Heart Failure

What Is Heart Failure?

Heart failure does not mean that the heart has failed. It simply means that the heart does not pump as powerfully as it used to, and is not working efficiently enough to meet the body’s needs for oxygen-rich blood.

In heart failure:

  • The contractions of the heart muscle are less powerful than they used to be.
  • Less blood is pumped out from the heart with each beat.
  • The pumping heart chambers overfill with blood, because the heart muscle is not strong enough to pump out all the blood it receives.

When the heart can’t pump efficiently, a number of things happen.

  • Your circulation slows down. Your muscles don’t get all the oxygen they need, which is why you may tire easily. Sometimes blood flow to the brain is reduced, which is why you may feel dizzy or faint.
  • Blood backs up in the veins, and fluid seeps from the veins into the surrounding tissues. That causes swelling (edema). This is most common in the legs and ankles, but may affect other parts of the body as well.
  • Blood also backs up in the blood vessels within the lungs. The inside of the lungs becomes swollen and stiff with the extra fluid, which is why you may feel short of breath and may have a cough.

There is another problem: extra fluid in the blood. When the blood flow around the body slows down, as occurs in heart failure, the brain gets a signal that there is not enough blood to go around. To make up for the decreased blood flow, the brain signals to the kidneys to retain fluid in the blood. This has further effects:

  • In the daytime, this extra fluid in the blood adds to the swelling in legs and ankles.
  • When you are lying down, the fluid may flow to other parts of your body. Some of it gets into the tissue around your lungs, making it especially hard to breathe at night.
  • The kidneys try to get rid of this extra water, which is why you may have to go to the bathroom more often, especially at night.

These effects are responsible for the symptoms of heart failure.

Nice To Know:

Different Types of Heart Failure:

There are 2 major types of heart failure:

  • In the one type, the heart is unable to pump effectively, so less blood is pumped out of the heart with each beat. This is called systolic heart failure (systolic refers to the period in the pumping cycle when the heart pumps and is not resting between pumps).
  • In the other less common type, the heart is unable to relax normally between pumping. This is called diastolic heart failure (diastolic refers to the period in the pumping cycle when the heart rests between beats).

Other terms used to describe various types of heart failure include:

Congestive heart failure – A general term used to describe heart failure. Refers to the fluid in the lungs or body that results from the heart’s inability to pump. Actually, this is only one aspect of heart failure, and does not always occur.

Right-sided heart failure – Results from failure of the pumping action of the right side of the heart and causes swelling in the body, usually the legs and abdomen.

Left-sided heart failure – Results from failure of the pumping action of the left side of the heart and causes congestion in the lungs.

Forward heart failure – Is the inability of the heart to pump enough blood to meet the needs of the body for oxygen during exercise or at rest.

Backward heart failure – Is the inability of the heart to meet the oxygen needs of the body when heart filling pressures are too high.

High output heart failure -This differs from the usual heart failure in that the heart may pump out its usual amount of blood, but that still may not be enough to meet the body’s needs.

This may occur in certain conditions when the body’s need for blood is increased (for example hyperthyroidism, or Pagets Disease), and the heart is not able to meet those increased needs for oxygen-rich blood.

For more detailed information about hyperthyroidism, go to Hyperthyroidism.

The Heart As A Pump

The heart has four chambers-two that allow blood to flow into it

and two that pump the blood out to the rest of the body:

The right ventricle pumps blood to the lungs. There, the blood picks up oxygen, then it returns to the left side of the heart.

The left ventricle then pumps the oxygen-rich blood out to the rest of the body.

The heart is a strong, muscular pump, a little larger than a fist. A healthy heart pumps out five to six quarts of blood every minute when we are at rest and up to 20 quarts during exercise.

In heart failure, the heart is unable to pump with the same force it used to, so the ventricles can’t keep up with their work. Less blood than usual is pumped out with each beat, usually causing important symptoms.

