Heart Failure

Cause and What to Watch For

Heart failure (congestive heart failure) happens when the heart is unable to effectively pump blood in the body. This occurs when the heart is either too weak (systolic heart failure) or too stiff (diastolic heart failure). When the heart is not pumping well, fluid backs up in the system and causes symptoms. Also poor pump function can lead to inadequate blood delivery to the other parts of the body.

There are two categories of heart failure (and you may have a mixture):

With pump failure that leads to back-up of fluid, you may experience these symptoms:

• Trouble breathing
• Trouble lying flat
• Leg swelling

With pump failure that leads to poor delivery of blood to the body, you may experience these symptoms:

• Lightheaded / dizzy
• Fatigue
• Chest pain
• Cold arms and legs
• Drop off in urine output

How to Diagnose Heart Failure

Your doctor may recommend a variety of tests to diagnose and categorize your heart failure. These may include a physical exam, lab tests, an echocardiogram and heart catheterization. Along with these tests, your symptoms and medical history are also considered when deciding on the best course of treatment for you.

How to Treat Heart Failure

Heart failure is a chronic disease that can have a number of causes, including coronary artery disease and high blood pressure. It is important to manage your symptoms and work on the cause of your heart failure. Medications, lifestyle changes and recognizing and treating symptoms can help bring heart failure under control. Procedures to treat heart failure or its cause may be recommended.

• Medications
  • Diuretics (make you urinate off fluid): Lasix, Bumex, Demadex, HTCZ, Chlorthalidone, Aldactone, Zaroxyln
    • Many of these are pills, but some can also be given intravenously in a clinic setting
  • Beta blockers (relax the heart): Coreg, Toprol, Atenolol, Metoprolol
  • ACE inhibitors and ARBs (decrease the resistance that the heart pumps against, making it easier for the heart to pump blood forward): Lisinopril, Captopril, Ramapril, Losartan, Diovan
  • Entresto (combination pill with an ARB and a neprilysin inhibitor, which has been found to be more effective than just the ARB alone)
  • Hydralazine and Imdur (blood pressure pills that have a similar but less beneficial effect on the heart as ACE/ARBs): Usually for people who cannot tolerate ACE/ARBs
  • Digoxin: Improves heart contractility and lowers heart rate
  • Corlanor: Lowers heart rate if you have a fast heart rate
  • Ionotropes (intravenous medications that can force the heart to act stronger): Milrinone and Dobutamine
• Blood Pressure Control
• Daily Weight
  • A change of 3-4 pounds in a few days can be an early warning sign.
• Diet
  • Avoid salt (less than 2 grams a day)
  • Watch fluid intake (less than 1.5 liters a day)
• Exercise

Work on the Cause of the Heart Failure

• If due to coronary disease, stents or bypass surgery may help
• If due to high blood pressure, blood pressure control may help
• If due to a fast heart rate, heart rate control may help
• If due to a virus, medications and time may help
• If due to chemotherapy, medications and time may help
• If due to a valve problem, fixing the valve may help

Procedures to Treat Heart Failure

• CardioMEMS
  • Device implanted in the arteries of the lung that can monitor fluid levels and notify your doctor if there is a problem
• Pacemakers
  • Special pacemakers may make the heart stronger in individuals who have an abnormal heart electrical system
• LVAD (Left Ventricular Assist Device)
  • Special pumps inserted surgically that can pump blood around the body
• Heart transplant