Heart Failure

Heart failure means that the heart is unable to pump enough blood throughout the body. Without proper blood supply, the rest of the body can’t receive enough oxygen and nutrients to function properly.
Congestive heart failure (CHF) is a type of heart failure where fluid builds up around the heart and surrounding tissues. This leaves the heart unable to pump enough blood throughout the body. CHF requires immediate medical attention.

Heart failure is a chronic, progressive disease that typically develops over four stages:

A: People who have risk factors for heart failure

B: People with changes in the structure of the heart but no symptoms

C: People with symptoms of heart failure

D: People with advanced (end-stage) heart failure symptoms requiring specialized medical and surgical treatments

While there is no cure for heart failure, patients can live longer and with reduced symptoms and a better quality of life. Making lifestyle changes can help control risk factors, and medications and implantable devices can help the heart function better.

Causes and Risk Factors

The majority of people diagnosed with heart failure have previously experienced other major cardiac conditions, such as:

• Coronary artery disease
• High blood pressure
• Previous heart attack(s)
• Congenital heart disease
• Cardiomyopathy
• Risk factors like diet, lifestyle, and genetics also contribute to the likelihood of developing heart failure.

Symptoms

Heart failure can progress before symptoms become severe enough to notice, so it’s important to visit your doctor soon if these signs persist. Symptoms of heart failure include:

• Shortness of breath
• Coughing
• Wheezing
• Fatigue
• Lack of appetite
• Nausea
• Confusion
• Increased heart rate

Diagnosis

After a review of medical history and physical examination, heart failure can be diagnosed using a combination of diagnostic procedures, including:

• Chest X-ray 
• Electrocardiogram (ECG/EKG)
• Echocardiogram
• B-type natriuretic peptide (BNP) blood test
• Stress Test

Treatment

Heart failure cannot be cured, but can be treated with a combination of a healthy lifestyle, medications, and surgically implantable devices and procedures.

Lifestyle Changes

Patients with heart failure can live longer and manage their symptoms by working with their doctor cardiologist to maintain a heart-healthy lifestyle. These changes include:

• Regular doctor visits
• Eating a healthy diet
• Regular exercising
• Avoiding smoking
• Getting enough sleep
• Managing stress

Medications 

Patients with heart failure can benefit from a variety of medications to both prolong their lives and manage or reduce symptoms. There medications include:

• Beta-blockers - reduce blood pressure and slow a rapid heart rhythm
• Angiotensin-Converting Enzyme (ACE) inhibitors - relax blood vessels, making it easier for your heart to pump
• Sacubitril/Valsartan (Entresto): is the first-in-class angiotensin receptor neprilysin inhibitor (ARNI) that reduces strain on the failing heart. It contains two active components, sacubitril, a neprilysin inhibitor and valsartan, an angiotensin receptor blocker. It should be used in place of an angiotensin-converting enzyme (ACE) inhibitor or other angiotensin II receptor blocker (ARB) therapy.
• Mineralacorticoid antagonists - reduce the amount of fluid in the body and also strengthen the heart
• Ivabradine - reduces heart rate to help the heart to relax
• Digitalis - increases blood flow throughout the patient’s body by helping the heart pump more efficiently and strengthening the force of the heart muscles contractions

Surgical Options 

As heart failure progresses, it may be necessary to use implantable devices or procedures to help monitor or support the heart’s function. These include:

• Implantable Cardioverter Defibrillator - A device that delivers an electric counter shock when the heart has an unusual rhythm, helping to restore proper pacing.
• Cardiac Resynchronization Therapy (CRT) - A type of pacemaker that improves heart function
• Ventricular Assist Device/Left Ventricular Assist Device (VAD/LVAD) - A battery-operated pump that is surgically implanted in the heart to help it pump blood throughout the body.
• Transplant - A heart transplant from a donor may be necessary for patients that do not respond to other treatment options