Facts About Heart Failure

  • In the average lifetime, the human heart beats (expands and contracts) more than 2.5 billion times.
  • Heart failure affects between 2 to 4 million people in the U.S.
  • 300,000 new cases of heart failure diagnosed every year.
  • Many people with heart failure remain undiagnosed because their symptoms-shortness of breath, tiredness, and weakness-are overlooked, ignored, or attributed to aging.
  • The good news is that proper diagnosis and new forms of treatment are enabling people with heart failure to live longer, more active lives.

 


What Are The Symptoms Of Heart Failure?

Many people with heart failure remain undiagnosed because their symptoms are often overlooked, ignored, or attributed to aging. And symptoms of heart failure may be similar to those of other diseases.

The symptoms result from the inability of the heart to supply enough oxygen to meet the tissues needs and from the backup of blood in the veins. Symptoms include:

  • Shortness of breath from the increased pressure or fluid (or both) in the lungs. This is a common symptom of heart failure and is referred to as pulmonary congestion, or, if it is severe, pulmonary edema. Although breathlessness is usually noticed during exercise, you may notice it when you rest.
  • Shortness of breath when lying down, a condition called orthopnea, occurs when the extra fluid kept in the legs by gravity returns to your chest after you lie down.
  • Excessive fatigue occurs when your organs are not getting enough oxygen. An important indication that your fatigue may be a sign of heart failure is if you are as tired in the morning when you get up as you are when you go to bed at night.
  • Swollen ankles or legs is called peripheral edema and often is a result of right-sided heart failure. Fluid cannot be pumped out to the lungs at an efficient rate, so fluid backs up in the veins, leaks out, and accumulates in tissues. However, swollen ankles or legs also can be caused by other conditions, such as liver problems or a side effect of certain medications.
  • Frequent urination – going to the bathroom more often occurs as the kidneys try to eliminate the extra fluid in the body.

Nice To Know:

Why the weight gain in heart failure?

To make up for the decreased blood flow, the brain signals to the kidneys to retain fluid in the blood.

When the body fills with fluid, you may also gain weight and notice edema (swelling) of the skin and soft tissues. This swelling is characterized by a gradual filling out after you depress the area with your finger. You may notice that your weight has increased before you notice swelling of the ankles or other extremities. Weight increases by about two pounds for each extra quart of fluid. You also may notice that a ring, watch, or belt feels too tight.

 


How Serious Is Heart Failure?

This depends on how severe the heart failure is.

If the heart failure is mild, it may not significantly affect a person’s lifestyle and day-to-day living.

On the other hand, severe heart failure can affect a person’s every move and can be fatal.

Thus there is a “spectrum” of severity from very mild heart failure to severe heart failure.

Treatment is essential in all types of heart failure, which can help significantly, and in most non-severe cases can allow the person to enjoy a normal and full life. Medication can also significantly help those suffering with severe heart failure to improve their day-to-day living and live longer.

Need To Know:

Physicians are able to determine exactly how severe heart failure is by calculating what is called the ejection fraction. This is the amount of blood, expressed as a percentage, pumped out of the heart with each heartbeat.

Normally the ejection fraction is 50-75%.

Heart failure can be “left-sided”, due to failure of the pumping action of the left side of the heart, or “right-sided”, due to failure of the pumping action of the right side of the heart (which is much less common).

  • In left-sided heart failure, the ejection fraction falls below 40%, and in severe heart failure, can drop to below 10%.
  • In right-sided heart failure the ejection fraction may be normal or even high due to the backup of blood entering the heart.
  • Left-sided heart failure is much more common than right-sided heart failure and may lead to right-sided heart failure.

 


What Causes Heart Failure?

Heart failure may occur for a number of different reasons:

  • Because of chronic high blood pressure. When the blood pressure is high, the heart has to work much harder to pump blood through the arteries. This results in enlargement of the heart, especially the left ventricle, which is the heart’s main pumping chamber, making it less efficient.

