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Heart failure means that your heart muscle doesn't pump as much blood as your body needs. Failure doesn't mean that your heart has stopped. It means that your heart is not pumping as well as it should.
Because your heart cannot pump well, your body tries to make up for it. To do this:
Your body has an amazing ability to make up for heart failure. It may do such a good job that you don't know you have a disease. But at some point, your heart and body will no longer be able to keep up. Then fluid starts to build up in your body, and you have symptoms like feeling weak and out of breath.
This fluid buildup is called congestion. It's why some doctors call the disease congestive heart failure.
Heart failure usually gets worse over time. But treatment can slow the disease and help you feel better and live longer.
Anything that damages your heart or affects how well it pumps can lead to heart failure. Common causes of heart failure are:
Other conditions that can lead to heart failure include:
Symptoms of heart failure start to happen when your heart cannot pump enough blood to the rest of your body. In the early stages, you may:
As heart failure gets worse, fluid starts to build up in your lungs and other parts of your body. This may cause you to:
If your symptoms suddenly get worse, you will need emergency care.
Your doctor may diagnose heart failure based on your symptoms and a physical exam. But you will need tests to find the cause and type of heart failure so that you can get the right treatment. These tests may include:
An echocardiogram can help show if you have heart failure, what type it is, and what is causing it. Your doctor can also use it to see if your heart failure is getting worse.
This test can measure how much blood your heart pumps to your body. This measurement is called the ejection fraction. If your ejection fraction gets lower and you are having more symptoms, it means that your heart failure is getting worse.
Most people with heart failure need to take several medicines. Your doctor may prescribe medicines to:
It is very important to take your medicines exactly as your doctor tells you to. If you don't, your heart failure could get worse.
Pacemaker or defibrillator
A pacemaker or a defibrillator (such as an ICD) may be an option for you if you have a problem with your heart rhythm. A pacemaker can help your heart pump blood better. A defibrillator can prevent a dangerous heart-rhythm problem.
Care at home
Lifestyle changes are an important part of treatment. They can help slow down heart failure. They may also help control other diseases that make heart failure worse, such as high blood pressure, diabetes, and coronary artery disease.
The best steps you can take are to:
Ask your doctor if cardiac rehab is right for you. Rehab can give you education and support that help you learn self-care and build new healthy habits, such as exercise and healthy eating.
To stay as healthy as possible, work closely with your doctor. Have all your tests, and go to all your appointments. It is also important to:
Medicines and lifestyle changes can slow or even reverse heart failure for some people. But heart failure often gets worse over time.
Early on, your symptoms may not be too bad. As heart failure gets worse, you may need to limit your activities. Treatment can often help reduce symptoms, but it usually doesn't get rid of them.
Heart failure can also lead to other health problems. These may include:
Your doctor may be able to give you medicine or other treatment to prevent or treat these problems.
Heart failure can get worse suddenly. If this happens, you will need emergency care. To prevent sudden heart failure, you need to avoid things that can trigger it. These include eating too much salt, missing a dose of your medicine, and exercising too hard.
Knowing that your health may get worse can be hard. It is normal to sometimes feel sad or hopeless. But if these feelings last, talk to your doctor. Antidepressant medicines, counseling, or both may help you cope.
Health Tools help you make wise health decisions or take action to improve your health.
Heart failure can be caused by any problem that damages your heart or affects how well it works.
Certain triggers, such as too much sodium or not taking medicines the right way, may suddenly make heart failure worse. This can sometimes cause deadly problems such as pulmonary edema or cardiogenic shock.
At first you may not have any symptoms from heart failure. For a while, your heart and body can make up for heart failure. For example, your heart can pump faster and pump more blood with each beat. This is called compensation.
But as your heart has more trouble pumping enough blood to your body, you will likely have symptoms. These symptoms may get worse or change if your heart failure gets worse.
Symptoms of heart failure start to happen when your heart can't pump enough blood to the rest of your body. In the early stages, you may:
There is more than one type of heart failure. Each type is based on what problem in the heart is causing it to not pump as much blood as normal.
