Medical Director: Dr. Thomas J. Johnson, M.D.
Clinical Coordinator: Glenda Morris, MA, RNCS, CNP
"My doctor says I have 'heart failure'. What does that mean?"
Heart failure means that the heart is not able to pump enough blood to meet the rest of your body's needs. Your heart is not working as well as it should. It doesn't mean your heart has stopped working, or that it's about to stop working. It doesn't necessarily mean that you have had a heart attack. It means that your heart's pumping power is weaker than it should be. Activities such as walking, carrying groceries, or climbing stairs can be difficult. These activities may cause you to feel short of breath or very tired. This is because the rest of the body is not getting all the oxygen it needs.
"What caused my heart to become weak?"
Heart failure develops when something has damaged the heart muscle.
There are many ways the heart can become damaged. Here are a few:
- Coronary artery disease - usually with previous heart attack
- High blood pressure that is not controlled
- Damage to the heart valves due to rheumatic fever or another condition
- Diseases of the heart muscle caused by viral infections, certain drugs used to treat cancer, or chemicals such as alcohol or cocaine
- Many times there is no known cause
"What does heart failure feel like? What are the symptoms?"
Heart failure typically does not occur suddenly. It develops slowly over time; usually the first and only symptom is shortness of breath with physical activity. Other common symptoms are:
- Shortness of breath while lying in bed or on the sofa
- Waking up breathless at night
- A dry hacking cough, especially when lying down
- Fatigue or weakness
- Sudden weight gain over a few days or a week
- Swollen feet, ankles, and legs
- Nausea with abdominal swelling, pain, or tenderness
A healthy heart can increase the amount of oxygen-rich blood to vital organs and muscles as it is needed. A heart with less pumping ability or power than normal cannot supply the vital organs and muscles when it is needed. As a result, your body cannot do as much. Blood and fluid may collect or pool in the lungs. This causes the shortness of breath you experience when you are active. If the amount of fluid in the lungs continues to build up, you may notice breathing difficulties when you lie down. Fluid can also collect in other parts of the body, giving you swollen feet, ankles, and legs. Some people collect fluid in their abdomen. When this occurs, they may notice a loss of appetite, nausea, or vomiting. Swelling in the stomach and intestines cause these symptoms.
"How does my doctor know I have this condition?"
A health history and physical examination are usually the first part of the evaluation. A chest x-ray may be done. This will show the size of your heart (with heart failure, it may be larger than normal) and whether there is fluid buildup in your lungs. An electrocardiogram (EKG) will indicate the heart's rhythm and rate. It may also reveal if there has been any damage to the heart muscle, such as a heart attack.
The test that will give the most information about your heart's pumping ability is an echocardiogram. This is an ultrasound of the heart. It uses sound waves to make images of the heart and its chambers. The test is safe and does not require entering the body with any instruments or devices. Using an echocardiogram, measurements can be made about the size of the heart's four chambers and its ability to pump blood.
"How will heart failure affect my life? Will I have to make changes in what I eat and how active I am?"
No matter what caused your heart failure, or how severe it is, there is a lot you can do to manage it. Making changes in your habits of daily living can often help relieve the symptoms of heart failure. The changes may even prevent the disease from worsening. Simple actions can produce dramatic results in how you feel. These activities include:
- Weighing yourself every morning - this is one of the most important steps you can take in controlling your heart failure. Weighing daily will help you and your healthcare provider determine if you are retaining fluid. Sudden weight gain of 2 or more pounds over night or weight gain of 2 days straight, represent fluid retention. You should call your healthcare provider when you note this.
- Limiting your salt intake - this is as important as taking the medications that are prescribed. Eating foods high in salt (or sodium) cause your body to retain fluid. The weakened heart has to work even harder when there is extra fluid buildup in the body. It is important to not add salt to foods when cooking or at the table. Learning to reading food labels is especially helpful. A dietician can be of great help in outlining a healthy, low salt diet for you.
- Limiting alcohol - Alcohol can further depress your heart's pumping ability. It may also interact with some of the medications used to treat your heart condition. You will likely be advised to avoid alcohol completely.
- Exercise - It is important for you to remain as active as you feel comfortable. After you have been stabilized on a regimen of medication, an exercise program may be added. This may be as simple as walking 5 to 10 minutes three to four times per week, gradually increasing the walk-time over a period of weeks and months. The benefits of remaining active are many. Regular activity help make you feel better by:
- Increasing your energy through the day and allowing you to sleep better at night
- Exercising your muscles to help build strength, so every day tasks won't cause you to be so tired
- Helping you lose weight if needed
- Helping you cope with stress
- Helping you feel more positive and confident
Before you start exercising, talk to your health care provider about an exercise plan that is right for you.
"Am I going to have to take a lot of medicine? Will I have to take this much for the rest of my life?"
Almost everyone with heart failure needs to take medication usually for the rest of his or her life. The goal of treatment is to prevent further heart muscle damage and help it pump as efficiently as possible. Several different types of medications are used. They usually include:
- ACE Inhibitors - These medications dilate or widen blood vessels, reducing the amount of work the heart has to do. ACE Inhibitors also reduce substances in the body that damage the heart muscle. Large studies have shown that ACE Inhibitors help to keep you out of the hospital, improve your chances of living longer and make you feel better.
- Beta-Blockers - Several large studies have indicated that two beta-Blockers (carvedilol and metoprolol XL) are very beneficial for the long-term treatment of heart failure. These medications block adrenaline-like substances that can further damage the heart muscle. They help strengthen the heart's pumping ability, keep you out of the hospital and feel better over the long term.
- Diuretics - These medications are often called "water or fluid pills". They help the body get rid of extra fluid by increasing the amount of urine you make. This decreases the amount of fluid that may have collected in the lungs, abdomen, or ankles/feet. It is important to take your diuretic early in the day so that you are not up during the night to use the bathroom. Many diuretics cause your body to lose potassium and/or magnesium. You may need to be on a potassium and/or magnesium supplement to replace these minerals. Your healthcare provider will frequently monitor your potassium/magnesium levels through blood tests.
- Digoxin/Digitalis - This medication helps the heart pump more strongly and can also help control the rhythm of the heartbeat. Digoxin may help you feel and function better on a daily basis.
"Are there other people who have this same condition?"
Heart failure has become the most important public health problem in cardiovascular medicine. It is felt that 4.7 million Americans have heart failure. This condition affects men and women equally, with 1.4 million people under the age of 60.
St. Paul Heart Clinic has been seeing heart failure patients in a special outpatient program since January, 1998. The heart failure team includes cardiologists with special interest/experience in heart failure, as well as nurse practitioners and nurse clinicians. Additional team members include a dietician and cardiac rehabilitation specialist from United Hospital.
"Where can I get more information about heart failure?"
Ask your healthcare provider to help you find the information you need about heart failure. They can suggest useful books, support groups, and other resources. Here are some other references:
by Marc A. Silver, MD; Insight Books/Plenum Publishing Corp., 1994.