    For more detailed information about high blood pressure and its treatment, go to High Blood Pressure.

  • Because of coronary artery disease. The heart muscle itself may not be getting enough blood to do its work. This is usually caused by atherosclerosis, the buildup of cholesterol and fatty substances or plaque on the walls of the arteries that carry blood to the heart muscle.

    For more detailed information about how to lower your blood cholesterol, go to Lowering Your Cholesterol.

  • Because of a previous heart attack. The heart muscle may have been weakened by a previous heart attack. During a heart attack, the heart muscle is deprived of oxygen, resulting in tissue death and scarring. The development of heart failure depends on the extent and location of the scarring.

    For more detailed information about heart attack, go to Heart Attack.

  • Because of diseased heart valves. A narrowed or leaking heart valve fails to direct blood flow properly through the heart. The problem may be something you were born with, an inherited condition, or the result of an infection such as endocarditis or rheumatic fever. This condition increases the heart’s workload and increases the risk of heart failure.
  • Because of an irregular heart rate (cardiac arrhythmia). Irregular heart rates can lead to heart failure, but they usually have to be severe and last a long time. They change the pattern of filling and pumping of blood from the heart.

    For more detailed information about irregular heart beats and their treatments, go to Palpitations.

  • Because of cardiomyopathy. This condition is a disease of the heart muscle itself, which can lead to heart failure. Causes of cardiomyopathy include infection, alcohol abuse, cocaine abuse, and family predisposition.

How Is Heart Failure Diagnosed?

It’s important for your doctor to determine whether you have heart failure or another condition that has similar symptoms. It’s also important to find out what caused your heart failure, so the doctor will know how to treat it.

Nice To Know:

Your doctor will examine you carefully and listen to your heart and lungs. The doctor will want to know:

  • What are your symptoms?
  • How long have you had them?
  • What other health problems have you had, or do you have now?
  • Has anyone in your family had heart trouble?
  • How are your health habits-particularly with regard to smoking and drinking?
  • Have you gained weight suddenly? If so, that could show you have extra fluid in your body.

What Tests Will The Doctor Use?

The doctor may arrange for tests that include:

  • A chest x-ray
  • Blood and urine tests
  • An electrocardiogram (called an EKG), which provides information about electric current produced by the contraction of the heart. In this painless test, small sticky patches connected with wires to a computer are placed on your chest. The computer records the information from your heart.

The doctor may also arrange for:

  • An echocardiogram, which simply involves moving a probe across the chest. This painless test uses sound waves to make images of the heart in action. Doctors can see how well the heart is pumping, how well the valves are working, the thickness of the wall of the heart, and the size of the chamber.

Managing Your Heart Failure

Heart failure cannot be cured, but it can be successfully managed. Your health care team will design a plan to improve your quality of life and help you feel better.

In addition to your regular doctor, your health care team will include a cardiologist (heart specialist) and may also include a nurse, nutritionist (food specialist), health educator, and possibly an exercise specialist.

But you are the most important member of the team. If there is part of the plan you don’t like, say so. And if you have any questions, ask!

Your Treatment Plan

Everyone’s treatment plan for heart failure is different. Your individual plan may include some or all of the following:

  • Medication to strengthen your heart’s pumping action, help blood flow better through blood vessels, or regulate your heartbeat
  • Changes in the amount of your physical activity
  • Setting limits on the amount of salt and fat in your diet
  • Increasing the potassium in your diet, if instructed
  • Losing weight if necessary
  • Reducing your fluid intake, if necessary

Medication For Heart Failure

Medication can do a number of things for heart failure:

  • Help the heart maintain a strong, regular heartbeat
  • Open up (dilate) the blood vessels, to reduce the heart’s workload
  • Remove excess fluid from the body
  • Correct the balance of sodium and potassium in the body

Medications your doctor may prescribe for heart failure include:

  • Diuretics(water pills) remove excess fluid from the body.
  • ACE inhibitors open up (dilate) the blood vessels, making it easier for the heart to pump blood through the body.
  • Digitalis strengthens the heart’s pumping action.
  • Beta blockers help reduce the workload of the heart.