Heart failure is grouped—or classified—according to symptoms. Your treatment is based partly on what class of symptoms you have.
There's also another way to define heart failure. It's based on the stages you might go through as your heart failure gets worse. Your doctor also may make treatment choices based on your stage of heart failure.
Sometimes your symptoms may get worse very quickly. This is called sudden heart failure. It causes fluid to build up in your lungs, causing congestion. (This is why the problem is often called congestive heart failure.) Symptoms may include:
Sudden heart failure is an emergency. You need care right away.
Your risk for having heart failure is higher if you have certain risk factors. A risk factor is anything that increases your chance of having a particular problem.
Heart failure is usually caused by another health problem, often coronary artery disease or high blood pressure. So anything that increases your risk for one of those problems also increases your risk for heart failure.
The risk of heart failure rises as a person gets older.
Call 911 or other emergency services right away if you have:
Call your doctor right away if you have a pacemaker or ICD and think you have an infection near the device. Signs of an infection include:
Call your doctor soon if you have symptoms of heart failure, which include:
Call your doctor soon if:
Many different types of doctors and nurses can treat you for heart failure, including your family doctor.
Heart failure is a complex problem. So you will likely have several different tests over time. These tests can:
If you have symptoms that suggest heart failure, you may have:
An echocardiogram may be used to diagnose heart failure. It also can help guide treatment.
Tests also may be done to find areas of the heart that are not getting enough blood. These tests include:
When you're taking medicine for heart failure, you may have regular blood tests to check how the medicine is working. Or you may have a blood test to check the level of medicine in your body.
Your treatment for heart failure depends on:
In the early stages of heart failure, treatment can help your symptoms. It may also prevent more damage to your heart. Treatment may include:
As part of your ongoing treatment, your doctor will also try to prevent or treat problems—such as fever, arrhythmia, and anemia—that can lead to sudden heart failure. Treatment may include:
You might take part in a disease management program. These programs include a broad range of services, such as education, home health care, visiting nurses, and rehabilitation.
A very small number of people may have other treatments, including:
If you have other heart problems that may have led to heart failure, you might have treatment for those problems:
Sometimes heart failure can be fixed if another problem can be corrected, such as by treating hyperthyroidism.
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness. You can also have it if treatment to cure your illness no longer seems like a good choice.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see the topic Palliative Care.
Heart failure tends to get worse over time. So you need to decide what kind of care you want at the end of your life.
It can be hard to have talks with your doctor and family about the end of your life. But making these decisions now may bring you and your family peace of mind. Your family won't have to wonder what you want. And you can spend your time focusing on your relationships.
You will need to decide if you want life-support measures if your health gets very bad. An advance directive is a legal document that tells doctors how to care for you at the end of your life. This care includes electronic devices that are used for heart failure, such as pacemakers. You also can say where you want to have care. And you can name someone who can make sure your wishes are followed.
For more information, see the topic Care at the End of Life.
The best way to prevent heart failure is to have a heart-healthy lifestyle and control existing health problems like high blood pressure and diabetes.
To reduce your risk:
You can feel better when you have heart failure by taking your medicines as directed, having a healthy lifestyle, and avoiding things that make heart failure worse. Know what things you can do every day to stay healthy, what symptoms to watch for, and when to call a doctor.
Avoid triggers, such as too much salt (sodium) and certain medicines, that can cause sudden heart failure.
One Man's Story:
"I was having a lot of trouble getting enough sleep. I was snoring so bad that my wife was sleeping in another room. I'd wake up 7 times a night. Sometimes I'd wake up gasping for breath. The next day I'd be so tired that I'd fall asleep while doing my woodworking in the garage. And I was really fuzzy-headed. I couldn't remember anything.
"I thought it might be my heart failure. So I decided to talk to my doctor about it, and he suggested a sleep study. I found out that I have sleep apnea. I haven't been getting enough oxygen because of it. He put me on a CPAP machine at night. I've used it for the past 4 months.
