Heart Failure

Why You Should Care:

• About 5.7 million adults in the United States have heart failure.
• One in 9 deaths in 2009 included heart failure as contributing cause.
• About half of people who develop heart failure die within 5 years of diagnosis.
• Heart failure costs the nation an estimated $30.7 billion each year.
• This total includes the cost of health care services, medications to treat heart failure, and missed days of work.

Symptoms:

Common symptoms of heart failure include:

• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Fatigue and weakness
• Swelling (edema) in your legs, ankles, and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Increased need to urinate at night
• Swelling of your abdomen (ascites)
• Very rapid weight gain from fluid retention
• Lack of appetite and nausea
• Difficulty concentrating or decreased alertness
• Sudden, severe shortness of breath and coughing up pink, foamy mucus
• Chest pain if your heart failure is caused by a heart attack

Risk Factors:

Diseases that damage your heart also increase your risk for heart failure.

Some of these diseases include:

• Coronary heart disease (the most common type of heart disease) and heart attacks
• High blood pressure
• Diabetes

Unhealthy behaviors can also increase your risk for heart failure:

• Smoking tobacco
• Eating foods high in fat, cholesterol, and sodium
• Not getting enough physical activity
• Being obese

Complications:

• Kidney damage or failure
• Heart valve problems
• Heart rhythm problems
• Liver damage

Treatment:

Heart failure is a chronic disease needing lifelong management.

Medications:

Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one or more medications, including:

• Angiotensin-converting enzyme (ACE) inhibitors & Angiotensin II receptor blockers: These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the same benefits as ACE inhibitors. They may be an alternative for people who can't tolerate ACE inhibitors.
• Beta blockers: Examples include carvedilol (Coreg), metoprolol (Lopressor), and bisoprolol (Zebeta).
• Diuretics: Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics, such as furosemide (Lasix), also decrease fluid in your lungs so you can breathe more easily.
• Aldosterone antagonists: These drugs include spironolactone (Aldactone) and eplerenone (Inspra).
• Inotropes: Used in people with severe heart failure in the hospital to improve heart pumping function and maintain blood pressure.
• Digoxin (Lanoxin): This drug, also referred to as digitalis, increases the strength of your heart muscle contractions.

Surgery and Medical Devices:

In some cases, doctors recommend surgery to treat the underlying problem that led to heart failure. Some treatments being studied and used in certain people include:

• Coronary bypass surgery: In this procedure, blood vessels from your leg, arm, or chest bypass a blocked artery in your heart to allow blood to flow through the heart more freely.
• Heart valve repair or replacement: If a faulty heart valve causes heart failure, your doctor may recommend repairing or replacing the valve.
• Implantable cardioverter-defibrillators (ICDs): An ICD is a device similar to a pacemaker. It's implanted under the skin in your chest with wires leading through your veins and into your heart.
• Cardiac resynchronization therapy (CRT), or biventricular pacing: A biventricular pacemaker sends timed electrical impulses to both of the heart's lower chambers (the left and right ventricles) so that they pump in a more efficient, coordinated manner.
• Ventricular assist devices (VADs): A VAD, also known as a mechanical circulatory support device, is an implantable mechanical pump that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body.
• Heart transplant: Some people have such severe heart failure that surgery or medications don't help. They may need to have their diseased heart replaced with a healthy donor heart.

References:

• Mayo Clinic - Heart Failure