Other medications may be added depending on the cause of the heart failure, such as medication to lower blood pressure.

How To Information:

Take all your medicine regularly, as prescribed, even if you feel well, or even if you don’t think it is working. Complying with the medication part of your plan is essential in the overall success of treatment. Don’t make any changes in the dosage unless you talk with your doctor first.

Diuretics

Most people with heart failure take diuretics, which are sometimes called “water pills.” These medications work by pulling fluid out of the bloodstream and out of the tissues. The fluid is then passed out of the body in the urine.

This helps in several ways:

  • It decreases the heart’s workload. With less fluid in the body, it will be easier for the heart to pump blood around the body.
  • It reduces or eliminates accumulation of fluid in legs and lungs.

Possible side effects of diuretics are:

  • Frequent urination
  • Rash
  • Potassium deficiency (you may need to take potassium supplements)

Medications To Improve Blood Flow

These medications widen the blood vessels. With wider blood vessels, the heart does not have to work so hard to push the blood through the arteries. The most widely used are the ACE inhibitors, which work by inhibiting the production of a substance called angiotensin II, which normally causes blood vessels to tighten.

Possible side effects of ACE inhibitors are:

  • Dizziness when standing up suddenly due to lowered blood pressure
  • Dry cough
  • Skin rash

ACE inhibitors and diuretics can affect the sodium and potassium levels in the blood, and may also affect kidney function. You will need regular blood tests to monitor possible changes.

Medications To Strengthen The Heartbeat

The commonly used medication digoxin strengthens the pumping action of the heart and helps maintain a regular beat.

Digoxin has been used for centuries: it is made from digitalis, which comes from the foxglove plant.

Tell your doctor if you experience these side effects from digoxin:

  • Loss of appetite
  • Nausea
  • Blurred vision
  • Heartpalpitations, a sensation that your heart is beating too fast, too slow, or irregularly

Never take more digoxin than the dose prescribed. Too much can slow down the heart.

Other Medications

Depending on what caused your heart failure, you may need additional medications such as:

  • Beta-blockers to improve the function of the left ventricle
  • Nitroglycerine to cope with pain in the chest (angina)
  • Aspirin or other medication to keep the blood from clotting
  • Medications to lower blood pressure, or control cholesterol

Nice To Know:

It’s important to tell the doctor all the medication you are taking, including over-the-counter pills for colds, headaches, indigestion, etc. These may interact or interfere with your heart medication.

Need To Know:

If you are taking diuretics, you may need potassium supplements to replace possible potassium loss. ACE inhibitors, however, help preserve potassium. Potassium is essential to keep your muscles working properly. Low potassium causes the following:

  • Leg cramps
  • Heartpalpitations
  • Digestive problems, if the muscles of the digestive system cannot function properly
  • Breathing difficulties

A long-time shortage of potassium can lead to paralysis.

To prevent problems, inform your doctor immediately if you get leg cramps or feel muscle weakness. Be sure not to stop the potassium unless the doctor says you should.

Your doctor may suggest you eat more potassium-rich foods, such as bananas, melons, dried fruit, or leafy green vegetables.

 


Make Your Heart Failure Medication Work For You

Here’s how to get the most out of your medication:

  • Medications for heart failure need to be taken every day, as prescribed by your doctor.
  • Remember to take all doses, even if you feel better. Don’t be tempted to skip doses even if you feel “cured.” If you stop taking your medications, the symptoms probably will return.
  • Contact your doctor if you are uncertain what to do when you miss a dose or take the wrong amount.
  • Keep a list of your daily medications with you in case of emergency.

