HEART FAILURE

Symptoms

• Shortness of breath
• Persistent coughing or wheezing
• Buildup of excess fluid in body tissues (edema)
• Tiredness/fatigue
• Lack of appetite, nausea
• Confusion, impaired thinking
• Increased heart rate

DIAGNOSIS

Your doctor will perform a physical exam and ask about your symptoms. He may order a range of laboratory tests and imaging procedures to determine the diagnosis. These include:

• Blood tests to determine levels of important substances, such as sodium and potassium (sometimes called electrolytes), albumin (a type of protein) and creatinine (which is connected with kidney function).
• X-ray to see whether the heart is enlarged and whether there is congestion (fluid buildup) in the lungs.
• Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack, enlargement of heart muscle wall, and abnormal heart rhythm.
• Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. It can show how thick the heart muscle is and how well the heart pumps.
• Exercise stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. It can show whether your heart responds normally to the stress of exercise and whether the blood supply is reduced in the arteries that supply your heart. It can also help determine the kind and level of exercise appropriate for you.
• Cardiac catheterization. A very small tube (catheter) is inserted into a blood vessel in your upper thigh (groin area) or arm. The tip of the tube is positioned either in the heart or at the beginning of the arteries supplying the heart. A special fluid (called a contrast medium or dye) is injected. This fluid is visible by X-ray. The pictures that are obtained are called angiograms. Cardiac catheterization can show blockages in the coronary arteries and weakened or damaged parts of your heart due to lack of blood supply.

TREATMENTS

Lifestyle changes

Lifestyle changes can help to alleviate symptoms, slow disease progression and improve quality of life. These include:

• Quitting smoking
• Losing excess pounds or maintaining a healthy weight
• Tracking daily fluid intake
• Avoiding alcohol
• Eating a heart-healthy diet
• Being physically active
• Monitoring blood pressure
• Avoiding flu and pneumonia with vaccinations

Medications

Patients with heart failure may need to take several classes of medications, which treat different symptoms or contributing factors. These include:

• ACE Inhibitors (captopril, enalapril)
• Angiotensin Receptor Blockers (candesartan, losartan, valsartan)
• Angiotensin-Receptor Neprilysin Inhibitors (sacubitril/valsartan)
• Calcium channel blockers (amlodipine, diltiazem, nifedipine, verapamil)
• Beta blockers (bisoprolol, metoprolol, carvedilol)
• Diuretics (furosemide, chlorothiazide)
• Aldosterone antagonists (spironolactone)
• Anticoagulants (warfarin, heparin)
• Cholesterol-lowering medications (statins)

Devices and surgical procedures

• Implantable Cardioverter-Defibrillator (ICD) are indicated for patients with severe heart failure or serious arrhythmias (irregular heartbeats). These devices are surgically placed and deliver pacing, or an electric countershock, to the heart when a life-threatening abnormal rhythm is detected.
• Cardiac Resynchronization Therapy (CRT) may be prescribed for patients with heart failure who develop abnormal conduction of the heart’s electrical system that changes how efficiently the heart beats. In CRT, a special pacemaker is used to make the ventricles contract more like normal and in synchrony. This therapy can improve heart function, reduce hospitalization risk, and improve survival.
• Left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that’s surgically implanted. It helps maintain the pumping ability of a heart that can’t effectively work on its own.
• Heart transplantation is often the last resort for patients with severe, progressive heart failure that can’t be helped by medications and dietary and lifestyle changes.