Heart Failure

What is heart failure?

Heart failure means your heart has become too weak to pump enough blood to your organs and tissues and is often the result of damage or injury to your heart caused by other heart problems and high blood pressure.

Heart failure is a long-term condition that tends to get worse over time. It is important to manage your health to improve your quality of life. Heart failure can be worsened by heavy alcohol use, smoking, diabetes, and obesity.

What are the signs and symptoms of heart failure?

• Shortness of breath.
• Fatigue or lack of energy (often worsened by physical activity).
• Swelling in your ankles, legs, or abdomen.
• Coughing or wheezing.
• Recent weight gain or weight loss.
• Confusion or poor ability to concentrate.

How is heart failure diagnosed?

Tell your healthcare provider about your health history and the medicines you take. They will ask questions about your shortness of breath and other symptoms. Your healthcare provider will make a diagnosis based on your physical exam, symptoms, and tests. Ask them about the following and other tests you may need:

• Blood tests are used to check for any damage to your heart. Blood tests also give healthcare providers information about your kidney, liver, and thyroid function.
• An EKG test records your heart rhythm and how fast your heart beats.
• An echocardiogram is a type of ultrasound. Sound waves are used to show the structure and function of your heart.
• X-ray, CT, or MRI pictures may be taken of your heart and lungs. You may be given contrast liquid before a CT scan or MRI to help healthcare providers see the pictures better. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.

How is heart failure treated?

The goals of treatment are to help you feel better and live longer. Treatment may include the following:

• Heart medicines help regulate your heart rhythm, lower your blood pressure, and get rid of extra fluids.
• Antiplatelets, such as aspirin, help prevent blood clots. Take your antiplatelet medicine exactly as directed. These medicines make it more likely for you to bleed or bruise. If you are told to take aspirin, do not take acetaminophen or ibuprofen instead.
• Blood thinners help prevent blood clots. Examples of blood thinners include heparin and warfarin. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
  • Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
  • Tell your dentist and other healthcare providers that you take anticoagulants. Wear a bracelet or necklace that says you take this medicine.
  • Do not start or stop any medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
  • Tell your healthcare provider right away if you forget to take the medicine, or if you take too much.
  • Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin.
    • Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
    • You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
• Cardiac rehab is a program run by specialists who will help you safely strengthen your heart. The program includes exercise, relaxation, stress management, and heart-healthy nutrition. Healthcare providers will also make sure your medicines are helping to reduce your symptoms.
• Extra oxygen may help you breathe easier if your oxygen level is lower than normal. A CPAP machine may be used to keep your airway open while you sleep.
• Surgery can be done to implant a pacemaker in your chest to regulate your heart rhythm. Other types of surgery can open blocked heart vessels, replace a damaged heart valve, or remove scar tissue.

Call 911 if:

• You have any of the following signs of a heart attack:
  • Squeezing, pressure, or pain in your chest that lasts longer than five minutes or returns.
  • Discomfort or pain in your back, neck, jaw, stomach, or arm.
  • Trouble breathing.
  • Nausea or vomiting.
  • Lightheadedness or a sudden cold sweat, especially with chest pain or trouble breathing.

What can I do to manage heart failure?

• Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung damage and make heart failure difficult to manage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
• Limit or do not drink alcohol. Ask your cardiologist if it is safe for you to drink any alcohol. If it is safe, you must limit the amount you drink. Women should limit alcohol to one drink a day. Men should limit alcohol to two drinks a day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
• Weigh yourself every morning. Use the same scale, in the same spot. Do this after you use the bathroom, but before you eat or drink anything. Wear the same type of clothing. Do not wear shoes. Record your weight each day so you will notice any sudden weight gain. Swelling and weight gain are signs of fluid retention. If you are overweight, ask how to lose weight safely.
• Check your blood pressure and heart rate every day. Ask for more information about how to measure your blood pressure and heart rate correctly. Ask what these numbers should be for you.
• Manage any chronic health conditions you have. These include high blood pressure, diabetes, obesity, high cholesterol, metabolic syndrome, and COPD. You will have fewer symptoms if you manage these health conditions. Follow your healthcare provider’s recommendations and follow up with him or her regularly.
• Eat heart-healthy foods and limit sodium (salt). An easy way to do this is to eat more fresh fruits and vegetables and fewer canned and processed foods. Replace butter and margarine with heart-healthy oils such as olive oil and canola oil. Other heart-healthy foods include walnuts, whole-grain breads, low-fat dairy products, beans, and lean meats. Fatty fish such as salmon and tuna are also heart healthy. Ask how much salt you can eat each day. Do not use salt substitutes.
• Drink liquids as directed. You may need to limit the amount of liquids you drink if you retain fluid. Ask how much liquid to drink each day and which liquids are best for you.
• Stay active. If you are not active, your symptoms are likely to worsen quickly. Walking, bicycling, and other types of physical activity help maintain your strength and improve your mood. Physical activity also helps you manage your weight. Work with your healthcare provider to create an exercise plan that is right for you.
• Get vaccines as directed. Get a flu shot every year. You may also need the pneumonia vaccine. The flu and pneumonia can be severe for a person who has heart failure. Vaccines protect you from these infections.

Contact your provider if:

• You have symptoms of worsening heart failure:
  • Shortness of breath at rest, at night, or that is getting worse in any way.
  • Weight gain of five or more pounds (2.2 kg) in a week.
  • More swelling in your legs or ankles.
  • Abdominal pain or swelling.
  • More coughing.
  • Loss of appetite.
  • Feeling tired all the time.

• You feel hopeless or depressed, or you have lost interest in things you used to enjoy.
• You often feel worried or afraid.
• You have questions or concerns about your condition or care