Each time the doctor prescribes a new medication, make sure that you understand what it is for, and how to take it. You should know:

  • What each medicine does.
  • What time of day you should take it.
  • Whether you should take it before or after food.
  • If you miss a dose, is it okay to take it later in the day? How much later?
  • What side effects should you expect? Which side effects are serious, and which are not?
  • If you have a side effect, how soon should you tell the doctor? Should you stop taking the medication? If you can’t reach your doctor, what should you do?

How-To Information:

Remembering to Take Your Medication

It is important to remember to take all of your medications, which may be difficult if you are taking several prescriptions. Try the following:

  • Buy a medication organizer from your pharmacy so you can sort out your pills for each day of the week.
  • Keep your medication near where you eat. That way, you will be reminded at mealtime.
  • Write reminders to yourself on stick-on notes. Place them around the house where you will notice them, i.e., on your shaving mirror, where you keep your toothbrush, or by the telephone.
  • Carry pills with you. If you need to take pills during your working day, keep some in your desk and/or your purse.
  • Renew prescriptions regularly. Plan ahead to go to the drugstore, especially if there are holidays coming up.
  • Make a note on your calendar. Don’t trust your memory. It’s easier to look on a calendar and see a reminder that it’s time to refill your prescription, especially if you are a busy person.

Nice To Know:

If you are going to be traveling:

  • Keep on you a list of the medications you are taking.
  • Take your medical records and your EKG.
  • Split your medications – keep a few doses with you in case your bags get separated.

 


Heart Failure: How Active Should You Be?

It’s very important to talk with your doctor about the amount of exercise you need and whether you should limit any of your normal activities. For example:

  • Can you go for a walk or swim, ride a bike, cut the grass, play golf?
  • Is it okay to return to work, either full time or part time?
  • Is sexual activity okay?

The answers will depend on:

  • Whether you have mild or severe heart failure
  • How successful your treatment is

If your heart failure is mild

If your heart failure is more severe

There’s probably no reason to stay home from work, stop the leisure activities you enjoy, or abstain from sexual activity. But it’s important to avoid exercising too hard and to rest if you find yourself getting short of breath. Your doctor will advise what’s best in your particular case.

If you get very short of breath just by walking half a block, your doctor may advise you to take it easy until your medications are working well. Then, gradually, you can do more and more.

Need To Know:

Is Exercise A Good Idea?

Exercise is intended to strengthen your heart, not stress it. For many people who suffer with heart failure, exercise can help the heart work better. And exercise can also help you to control your weight, which will reduce further strain on your heart. Regular exercise helps keep your whole body in good condition.

For most people, walking is the best exercise.

  • Start with a few blocks, adding distance as you get stronger.
  • Slow down or stop and rest if you become short of breath.

If it is hard for you to start an exercise program on your own, or if you don’t know how much is safe, ask your doctor about special programs for heart patients. For example, your local YMCA may have classes that will help you get just the right amount of activity. Also, some hospitals offer cardiac rehabilitation programs designed especially for people with heart problems.

Don’t exercise more than your doctor has advised. Your doctor may suggest the following:

  • An exercise stress test to determine how much exercise you can do safely.
  • A consultation with a cardiac rehabilitation specialist, who will help plan and monitor your exercise program.
  • Aerobic exercises (at 60% to 90% of your maximum heart rate-your doctor will tell you what that rate is).
  • A special “monitored” exercise program, where your exercises will be based on your pulse rate.

 


Heart Failure: Adjusting Your Diet

When you have heart failure, what you eat and drink can definitely affect the health of your heart. Your doctor may want you to do some or all of the following:

  • Reduce your sodium (salt) intake. Sodium causes your body to retain fluid. We get most of our sodium from salt, though we also get it from other sources, such as baking soda or MSG (monosodium glutamate), a preservative used commonly in Chinese foods and pre-packaged foods.
  • Eat more foods rich in potassium to replace the potassium you lose when you take diuretics. Potassium is present in green leafy vegetables and most fruits, especially bananas, oranges, and dried fruit.
  • Eat less fat.
  • Control your weight.
  • Regulate the amount of fluid you consume.

