Heart Failure:  When Our Most Important Muscle Pumps Poorly

Heart Failure: When Our Most Important Muscle Pumps Poorly

You have probably heard someone describe a grandparent as having an enlarged heart.  What does this mean?  Heart failure (also referred to as congested heart failure) is when the heart is not pumping efficiently.  According to the Cleveland Clinic, heart failure affects 5.7 Americans, and it is the leading cause of hospitalization of people over the age of 65.  Symptoms can range from mild to severe, and unfortunately worsens over time.

Heart failure can occur slowly over time, or suddenly.  The common symptoms include:

  • shortness of breath when exerting your self
  • shortness of breath when lying flat
  • swelling in the lower extremities (legs, ankles or feet)
  • reduced stamina
  • a rapid heart beat
  • a cough or wheeze, including phlegm that is pink in color
  • increased need to urinate in the night
  • a sudden weight gain from water retention
  • chest discomfort

The common causes of heart failure are factors that damage the heart, leading to a weakening of the heart muscle, or a stiffening of it.  This damage causes the heart to not pump efficiently, or to not fill up properly between heart beats.  Congestive heart failure is when the blood backs up in to the lungs, liver, abdomen or lower extremities causing a retention of fluid.  Symptoms include weakness and shortness of breath, although a person can have heart failure and NOT have these symptoms of congestion.

Coronary Artery Disease (CAD) is the most common cause of heart failure.  Narrowing of the arteries by fatty deposits and plaques reduces the flow of blood through the heart muscle.  If this worsens to the point of blocking flow to a part of the heart, or if a clot forms within the vessels of the heart, a heart attack occurs.  Damage from the heart attack also can weaken the pumping function of the heart. 

Factors that make the heart pump harder can also weaken the heart over time and lead to heart failure.  Uncontrolled high blood pressure is one such scenario.  As the heart tries to pump against the narrowed arteries, the walls of the heart can become stiff, and not squeeze (pump) efficiently.  This can weaken the heart muscle and the heart becomes enlarged.  Damaged or defective heart valves may also increase the workload of the heart and weaken it over time.

Infections, health conditions and lifestyle factors can also lead to heart failure.  This includes:  obesity, smoking, alcoholism, viruses, thyroid disease, diabetes (because CAD is more likely in an environment of high blood sugar), HIV and hemochromatosis (iron overload in the blood).  Sleep apnea can also be a possible cause due to changes such as high blood pressure that is associated with it.

Heart failure is diagnosed through review of the symptoms, a chest x-ray (which can show the enlarged heart and fluid in the lungs), an ultrasound of the heart (which may show the size of the heart, the thickness of the walls of the heart, check for a heart valve problem, and other signs), blood tests, and an electrocardiogram.  A stress test may also be performed.

Treatment often involves medications to manage the blood pressure by dilating the vessels, reduce the workload of the heart muscle, and increase blood flow of the vessels.  Other medications, like Digoxin, strengthen the hearts contractions as it pumps.  Diuretics ("water pills") reduce the swelling in the extremities, and retention of fluid in the lungs if this is present and lower the blood pressure.  A diet low in salt is very important.  The healthcare provider will encourage you to weigh daily to recognize weight gain due to retention of fluids. 

If you have heart failure, your healthcare provider will teach you signs to look for that may mean there is worsening of the heart failure.  You will need to go to the emergency room if you faint, have weakness, or any chest pain.  You should see the healthcare provider if you have:

  • a weight gain of 5 pounds in a week (or a weight gain that the doctor has stated)
  • new leg swelling
  • shortness of breath that is getting worse
  • heaviness in the chest
  • have to sleep in an upright position
  • coughing or wheezing at night
  • failure to lose weight even though you tried taking the "water pill"

How do you prevent heart failure from occurring in the first place?  Maintaining a healthy weight, eating a healthy diet, managing stress, staying active, controlling the blood pressure, controlling diabetes, and not smoking are key.  Limit or abstain from alcohol. If you suspect sleep apnea, see your healthcare provider to discuss your symptoms.  Taking a pill for high blood pressure or high cholesterol is one option, but taking control of your health and longevity by leading a healthy and active lifestyle is well worth the investment in yourself.

http://familydoctor.org/condition/heart-failure. 12/8/16.  Retrieved on 2/13/17.

www.mayoclinic.org/disease-conditions/heart-failure/basics/symptoms/con-20029801.  8/30/16.  Retrieved on 2/13/17.

www.myclevelandclinic.org/health/articles/heart-failure.  Retrieved on 2/13/17.





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