Understanding and Managing Heart Failure

Heart failure is a common and serious condition, particularly for older adults. Understanding heart failure can help patients and caregivers take action to maintain heart health and quality of life.

Before understanding heart failure, it helps to know how a healthy heart functions and why proper function is important. The heart is a strong pump that beats approximately 100,000 times daily. It sits between the lungs, slightly to the left of your breastbone.

The heart has four chambers—two atria and two ventricles—and four valves that keep blood moving in the right direction. Here’s how blood flows through the heart:

• Deoxygenated blood (blood that is lacking oxygen) enters the right atrium via two large veins, the superior and inferior vena cava.
• The right atrium contracts, pushing blood into the right ventricle through the tricuspid valve.
• The right ventricle contracts, pumping blood to the lungs through the pulmonary valve.
• Oxygen-rich blood returns to the heart’s left atrium.
• The left atrium contracts, moving blood to the left ventricle via the mitral valve.
• Finally, the left ventricle contracts, sending the blood out to the rest of the body through the aorta.

Two types of blood vessels help with circulation: arteries (which carry oxygenated blood from the heart to the body) and veins (which bring deoxygenated blood back to the heart).

Heart failure is a very common condition that affects more than 6 million people in the United States. Despite its name, heart failure doesn’t mean the heart has stopped working—it means it’s not pumping as effectively as it should.

Over time, this can lead to the heart’s walls stretching or thickening as they work harder. The kidneys then retain more salt and water, causing fluid buildup or “congestion” in parts of the body like the legs and lungs. This is also known as congestive heart failure, or CHF.

Note that not all heart failure is classified as congestive heart failure, but CHF is the most common type, so many use the terms interchangeably. 

Heart failure usually develops due to conditions that make the heart work harder. These conditions may include:

• Coronary heart disease
• Diabetes
• High blood pressure
• Other heart conditions and diseases

Certain lifestyle factors, such as alcohol or drug abuse, thyroid disorders, and certain cancer treatments, may also lead to heart failure.

Your doctor may perform various tests to determine if you have heart failure. These tests may include:

• A physical exam
• Blood tests
• Chest x-rays
• An electrocardiogram (EKG or ECG)
• An echocardiogram (echo)
• An exercise stress test
• Radionuclide ventriculography or multiple-gated acquisition scanning (MUGA)
• Cardiac catheterization
• Magnetic resonance imaging (MRI)

The echocardiogram is important because it measures your ejection fraction, or EF. This number, expressed as a percentage, tells how much blood is pumped out per heartbeat. A normal EF is between 50 and 70%, while anything below 40% may suggest heart failure.

Because heart failure is a progressive disease, health professionals use a staging system to determine the best treatment plan. The staging model used by the American Heart Association breaks the disease into four stages:

• Stage A: High risk for heart failure but no symptoms yet
• Stage B: Diagnosed with heart failure but symptom-free
• Stage C: Symptoms are present, like shortness of breath or fatigue
• Stage D: Advanced heart failure requiring intensive treatment

If you have congestive heart failure but aren’t sure which stage you’re in, ask your doctor. Keep in mind that you cannot go backwards through stages—only forward.

Treatment for heart failure depends on the type and severity of the disease. Regardless of your stage, the goals for treatment include:

• Treating the underlying causes of the condition
• Reducing the symptoms
• Stopping the disease from getting worse
• Increasing a person’s lifespan
• Improving a person’s quality of life

To accomplish these goals, treatment usually involves many factors. These include making heart-healthy lifestyle changes, taking medication as prescribed by your healthcare provider, and closely monitoring your symptoms.

Living with heart failure means making adjustments to your daily life. Here are some tips to feel your best after a heart failure diagnosis.

Treating heart failure is a team effort. Your healthcare team may consist of many people, including doctors, social workers, pharmacists, nurses, dieticians, and fitness professionals. A loved one or caregiver may also play an active role in your treatment. Even though you have a big team of people, remember that you are the key player on your healthcare team.