"It took a little time to get used to sleeping with a mask. But I'm sleeping much better. Now if I wake up, it's only once, and I go right back to sleep. I feel so much better during the day."— Pete
This story is based on information gathered from many people living with heart failure.
Many people with heart failure have trouble sleeping. Your doctor may be able to find out what is causing your sleep problems and help you get a good night's sleep.
Most people with heart failure can still have an active and safe sex life. Talk with your doctor if you have concerns about having sex.
Unfortunately, sexual problems are common. Your interest may drop, or you may have shortness of breath or other symptoms that limit your ability to have sex. Men may have erection problems.
Talk to your doctor. You can get help for erection problems or other sexual troubles.
It can be rewarding to help a loved one with heart failure. But it's also a lot of work. And it can be hard emotionally.
If you are taking care of a loved one, make sure that you also take care of yourself. This can mean taking breaks by getting help from family or friends. You also may be able to use respite care. These services provide someone who will stay with your loved one while you get out of the house for a few hours.
Heart failure brings big changes to your life. You may struggle with sadness and worry. You may wonder if you'll still be able to enjoy your life. Coping with your feelings and seeking help when you need it can help you live better with heart failure.
Heart failure can be hard on your emotions. You may feel depressed that you can't do some of the things you used to do. You may worry about your future. And symptoms of heart failure, such as shortness of breath, can make this anxiety worse.
These feelings are common. Talk to your doctor if you have symptoms of depression or are worried a lot. Depression and anxiety can be treated with counseling and medicine.
You also can help yourself feel better by changing your "self-talk." Those are the things you tell yourself about how you're coping. Negative thoughts can make you feel bad. Changing the way you think can change the way you feel.
One Woman's Story:
"I would sit at my kitchen table and feel I was in this cloud of dread. I didn't feel like me. I felt like, 'I'm never going to be me again.' "— Joan
Read about how Joan got help for depression and anxiety.
For more information, see:
The challenges of living with heart failure can increase your stress. And stress can make living with heart failure even harder. Stress also can disturb your sleep and make depression and anxiety worse. Explore ways to relax and manage stress to help your body, mind, and spirit.
Emotional support from friends and family can help you cope with the struggles of heart failure. You might want to think about joining a heart failure support group. Ask your doctor about the types of support that are available where you live.
Cardiac rehab programs can offer support for you and your family. Ask your doctor if rehab is right for you.
Meeting other people with the same problems can help you know you're not alone. If you're shy or aren't a joiner, you can look at an online support group. Even though people online aren't talking face-to-face, they're sharing their feelings and creating a community.
You probably will need to take several medicines to treat heart failure, even if you don't have symptoms yet.
Medicines don't cure heart failure. But they can help your heart work better and improve symptoms.
It's very important to take your medicines exactly as your doctor says. If you don't, your heart failure may get worse or you may get sudden heart failure.
The medicines you take will depend on the type of heart failure you have. The most commonly used medicines are listed below.
You also may take other medicines for health problems that can cause heart failure or for problems caused by heart failure.
Talk to your doctor before you take any over-the-counter medicines. Some of them might make your symptoms worse.
Surgeries for heart failure include:
Cardiac resynchronization therapy (CRT) uses a biventricular pacemaker, which makes the heart's lower chambers (ventricles) pump together. This can help your heart pump blood better. This type of pacemaker can help you feel better so you can be more active. It also can help keep you out of the hospital and help you live longer.
If you get a pacemaker, you have to be careful not to get too close to some devices with strong magnetic or electrical fields. These include MRI machines (unless your pacemaker is safe for an MRI), battery-powered cordless power tools, and CB or ham radios. But most everyday appliances are safe.
A pacemaker may be used alone or along with an implantable cardioverter-defibrillator (ICD) for heart failure.
