for those with advanced heart failure. It is a surgically implanted, battery-powered pump that does the work of the left ventricle.

Extracorporeal Membrane Oxygenation (ECMO)

ECMO can be an option for patients with severe heart failure when standard treatments are no longer effective. ECMO provides temporary life support by helping the heart circulate blood and deliver oxygen to the body, allowing time for recovery or evaluation for longer-term treatments.

Heart Failure Prevention

You can take steps to prevent heart failure by making lifestyle modifications and preventing the conditions that contribute to it.

• If you smoke, try to quit. Learn how University Health can help..
• Eat heart-healthy foods, like those found in the Mediterranean diet.
• Stay physically active and get at least 150 minutes of exercise each week.
• Manage health conditions like Type 2 diabetes and high blood pressure using prescribed medications.

Heart Failure Symptoms

Symptoms of heart failure can be easily written off or misattributed to other conditions. If you have any of the following risk factors for heart failure, call your doctor to be evaluated:

• Shortness of breath
• Fatigue
• Fluid buildup and swelling (edema)
• Breathlessness lying flat (orthopnea)
• Waking at night gasping (paroxysmal nocturnal dyspnea)
• Faster heart rate while resting
• Sudden weight gain or loss
• Trouble sleeping
• Loss of appetite

When to Seek Emergency Care

Some symptoms are more life-threatening and require immediate medical attention. If you are experiencing the following, call 911:

• Severe shortness of breath while resting
• Coughing or wheezing with pink-tinged spittle
• Chest pain
• Fainting

Diagnosis and Monitoring

In addition to a full physical exam and asking questions about your health history, your doctor will order tests that may include:

• Blood test
• Echocardiogram (heart ultrasound) to measure your ejection fraction and how well the heart pumps and fills
• Chest X-ray
• Exercise stress test
• Electrocardiogram
• CT scan
• Heart MRI

Heart Failure Stages

The American Heart Association stages heart failure from A to D, with D being the most severe.

Living with Heart Failure

Getting a heart failure diagnosis can be scary, but the heart team at University Health is here with you every step of the way. With proper care, people with heart failure can live for many more years and successfully manage their symptoms.

Making healthy lifestyle changes and taking all medications as prescribed is crucial to relieving symptoms and living a full life.