The Importance Of Vegetables And Fruit

Vegetables and fruit are the perfect food for heart failure patients.

  • They are naturally low in fat, low in sodium, and high in potassium.
  • They help control weight.

Aim to eat at least five servings of fruits and vegetables a day.

Why Eat Less Fatty Foods?

Eating less fat can help in two ways:

  • Eliminates extra weight that puts strain on your heart.
  • Reduces cholesterol in the blood that blocks arteries and makes the heart work harder.

To lose weight or to control your cholesterol level:

  • Cut down on fat from meat. Eat smaller portions of red meat. Trim fat off meat. Eat chicken or fish instead. Don’t fry your food.
  • Eliminate butter on vegetables. Eat fruit instead of pastry for dessert.
  • Choose low-fat or non-fat milk and other dairy products.
  • Check “Nutrition Facts” labels and buy the brands of food that have low fat or no fat.
  • Use olive oil. Although still high in calories, olive oil doesn’t raise the “bad” cholesterol level in your blood.

How-To Information:

It’s not easy making adjustments to what you eat, especially if your doctor wants you to make the changes in a hurry. Don’t try to go it alone!

If there is a dietitian on your health team, take advantage. Ask for help in making changes without “going on a diet.” Eating should still be enjoyable!

Watching Your Sodium

Sodium causes your body to retain fluid. In some cases, people with heart failure need to avoid sodium altogether, or your doctor may just want you on a low-sodium diet (for example, consuming less than 2,000 milligrams a day, which is about half the average).

Although we get most of our sodium from salt, we also get some from other sources, such as monosodium glutamate or baking soda.

When food shopping, look for foods labeled “very low sodium,” “sodium free,” or “unsalted.” Or check the “Nutrition Facts” label on packaged food and choose the brand lowest in sodium.

How-To Information:

Tips for Reducing Sodium

You can train yourself to like foods with much less salt.

  • Move the salt shaker off the table.
  • Use much less salt in cooking.
  • Substitute seasonings such as garlic, lemon, onion, pepper, mustard, herbs, and spices.
  • Rinse canned vegetables before heating or cooking.
  • Ask for food low in sodium or sodium free when dining out.

 


Heart Failure: Keeping Track Of Your Liquid Intake.

You can help your heart by keeping excess fluid out of your bloodstream. Although diuretics may be doing the job on their own, some people may be advised by their doctor to cut down on the amount of liquid they drink.

Ask your doctor if you should set a limit for your daily fluids. If so, here’s one way to keep track:

  1. Put your “daily allowance” of water in a pitcher.
  2. Every time you finish a drink, fill the same cup or glass with water from the pitcher. Then throw that water out. Include soups, sherbet etc. as part of your liquid allowance.
  3. You’ll see from the amount of water in the pitcher how much you can drink for the rest of the day.
  4. When the pitcher’s empty, you’ve consumed your daily allowance.

Need To Know:

Weigh Yourself Daily

Weigh yourself every morning after you have urinated but before breakfast. Weighing yourself is a good way to know if you are retaining extra fluid.

Inform your doctor if you gain more than five pounds in a week or more than three pounds in a day. You may need to adjust your medication, drink less, or cut down on salt.

What About Alcohol?

Ask your doctor about alcohol. It may be okay to have a drink a day. You should avoid beer, but wine may be acceptable. However, alcohol can damage the heart muscle and interfere with medication.


Heart Failure: When Does Surgery Help?