Implantable cardioverter-defibrillators (ICDs) can prevent sudden death from an abnormal heart rhythm and may help you live longer. An ICD checks the heart for very fast and deadly heart rhythms. If the heart goes into one of these rhythms, the ICD shocks it to stop the deadly rhythm and returns the heart to a normal rhythm.
If you get an ICD, you have to be careful not to get too close to some devices with strong magnetic or electrical fields. These include MRI machines (unless your ICD is safe for an MRI), battery-powered cordless power tools, and CB or ham radios. But most everyday appliances are safe.
An ICD may be used alone or along with a pacemaker for heart failure.
Ventricular assist devices (VADs), also known as heart pumps, may be placed into the chest to help the heart pump more blood. VADs can keep people alive until a donor heart is available for transplant. In some cases, VADs may also be used as an alternative to heart transplant for long-term treatment. VADs are used in people who have severe heart failure.
An intra-aortic balloon pump is sometimes used to help the heart pump more blood during sudden heart failure.
Talk to your doctor before you take any over-the-counter medicine or supplement. They are used along with medical treatments for heart failure, not instead of treatment.
You may hear about supplements, vitamins, or hormones that might improve heart failure symptoms.
Fish oil (omega-3 fatty acid) supplements have been shown to help some heart failure patients. In some studies, fish oil supplements, taken along with other heart failure medicines, helped people stay out of the hospital and live longer.footnote 2
No other supplement, vitamin, or hormone has been shown definitely to relieve heart failure or help you live longer.
Examples include coenzyme Q10 and hawthorn.
U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
Siscovick DS, et al. (2017). Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: A science advisory from the American Heart Association. Circulation, 135(15): e867-e884. DOI: 10.1161/CIR.0000000000000482. Accessed April 10, 2017.
Coenzyme Q10 (2006). Medical Letter on Drugs and Therapeutics, 48(1229): 19–20.
Other Works Consulted
Allen LA, et al. (2012). Decision making in advanced heart failure: A scientific statement from the American Heart Association. Circulation, 125(15): 1928–1952.
Drugs for treatment of chronic heart failure (2009). Treatment Guidelines From The Medical Letter, 7(83): 53–56.
Levine GN, et al. (2012). Sexual activity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 125(8): 1058–1072.
McKelvie R (2011). Heart failure, search date August 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Riegel B, et al. (2009). State of the science. Promoting self-care in patients with heart failure. A scientific statement from the American Heart Association. Circulation, 120(12): 1141–1163.
Rosendorff C, et al. (2015). Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation, 131(19): e435–e470. DOI: 10.1161/CIR.0000000000000207. Accessed March 31, 2015.
Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.
Somers VK, et al. (2008). Sleep apnea and cardiovascular disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing in collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation, 118(10): 1080–1111.
Yancy CW, et al. (2013). 2013 ACCF/AHA Guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16): e147–e239.
Yancy CW, et al. (2016). 2016 ACC/AHA/HFSA Focused update on new pharmacological therapy for heart failure: An update of the 2013 ACCF/AHA guideline for the management of heart failure. Circulation, published online May 20, 2016. DOI: 10.1161/CIR.0000000000000435. Accessed June 10, 2016.
Current as ofJuly 22, 2018
Author: Healthwise StaffMedical Review: Rakesh K. Pai MD, FACC - Cardiology, ElectrophysiologyE. Gregory Thompson MD - Internal MedicineMartin J. Gabica MD - Family MedicineElizabeth T. Russo MD - Internal MedicineAdam Husney MD - Family MedicineKathleen Romito MD - Family MedicineStephen Fort MD, MRCP, FRCPC - Interventional Cardiology
Current as of:
July 22, 2018
Medical Review:Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology & E. Gregory Thompson MD - Internal Medicine & Martin J. Gabica MD - Family Medicine & Elizabeth T. Russo MD - Internal Medicine & Adam Husney MD - Family Medicine & Kathleen Romito MD - Family Medicine & Stephen Fort MD, MRCP, FRCPC - Interventional Cardiology
To learn more about Healthwise, visit Healthwise.org.
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