By Sara Weiss, MD
According to the American Heart Association’s latest statistics, heart failure affects 6.5 million Americans and is projected to increase 46 percent by 2030 resulting in more than 8 million people with the malady. Unfortunately, though, the common condition known as “heart failure” was given one of the most misleading names in medicine.
Heart failure does not mean the heart has stopped working. It means the heart’s pumping power is weaker than normal.
With heart failure, blood moves through the heart and body at a lesser rate, and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body’s needs. The chambers of the heart may respond by stretching to hold more blood or by becoming stiff and thickened. This helps keep blood moving, but the heart muscle walls may eventually weaken and pump less efficiently. As a result, the kidneys may respond by retaining fluid and salt. If fluid builds up in the arms, legs, ankles, feet, lungs or other organs, the body becomes congested — thus the term “congestive heart failure.”
Heart failure may result from many health conditions that directly affect your cardiovascular system. This is why it is important to get annual checkups to lower your risk for heart health problems.
Heart failure can be prevented by early treatment of high blood pressure, coronary artery disease, and valve conditions. Other less common causes of heart failure include alcohol abuse, certain kinds of chemotherapy, and genetic disorders.
Heart failure can be ongoing (chronic), or your condition may start suddenly (acute).
In the early stages of heart failure, you may not have any obvious symptoms. However, if your condition progresses, your body will experience gradual changes.
Symptoms you may notice first include fatigue; swelling in lower legs, ankles and feet; and weight gain. Symptoms that indicate your condition has worsened include irregular heartbeat; a cough that develops from congested lungs; wheezing; and shortness of breath, which may indicate pulmonary edema (fluid accumulation in the lungs). And symptoms that indicate a severe heart condition include rapid breathing; skin that appears blue due to lack of oxygen; fainting; and chest pain that radiates through the upper body.
Since chest pain that radiates through the upper body can also be a sign of a heart attack, if you experience this or any of the other symptoms that may point to a severe heart condition, you should seek immediate medical attention.
Although not all conditions that lead to heart failure can be reversed, treatments can improve signs and symptoms of the condition and help you live longer. For instance, lifestyle changes — such as exercising, reducing salt intake, managing stress and losing weight — can improve your quality of life.
Like the saying, “An ounce of prevention is worth a pound of cure,” one approach — and, really, the best way — to prevent heart failure is to control the conditions that cause it, such as coronary artery disease, high blood pressure, diabetes, or obesity.
When to see a doctor
If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. Contact your doctor promptly.
And if you experience any of the following, seek emergency treatment:
- Chest pain
- Fainting or severe weakness
- Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting
- Sudden, severe shortness of breath and coughing up pink, foamy mucus
Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. As I always tell patients, don’t try to diagnose yourself. Instead, call for immediate assistance. When you arrive at a hospital, emergency medicine providers will try to stabilize your condition and determine if your symptoms are due to heart failure or something else.
Heart failure is very treatable and usually involves the use of various medications. A cardiologist will work closely with you to find the ideal combination of medications that will help your heart work better and help with the demands of the body. Managing heart failure involves a delicate balance between taking the work load off your heart and supplying enough oxygen and nutrients to the other organs.
There are invasive treatments for advanced congestive heart failure including heart transplantation and the implantation of a pacemaker or pump that helps the heart push blood along.
In addition to compliance with medication, there are things that may help keep congestive heart failure at bay. They include:
- Regular visits with your primary care physician and cardiologist: Congestive heart failure must be closely monitored and any changes treated promptly. You should weigh yourself weekly and report weight gain of 3 lbs. or more to your physician since it could be the result of fluid retention.
- Dietary changes: Weight loss, even if you are slightly overweight, is imperative to prevent further damage to your heart muscle. The larger your body, the harder your already damaged heart has to work in order to supply much-needed oxygen and nutrients. Even moderate weight loss can greatly impact congestive heart failure management.
- Exercise: Exercise can be a challenge due to symptoms of congestive heart failure. However, any increase in activity is very helpful. Walking is a great low-impact option for patients with congestive heart failure. If weather is an issue, or if you don’t have a safe, level place to walk, try a local shopping mall. Many malls open early and even place distance markers for people who exercise there. It is a great way to meet people, have fun and stay healthy. Before starting an exercise regime, consult your doctor.
- Avoid fluid overload: Restricting fluid intake is important. A decrease in fluid intake can reduce the amount of work the heart has to deal with.
- Salt intake: As I always tell my patients, where there is salt, there is water. So, if you have a lot of sodium in your body, you will retain fluid. For this reason, avoid foods with high amounts of salt.
- Smoking: If you smoke, stop immediately. It must be avoided at all costs since cigarette smoke carries a lot of carbon monoxide, which worsens the ability of oxygen to be carried throughout the body.
- And lastly, stay healthy: It requires a lot of energy for your body to fight off common illnesses, like flu. So, stay current on flu and pneumonia vaccinations. Respiratory diseases may cause heart failure symptoms to worsen. So, the best approach is simply to avoid the risk.
Whether you have heart failure or not, February is a great time for everyone to focus on their cardiovascular health since February is American Heart Month. So, I encourage you to adopt some of these same basic heart health principles.
Sara Weiss, MD, is a board-certified cardiologist who specializes in heart failure management, echocardiography, and women and cardiovascular disease. She practices at Virginia Mason Hospital & Seattle Medical Center and lives on Mercer Island.