A Comprehensive Guide on Heart Failure

Congestive heart failure (often called heart failure) is a common heart condition that occurs when your heart muscle is ineffective at pumping blood. As a result, your body hangs on to salt and water, causing your heart to beat faster and potentially get bigger. Heart failure is not the same as a heart attack, which causes part of the heart muscle to die, or cardiac arrest, which causes blood flow to stop completely.

In 2015, heart failure affected about 40 million people globally. It may be a chronic condition (ongoing) or acute (occur suddenly). Certain conditions such as high blood pressure, diabetes and coronary artery disease can lead to congestive heart failure. There are a number of treatments for heart failure, and lifestyle changes can help improve your quality of life.

Causes of Heart Failure

There are a number of conditions that can lead to heart failure; it is most often related to another disease or illness such as:

  • Atrial fibrillation, an abnormal heart rhythm.
  • Coronary artery disease. This is the most common cause of heart failure, and can be the result of a previous heart attack.
  • High blood pressure. If your heart has to work harder to circulate blood throughout your body, it can make your heart muscle weak or stiff.
  • Diabetes. There is a link between diabetes and heart failure.
  • Cardiomyopathy. Diseases, infections or abuse of alcohol/drugs can cause this condition.
  • Excess alcohol or drug use (e.g., methamphetamine, cocaine).
  • Viral infections that lead to inflammation of the heart muscle.
  • Medications including NSAIDS, COX-2 inhibitors, certain cancer medications, anesthetic agents such as ketamine, tricyclic antidepressants and calcium channel blockers.
  • Some supplements can exacerbate existing heart failure, such as ginseng, licorice, Lily of the valley and yohimbine.

Type of Heart Failure   

There are four types of heart failure:

  • Left-sided heart failure, which causes fluid to back up in the lungs.
  • Right-sided heart failure, which causes fluid to back up into your abdomen, feet and legs.
  • Systolic heart failure, also known as heart failure with reduced ejection fraction (HFrEF), is a pumping problem in the left ventricle.
  • Diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), is a filling problem in the left ventricle.

Symptoms of Heart Failure

It’s important to see your healthcare provider for regular checkups, and especially if you’re experiencing symptoms of heart failure, which can include:

  • Shortness of breath, especially when you exercise or lie down
  • Chest pain
  • Fatigue
  • Nausea
  • Irregular or rapid heartbeat
  • Weakness
  • Edema (swelling) in your feet, ankles, legs or abdomen
  • Wheezing or cough
  • Lack of appetite
  • Difficulty concentrating
  • Pink-tinged mucus or phlegm

Risk Factors for Heart Failure

There are many different risk factors for heart failure, including:

  • Coronary artery disease
  • High blood pressure
  • Diabetes and some diabetes medications
  • Heart attack
  • Obesity
  • Viruses
  • Sleep apnea
  • Certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Alcohol or drug use
  • Congenital heart defects
  • Smoking

There are also complications that can occur as a result of heart failure, including:

  • Heart valve or heart rhythm problems
  • Liver damage from a buildup of fluid that puts pressure on the liver and causes scarring
  • Kidney damage, due to reduced blood flow to the kidneys

Diagnosing Heart Failure

To diagnose heart failure, your physician will perform a physical exam to look for things like congested lungs or fluid buildup. He or she will review your medical history and you’ll have a chance to discuss your symptoms. If your physician thinks you should undergo further testing, he or she may order:

  • Blood tests. This may show conditions that can affect the heart and a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP).
  • X-rays. An X-ray image of your chest can show the condition of your heart and lungs.
  • Echocardiogram. This test produces a video image of your heart, which can show abnormalities and measure how well your heart is pumping.
  • Electrocardiogram (ECG or EKG). Your doctor will attach electrodes to your skin to record the electrical activity of your heart.
  • Cardiac computerized tomography (CT) scan. This machine collects images of your chest and heart while you lie on a table.
  • Magnetic resonance imaging (MRI). This machine produces a magnetic field to create images of your heart.
  • Coronary angiogram. The doctor will insert a thin catheter into a blood vessel (groin or arm), and then guide it into your coronary arteries. Dye is injected into the catheter so that your physician can visualize blockages.
  • Stress tests. Usually, you’ll walk on a treadmill while attached to an ECG machine to measure the effects of exertion on your heart.

There are other medical conditions with similar symptoms to heart failure, including kidney failure, liver problems, obesity and thyroid disease.

Treatment of Heart Failure

Treatment of your heart failure depends on the type and severity. It’s important to remember that there is no cure for heart failure, but treatment can improve your symptoms and strengthen your heart. There are three main types of treatment for heart failure: medications, devices and surgery.