Your doctor may advise surgery for heart failure under certain circumstances. For example:

  • If you have coronary artery disease (blockage in the coronary arteries of the heart). It may be possible to improve the circulation to your heart with bypass surgery during which a vein from the leg or chest is used to “bypass” the blocked part of the artery, a major operation, or angioplasty which does not require an incision in the chest. In this procedure surgeons clear out the blockage from the inside by inserting a thin flexible tube (a catheter) into an artery in the arm or leg and threading it up towards the blocked section of the artery in the heart.

    For more detailed information about bypass surgery, go to Cardiac Bypass Surgery.

    For more detailed information about angioplasty, go to Angioplasty.

  • If you have a defective heart valve. Heart valves can be replaced.

Heart transplantation helps a few people each year. Unfortunately, even if plenty of donor hearts were available, this option is not suitable in most cases.


Heart Failure: How Can The Family Help?

Family and friends can be a great help. Here are some of the things they can do:

  • Give gentle reminders about taking medication.
  • Help get prescriptions refilled on time.
  • Research good ways of preparing food without salt or excess fat.
  • Keep up to date on the latest information about heart failure.
  • Research information from the Internet. Make sure information comes from a reliable source.
  • Go for walks with the person who has heart failure.
  • Join support groups for families.

Heart Failure: Frequently Asked Questions

Here are some frequently asked questions related to heart failure.

Q: My brother was just diagnosed with heart failure. How can he continue his normal activities if his heart has failed?

A: Heart failure does not mean that your brother’s heart has failed. It simply means his heart is not working as efficiently as it should, and is unable to pump oxygen-rich blood adequately to all parts of the body. Heart failure is serious, but it is a treatable condition.

Q: I find that I often get short of breath, and not just when I’m exercising. I’m breathless when I’m simply sitting down and relaxing, and it’s even worse if I lie down. I thought I might have a lung problem, but my doctor wants me to have tests for my heart. Why?

A: There are many conditions that can cause breathlessness, some of which have to do with your heart, not your lungs. Your doctor probably wants to check for heart failure, a condition that can lead to fluid buildup in the lungs and other parts of the body. Breathlessness when you lie down is called orthopnea, and occurs when fluid buildup kept in your legs by gravity moves to your lungs; it is another symptom of heart failure.

Q: I’m taking a diuretic for my heart failure, and my doctor has prescribed a potassium supplement. Is there any way I can get more potassium from my diet so I don’t have to take a pill?

A: Diuretics can cause a potassium deficiency in the body. Potassium comes from bananas, melons, dried fruits, and leafy green vegetables such as kale. Stocking up on these healthy foods is a good idea and will help replenish the potassium in your body. However, don’t stop taking your supplement without first talking with your doctor.

Q: I’ve been taking medication for my heart failure for a few months, and I feel fine now. When can I stop taking the medicine?

A: Heart failure is a condition that can be successfully managed, but you may have to stay on medication for the rest of your life. If you stop taking your medicine, chances are your heart will not work as efficiently and your symptoms will return. Take the fact that you are feeling better as a sign that you are taking good care of yourself, and keep doing exactly what you’re doing now-including taking your medication. Don’t make any changes to your dosage without talking with your doctor.

Q: Is it okay to exercise if I have heart failure?

A: In most cases, exercise can help people manage heart failure successfully. It strengthens the heart and improves circulation, and also helps you lose weight so your heart doesn’t have to work so hard. A good exercise to start with is walking. You may only be able to walk half a block at first-don’t push yourself. Try to go a bit further each week, and take it one day at time. Also, be sure to consult with your doctor before starting an exercise routine.

Q: My mother has heart failure, and her doctor told her to be careful not to drink too much water. I thought water was good for you. Why can’t she drink as much as she wants?

A: Water is good for you, and it’s important to stay hydrated. However, too much fluid in the body can be bad for heart failure sufferers, because it increases blood volume and makes the heart work harder. Your mother can drink water, however, she should measure her fluid intake carefully and follow her doctor’s recommendation. Remember that fluid intake includes soups, sherbet, juice, and other liquids. If your mother is feeling unusually thirsty or is having trouble staying within her recommended fluid intake, talk with her doctor.