There are many different medications that your doctor may prescribe to manage heart failure. Some medications help to lessen the symptoms you may experience, and others are meant to treat other chronic conditions, like high blood pressure.

If your healthcare provider prescribes a medication, it’s important to take it as prescribed. Make sure you understand the instructions on how to take each medication. 

If you’ve been diagnosed with heart failure, there are several changes you can make to help control the condition.

If you’ve been diagnosed with heart failure, there are several changes you can make to help control the condition.

A heart-healthy diet is low in saturated fat, trans fat, cholesterol, and sodium. Too much sodium can cause your body to retain more water, which makes your heart work harder.

It’s also important to maintain a healthy weight if you’ve been diagnosed with heart failure. Work with your doctor to determine your ideal weight. You may find that you need to lose some weight. Remember that even small amounts of weight loss can help.

Your doctor may also advise that you quit smoking or limit the amount of alcohol you drink. Taking these actions, along with getting enough sleep and reducing your stress levels, can help your heart stay healthy for longer.

In addition to making select lifestyle changes, your healthcare provider may recommend some daily management strategies. Many of these involve monitoring your own symptoms and looking for changes or abnormalities in your body.

Here are some things you may be asked to keep an eye on:

As mentioned earlier, heart failure can cause fluid buildup in your body. This is why it’s so important to check your weight frequently.

Keep a close eye on symptoms like shortness of breath, increased swelling, and frequent coughing. If you notice any new or worsening symptoms, notify your healthcare provider.

Notify your healthcare provider if you’re having trouble sleeping. This may involve waking up feeling short of breath, having to use more pillows than usual, or having to sleep in a recliner. In addition, watch out for any loss of appetite that you may experience.

Dealing with heart failure can be emotionally challenging and hard to cope with. It’s not uncommon to have feelings of fear, anxiousness, stress, or depression. A strong support system can help you talk about your feelings and seek help when needed.

Talk to your healthcare team about how you’re feeling. They may be able to recommend treatment options that can help.

You can also reach out to family and friends for help. It’s likely you won’t be able to do everything you once did on your own. You may need help with daily chores and activities. Don’t be afraid to ask for help.

In addition, consider joining a support group for people with heart failure or other conditions. Check your local hospital or senior center to see if any support groups are available.

It’s also important to talk about the role of a caregiver when managing heart failure. As a caregiver, it’s important to do the following:

• Work with your loved one’s healthcare team to provide the best care possible.
• Learn as much as you can about heart failure to understand how to monitor symptoms and make positive lifestyle changes.
• Encourage your loved one to stick with their lifestyle changes and offer emotional support as needed.
• Take care of yourself by staying connected with friends, managing stress, and prioritizing your health.

Heart failure is a challenging condition, but with the right treatment plan and support, it’s possible to lead a fulfilling life. Working closely with your healthcare team, managing symptoms, and making heart-healthy lifestyle changes can all help to control heart failure.

Whether you’re a patient or caregiver, remember you’re not alone. There are many resources and people who are ready to help you on this journey to better heart health.

Sources:

National Heart, Lung, and Blood Institute

1. https://www.nhlbi.nih.gov/health/heart-failure
2. https://www.nhlbi.nih.gov/health/heart
3. https://www.nhlbi.nih.gov/health/heart-failure/causes
4. https://www.nhlbi.nih.gov/health/heart-failure/treatment

Heart.org

1. https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/common-tests-for-heart-failure#.WJyP2U0zWM8
2. https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/lifestyle-changes-for-heart-failure
3. https://www.heart.org/en/health-topics/heart-failure/living-with-heart-failure-and-managing-advanced-hf/physical-changes-to-report-for-heart-failure
4. https://www.heart.org/en/health-topics/heart-failure/living-with-heart-failure-and-managing-advanced-hf/your-heart-failure-healthcare-team
5. https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/ejection-fraction-heart-failure-measurement
6. https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-of-heart-failure

FamilyDoctor.org

1. https://familydoctor.org/condition/heart-failure/