Heart Failure

Definition

Heart failure is a condition that develops when your heart doesn’t pump the amount of blood your body needs. This can happen if your heart can’t fill up with enough blood. It can also happen when your heart is too weak to pump properly. Although “heart failure” is a serious condition that needs immediate medical care, it does not mean that your heart has stopped. 

More than 6 million adults in the United States have heart failure, according to the Centers for Disease Control and Prevention. Children can also develop heart failure.

Heart failure can develop suddenly (the acute kind) or over time as your heart gets weaker (the chronic kind). It can affect one or both sides of your heart. 

Heart failure can also damage your liver or kidneys. Other complications include pulmonary hypertension or other heart conditions, such as an irregular heartbeat, heart valve disease, and sudden cardiac arrest. 

Blacks are more likely to have heart failure than people of other races. They also often have more serious cases of heart failure and at a younger age. 

Between the ages of 45 and 64, Black males have a 70% higher risk for heart failure than Caucasian males. Black females between the ages of 45 and 54 have a 50% greater risk to develop heart failure than Caucasian females, according to USC Journal.

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Causes

Left-sided and right-sided heart failure may have different causes. Typically, heart failure is caused by another medical condition that damages your heart. This includes coronary heart disease, heart inflammation, high blood pressure, cardiomyopathy, or an irregular heartbeat. Symptoms of heart failure may not show right away. However, you may eventually feel tired and short of breath and notice fluid buildup in your lower body, around your stomach, or neck. 

Risk factors

There are several factors that can raise your risk of heart failure. Some factors can be controlled by making changes to your lifestyle habits. Others including your age, race, or ethnicity cannot. Your risk of heart failure goes up if you have more than one of these factors. 

• Age. People 65 years or older have a higher risk of heart failure because aging can weaken and stiffen your heart. Older adults are also more likely to have other health conditions that cause heart failure.  
• Family history and genetics. Your risk of heart failure is higher if people in your family have been diagnosed with heart failure. Certain gene mutations can also raise your risk. These mutations make your heart tissue weaker or less flexible. 
• Lifestyle habits. An unhealthy diet, smoking, using cocaine or other illegal drugs, heavy alcohol use, and lack of physical activity can raise your risk of heart failure. 
• Other medical conditions. Any heart or blood vessel condition such as serious lung disease, or infections such as HIV or SARS-CoV-2 may raise your risk of heart failure. Long-term health conditions such as obesity, high blood pressure, diabetes, sleep apnea, chronic kidney disease, anemia, thyroid disease, or iron overload also raise your risk. Cancer treatments such as radiation and chemotherapy can injure your heart and raise your risk. Atrial fibrillation, a common type of irregular heart rhythm, can also cause heart failure. 
• ​​​​​​​Sex. Heart failure is common in both men and women, although men often develop heart failure at a younger age than women and women have worse symptoms. Women more commonly have heart failure with preserved ejection fraction (HFpEF), which occurs when the heart does not fill with enough blood. Men are more likely to have heart failure with reduced ejection fraction (HFrEF). 

Symptoms

Symptoms of heart failure vary depending on the type of heart failure you have and how serious it is. Those who have mild heart failure may not notice any symptoms except when doing hard physical work. Symptoms also vary depending on whether you have left-sided or right-sided heart failure. However, you can have symptoms of both types. Symptoms will typically get worse as your heart grows weaker.  

Symptoms of heart failure include:

• Shortness of breath after routine activities like climbing stairs (one of the first symptoms you may notice). As your heart grows weaker, you may notice this while getting dressed or walking across the room. Some people may even experience shortness of breath while they are lying flat. 
• Cough 
• Fatigue (extreme tiredness even after rest) 
• General weakness 
• Bluish color of finger and lips  
• Sleepiness and trouble concentrating 
• Inability to sleep lying flat 
• Older adults who do not get much physical activity may not experience shortness of breath. But they may feel tired and confused. 

People who have right-sided heart failure may also have the following symptoms:

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• Nausea (feeling sick in the stomach) and loss of appetite 
• Pain in your abdomen (area around your stomach)  
• Swelling in your ankles, feet, legs, abdomen, and veins in your neck 
• ​​​​​​​Needing to pee often 
• Weight gain

Diagnosis

Your doctor will diagnose heart failure based on your medical history, a physical exam, and test results. Your doctor may also refer you to a cardiologist (a doctor who specializes in diagnosing and treating heart diseases).

Medical history and physical exam 

During your exam, you should bring a list of your symptoms to your doctor’s appointment, including how often they happen and when they started. Also, bring a list of any prescription and over-the-counter medicines you take. Let your doctor know if you have any risk factors for heart failure. 

During your physical exam, your doctor will: 

• Measure your heart rate, blood pressure, and body weight. 
• Listen to your heart with a stethoscope for sounds that suggest that your heart is not working properly. 
• Listen to your lungs for the sounds of fluid buildup. 
• Look for swelling in your ankles, feet, legs, liver, and veins in your neck.

Treatment

Heart failure has no cure. However, the proper treatment can help you live a longer, more active life with fewer symptoms. What treatment your doctor recommends will depend on the type of heart failure you have and how serious it is but usually includes heart-healthy lifestyle changes and medicines. You may need a procedure or surgery for some types of serious heart failure. Because heart failure often gets worse over time and causes complications such as kidney or liver damage​​​​​​​, malnutrition, an irregular heartbeat, leaking heart valves , or sudden cardiac arrest and pulmonary hypertension; it is important to discuss your long-term treatment goals with your healthcare team. 

Your healthcare team will also treat any medical condition that may have caused or worsened your heart failure.