Heart Failure: Putting It All Together

Here is a summary of the important facts and information related to heart failure.

  • Heart failure does not mean that the heart has failed. It simply means that the heart is not pumping as powerfully as it used to.
  • Symptoms of heart failure may include fatigue, shortness of breath (especially when lying down), and swelling of the ankles. These symptoms occur because heart failure causes the body to retain fluid.
  • If your doctor prescribes medication for your heart failure, it is absolutely essential to take it every day, even if your symptoms disappear. If you stop the medication, the symptoms will likely reappear.
  • There are various types of medications for heart failure. They work by removing excess fluid from the body, strengthening the heart’s pumping action, and widening blood vessels to help reduce the workload on the heart.
  • You also may need to make some changes in your diet, such as cutting down on salt, eating more fruits and vegetables, and limiting fats.
  • Get as much exercise as your doctor allows. But don’t overexert yourself.
  • Keep in close touch with your medical team. Tell them at once about any changes in your condition and any problems with medication.
  • Work with your doctor and health care team to get your life as normal and comfortable as possible.

Heart Failure: Glossary

Here are definitions of medical terms related to heart failure.

Angina: A condition in which the heart does not get enough oxygen, resulting in chest pain and a feeling of suffocation.

Arrhythmia: Any rhythm that is not the normal rhythm of the heart; it may mean a slow or fast heart rate or an irregular rhythm.

Cardiomyopathy: Any disease that affects the structure and function of the heart.

Cholesterol: A type of fat normally present in the bloodstream. A high level is directly related to the risk of developing heart disease.

Diastolic heart failure: Heart failure that occurs because the heart is unable to relax normally between each contraction. Diastole is the period in the pumping cycle when the heart rests between contractions.

Echocardiogram: A noninvasive test that uses sound waves to produce images of the heart on a monitor.

Edema: An abnormal accumulation of fluid in the body’s tissues.

Electrocardiogram (ECG or EKG): A recording of the electrical activity of the heart.

Ejection fraction: This is the amount of blood pumped out of the heart with each beat. It is expressed as a percent. Normal value is 45-55%. It can be measured by special tests.

Endocarditis: A condition that affects the lining of the heart’s chambers and the heart valves.

Orthopnea: A condition in which a person must sit or stand in order to breathe deeply or comfortably.

Palpitations: Awareness of the heart beating; the heartbeat may feel fast, slow, forceful, or irregular.

Plaque: A buildup of fatty substances within the blood vessels that can cause them to narrow, restricting blood flow.

Potassium: An element necessary to the lives of all plants and animals; in humans, one of its roles is to help regulate muscle contraction.

Pulmonary edema: An accumulation of fluid in the tissues of the lungs.

Rheumatic fever: An inflammatory disease that can develop as a delayed reaction to an infection of the upper-respiratory tract.

Right-sided heart failure: Swelling in the body, usually the legs and abdomen, that results from failure of pumping action of the right ventricle.

Sputum: Material coughed up from the lungs and expelled through the mouth.

Systolic heart failure: Heart failure that occurs because the heart is unable to contract as powerfully as it used to. Systole is the period in the pumping cycle when the heart contracts.

Tachycardia: The term used to describe a rapid heartbeat of greater than 100 beats per minute.

Ventricle: One of the two lower chambers of the heart (the left ventricle and the right ventricle), which pump blood out of the heart and into the arteries.


Heart Failure Additional Sources of Information

Here are some reliable sources that can provide more information on heart failure.

American Heart Association 
Phone: 800-242-8721
www.americanheart.org

They will advise you of the location of the nearest chapter in your area. They’ll also offer you information about local rehab groups.

National Heart, Lung and Blood Institute 
Phone: 301-251-1222
http://www.nhlbi.nih.gov


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