What is heart failure?

Despite the way it sounds, the term "heart failure" simply means that your heart isn't pumping blood as well as it should. Heart failure does not mean your heart has stopped working or that you are having a heart attack (though people who have heart failure often have had a heart attack in the past). Heart failure is also called congestive heart failure (CHF). "Congestive" means fluid is building up in the body because the heart isn't pumping properly.

What are the symptoms of heart failure?

Some people who have heart failure have few problems or symptoms, while others have many symptoms. The following is a list of symptoms people who have heart failure might experience:

• Shortness of breath (perhaps when walking, climbing stairs or being active)
• Shortness of breath when lying down
• Lack of appetite
• Waking up in the night, suddenly breathless
• General tiredness or weakness, including the reduced ability to exercise
• Swelling of the legs, feet or ankles
• Swelling of the abdomen
• Rapid or irregular heartbeat
• Rapid weight gain (1 or 2 pounds a day for 3 days in a row)
• Chronic cough or wheezing
• Nausea

Call your doctor if you have any of these symptoms, especially if you've had heart problems before.

What causes heart failure?

Heart failure has many different causes. Sometimes the exact cause cannot be found. The most common causes of heart failure are listed below:

• Coronary artery disease (when the blood supply to the heart is partially or completely blocked); with or without a heart attack in the past
• Problems with the heart muscle itself (cardiomyopathy)
• High blood pressure (hypertension)
• Problems with any of the heart valves
• Abnormal heart rhythms (arrhythmias)
• The use of toxic substances (such as alcohol or drug abuse)
• Congenital heart defect (a heart problem you were born with)
• Diabetes
• Thyroid problems

How will my doctor know if I have heart failure?

Your doctor will ask you about your medical history and symptoms. He or she will give you a physical exam and may order some the following tests:

• Blood tests
• Urine tests
• Chest X-ray
• Electrocardiogram (also called EKG or ECG)
• Echocardiogram
• Radionuclide ventriculography

An electrocardiogram records the electrical activity of your heart. It can help diagnose heart rhythm problems or damage to the heart. An echocardiogram is a test that sends out sound waves that allow your doctor to see pictures of your heart. The pictures show your doctor how well your heart is pumping.

Radionuclide ventriculography involves injecting a very small amount of a radioactive substance into your blood. This substance travels to your heart. A special camera or scanner uses the radioactive substance to produce pictures that show your doctor how well your heart is pumping. The radioactive substance is safe and leaves your body completely after the test is finished.

What treatment will I need?

Treatment can improve how well the heart pumps and can help relieve your symptoms, but heart failure cannot be completely cured. An important part of treatment is taking care of any underlying problems, such as lowering high blood pressure or fixing a heart valve. Treatment also includes lifestyle changes and medicine.

What medicines will I need to take?

Many different medicines are used to treat heart failure. You may need one or more medicines, depending on your symptoms. Your doctor will talk about these medicines with you. It may take some time to find the best type of medicine and the best dosage (amount) of medicine for you.

Several kinds of medicines are commonly used to treat heart failure:

• ACE inhibitors. ACE inhibitors help open (dilate) your arteries and lower your blood pressure, improving blood flow.
• Diuretics. Diuretics are often called "water pills" because they cause you to urinate more often and help keep fluid from building up in your body. They can also decrease fluid that collects in your lungs. This will help you breathe easier.
• Beta-blockers. Beta blockers can lower blood pressure and slow a rapid heartbeat. They may also help prevent some heart rhythm problems.
• Digoxin. Digoxin (also called digitalis) helps the heart pump better by strengthening the muscle contractions of the heart.

You might need to take other medicines if you have other problems or if you experience side effects with any of these medicines.

When you're taking medicine for heart failure, you'll also need to have blood tests to check your potassium level and kidney function. How often you need blood tests depends on the type and strength of medicine you are taking. Many patients take heart failure medicines without any problems. However, if you have concerns about the medicine or think you may be having side effects, you should talk to your doctor. It's very important that you take your medicine exactly as your doctor tells you.

How often will I need to see my doctor?

If you've just been in hospital for heart failure, be sure to follow up with your doctor within the first week of being home. At first, you may need to be checked as often as every week to see how you're responding to the medicine. Once your doctor has adjusted your medicine and you're feeling better, you may need to be seen less often.

When should I call my doctor?

Talk to your doctor if you have any of the following:

• Shortness of breath that gets worse
• A weight gain of more than 5 pounds in one week
• Leg swelling that is new for you
• Coughing or wheezing in the night, or needing to sleep propped up or sitting up
• Chest pain or a heavy feeling in your chest
• Side effects from the medicine
• Failure to lose weight even though you take more water pills

You should also call your doctor if you have any questions about your condition or medicine.

What can I do to help treat my CHF?

Avoid eating too much salt or too many salty foods (such as canned vegetables or soups, chips and pizza). Salty and high-sodium foods can cause your body to retain water. Talk to your doctor before using salt substitutes because they often contain potassium and may not be good for your health either. This will depend on your kidney function and what medicines you are taking. Some people need extra potassium but other people don't.

Although drinking a small amount of alcohol (one drink a day) seems to be helpful for some people who have heart disease, drinking too much may cause heart failure and interfere with medicines. Ask your doctor if any amount of alcohol is safe for you.

Keep your blood pressure under control. High blood pressure strains your heart and further weakens it.

You'll be healthier if you exercise. Ask your doctor to recommend an exercise program for you. Try to reduce the stress in your life and get plenty of sleep. If you smoke, quit! If you are overweight, talk to your doctor about how to lose weight safely.

Also talk to your doctor before you take any medicine. Common arthritis medicines such as naproxen (one brand name: Aleve) and ibuprofen (one brand name: Advil) can cause fluid retention.

Fluid retention and weight gain are one signal that your CHF may not be in good control. Weigh yourself daily at the same time of day and report any unexplained changes to your doctor.

• What is the likely cause of my congestive heart failure?
• How serious is my condition?
• How will my life change now that we know I have heart failure?
• How will I know if my condition is getting worse? When should I contact you or seek treatment?
• What is the best treatment option for me? Will I need medicine? Surgery?
• What are the side effects of the medicines used to treat heart failure?
• Will I need a heart transplant?
• Is it safe for me to exercise? What kind of exercise should I do?
• Should I make any lifestyle changes at home to reduce my risk of complications?