Generally, physicians will prescribe a combination of medications to treat your condition, including:

  • ACE (angiotensin-converting enzyme) inhibitors. These drugs are a type of vasodilator, which lower blood pressure and improve blood flow. By widening the blood vessels, ACE inhibitors help you feel better, as there is less stress on the heart.
  • Aldosterone antagonists. Also known as potassium-sparing diuretics, these are often prescribed for patients with severe heart failure symptoms.
  • Angiotensin II receptor blockers. These drugs are often used as an alternative for patients who can’t tolerate ACE inhibitors; they have many of the same benefits.
  • Beta blockers. Another common medication for heart failure, beta blockers reduce blood pressure and slow your heart rate; they may even reverse some heart damage.
  • Digoxin. Also known as digitalis, this medication is used to slow the heartbeat and increase reduce heart failure symptoms.
  • Diuretics (water pills). These are prescribed to prevent you from retaining fluid, which can reduce edema. You’ll probably have to take potassium and magnesium supplements if you take diuretics.
  • Nitrates. These can help reduce chest pain.
  • Statins. You may take statins to lower cholesterol.

Some of the devices used to treat heart failure include:

  • Biventricular pacing (also known as cardiac resynchronization therapy). This type of pacemaker sends timed electrical impulses to the heart, improving pumping. This treatment may be combined with an ICD.
  • ICDs (implantable cardioverter-defibrillators). Similar to a pacemaker, an ICD is implanted in your chest, and its wires lead through your veins and into your heart. If your heart stops or begins beating too irregularly, the ICD will get it back into a normal rhythm.
  • Oxygen tanks. Patients with severe heart failure may need to use supplemental oxygen on a regular, long-term basis.
  • VADs (ventricular assist devices). A mechanical pump is implanted into your chest or abdomen to help pump blood from your heart to the rest of your body. These may be used in patients waiting for a heart transplant.

If you need surgery to treat heart failure, you may undergo:

  • Coronary bypass surgery. The cardiothoracic surgeon will take blood vessels from your leg, arm or chest to bypass a blocked artery in your heart. Following coronary bypass surgery, blood should flow more freely through your heart.
  • Heart valve repair (or replacement). If you have a faulty heart valve, you may need heart valve repair; if it’s more severe, you may require valve replacement surgery.
  • Heart transplant. If medications, devices or surgery doesn’t help, you may need to have a heart transplant.

Your healthcare team will determine the best treatment plan for you depending on the severity and cause of your heart failure. If you have chronic stable mild heart failure, you lifestyle modifications, dietary changes and medications may work well for you; more severe cases will require a combination of medications, lifestyle changes and non-surgical and surgical treatments.

Palliative Care for Heart Failure

While this can be a difficult topic, patients need to discuss palliative care with their healthcare team earlier rather than later. In fact, research shows that palliative care is actually associated with improved quality of life, reduced symptom burden and increased satisfaction with care. It can also help you plan advanced care and choose a medical power of attorney.

Heart failure may not be reversible, and according to American College of Cardiology/American Heart Association guidelines, those with Stage IV heart failure should be considered for palliative care or hospice.

How to Prevent Heart Failure

The best way to prevent heart failure is to make healthy lifestyle changes. Your risk of developing heart failure is inversely related to your level of physical activity, for example. In addition, see your physician regularly and take all medications as prescribed.

Some of the lifestyle changes that can prevent heart failure include:

  • Quitting smoking
  • Abstaining from alcohol or limiting your intake
  • Eating a healthy low-fat, low-sodium and low-sugar diet
  • Maintaining a healthy weight
  • Getting regular exercise
  • Effectively managing other conditions such as coronary artery disease and high blood pressure
Dr. Sean Virani, Cardiologist, BC

When Should I Call a Doctor?

Heart failure can be life-threatening, so call 911 if you experience any of these signs or symptoms. Too many patients question symptoms or wait to seek emergency treatment, which can lead to further heart damage.

  • Chest pain or tightness in your chest
  • Fainting
  • Severe shortness of breath that comes on suddenly
  • Coughing up pink, foamy mucus
  • Severe weakness

If you experience other symptoms of heart failure, such as edema or lack of appetite, contact your doctor or cardiologist.

With early diagnosis and treatment for congestive heart failure, it’s possible to live a long, healthy and active life. Talk to your physician about heart failure causes, symptoms, risk factors and treatments.

VSFL Websites Managed by HCF

Find more heart health resources at