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Oak Hill Hospital
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Oak Hill | Pediatric Emergency Care Center
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Heart Failure

Definition

With heart failure, the heart is unable to pump the right amount of blood throughout the body. This causes blood to back up in the veins. Depending on which part of the heart is affected, this can lead to a buildup of excess fluid in the lungs, feet, and elsewhere. Heart failure can worsen with time, which may lead to the use of many treatments. Because of this, doctors are aggressive in treating heart failure to try to prevent it from worsening.

Blood Flow through the Heart
heart
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Causes

The leading causes of heart failure are:

Other common causes include:

Other less common causes include:

Symptoms

Symptoms include:

  • Shortness of breath—at first only with activity, then progressing to shortness of breath at rest
  • Unexplained weight gain
  • Swelling of feet, ankles, or legs
  • Need to sleep propped up
  • Fatigue, weakness
  • Wheezing
  • Cough —may be dry and hacking or wet sounding, may have a pink, frothy sputum
  • Frequent urination, especially at night
  • Abdominal pain

Risk Factors

Heart failure is more common in older adults, men, and people of African American descent.

Factors that increase your chances of getting heart failure include:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

  • Blood tests
  • Urine tests

Your heart may be examined. This can be done with:

Treatment

Treatment of Condition Causing the Symptoms

Heart failure may be caused by another condition. Treating this condition should improve your heart failure or prevent it from getting worse.

Lifestyle Changes

The following lifestyle changes can help treat the symptoms of heart failure and slow down its progression:

  • Avoid alcohol.
  • If you smoke, talk to your doctor about ways toquit .
  • Lose weight if needed
  • Eat a healthful diet . Your diet should be low in fat and high in fiber .
  • In some cases, you may need to restrict salt and fluid intake.
  • Begin an exercise program with guidance from your doctor. Aerobic training may help improve your level of physical activity and quality of life. You should aim to exercise for 20-30 minutes at least five times each week. You can begin slowly and work your way to this goal. Talk to your doctor before you start an exercise program.
  • Weigh yourself every morning. This will allow you to quickly detect if you are retaining fluid. Call your doctor if you gain three or more pounds in one day, five or more pounds in one week, or whatever amount you were told to report. The best time to weigh yourself is before breakfast and after urinating. You should weigh yourself while wearing the same type of clothes, without shoes, and on the same scale. This will help you to know that your weight is accurate.

Medications

Your doctor will most likely prescribe a combination of medications, such as:

  • Angiotensin-converting enzyme (ACE) inhibitors or their alternatives to widen blood vessels
  • Digoxin, also called digitalis, to help your heart pump
  • Beta-blockers to slow your heart rate and lower blood pressure
  • Diuretics to remove excess fluid in your body
  • Nitrates to dilate the blood vessels

You may also be given medications to:

  • Thin the blood, such as aspirin, warfarin
  • Help manage chest pain, such as nitroglycerin
  • Help manage cholesterol levels
  • Help control high blood pressure

Your doctor may advise you to take supplements, such as coenzyme Q10. Follow your doctor's advice regarding taking any supplements.

If heart failure worsens, you may need medical devices to help your heart pump blood properly.

Note: Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can worsen your condition. Talk to your doctor about other medications you may be able to take.

Prevention

The best way to prevent heart failure is to reduce your risk of:

  • Coronary artery disease
  • High blood pressure
  • Diabetes

Take these steps to reduce your risk:

  • Begin a safe exercise program with the advice of your doctor.
  • If you smoke, talk to your doctor about ways to quit.
  • Limit alcohol.
  • Lose weight if needed. After you have lost weight, maintain a healthy weight .
  • Eat a healthy diet. The DASH diet , in particular, may reduce the risk of high blood pressure and heart failure, particularly in women. The DASH diet is:
    • Rich in fruits, vegetables, and low-fat dairy foods
    • Low in saturated fat, total fat, and cholesterol
  • Eat whole grain breakfast cereal. In addition to the other healthy habits, this may reduce your risk.

Revision Information

  • American College of Cardiology

    http://www.cardiosource.org

  • American Heart Association

    http://www.heart.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • Heart and Stroke Foundation of Canada

    http://www.heartandstroke.ca

  • ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009;119(14):1977-20016.

  • Congestive heart failure and congenital defects. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/Congestive-Heart-Failure%5FUCM%5F307111%5FArticle.jsp#.WEWiT02QwdU. Updated January 24, 2011. Accessed September 29, 2014.

  • Explore heart failure. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/hf. Accessed March 27, 2014. Accessed September 29, 2014.

  • Heart failure with reduced ejection fraction. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114099/Heart-failure-with-reduced-ejection-fraction. Updated November 22, 2016. Accessed December 5, 2016.

  • Hunt, SA, Abraham, WT, Chin, MH, et al. ACC/AHA 2005 Guideline Update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation . 2005;112(12):e154-e235.

  • Lifestyle changes for heart failure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/PreventionTreatmentofHeartFailure/Lifestyle-Changes-for-Heart-Failure%5FUCM%5F306341%5FArticle.jsp#.WEWi1k2QwdU. Updated September 20, 2012. Accessed September 29, 2014.

  • Paterna S, Parrinello G, Cannizzaro S, et al. Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart failure. Am J Cardiol. 2009;103(1):93-102.

  • Physical changes to report. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/PreventionTreatmentofHeartFailure/Physical-Changes-to-Report%5FUCM%5F306356%5FArticle.jsp. Updated June 30, 2014. Accessed September 29, 2014.

  • 4/16/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114099/Heart-failure-with-reduced-ejection-fraction: Nilsson BB, Westheim A, Risberg MA. Effects of group-based high-intensity aerobic interval training in patients with chronic heart failure. Am J Cardiol. 2008;102(10):1361-1365.

  • 7/6/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114476/Antihypertensive-medication-selection-and-management: Levitan EB, Wolk A, Mittleman MA. Consistency with the DASH diet and incidence of heart failure. Arch Intern Med. 2009;169:851-857.

  • 8/31/2009 DynaMed Plus Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Djoussé L, Driver JA, Gaziano JM. http://www.dynamed.com/topics/dmp~AN~T474271/Heart-failure-screening-and-prevention. JAMA. 2009;302(4):394-400.

  • 11/25/2013 DynaMed Plus Systematic Literature Surveillance. http://www.dynamed.com/topics/dmp~AN~T566763/Heart-failure-alternative-treatments: Madmani ME, Yusuf Solaiman A, Tamr Agha K, et al. Coenzyme Q10 for heart failure. Cochrane Database Syst Rev. 2014;(6):CD008684.

  • 4/2/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T905359/Choosing-Wisely: Updated July 23, 2015.