Heart Failure

What Is Heart Failure?

Heart failure occurs when the heart muscle is weakened and cannot pump enough blood to meet the body’s needs for blood and oxygen.

What Are the Symptoms of Heart Failure?

You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant, or can come and go. They are due to the changes that occur in your heart and body and include:

  • Shortness of breath or difficulty breathing with exercise, at rest, or when lying flat in bed. Even though you think of breathing as a lung problem, your heart condition can cause periods of shortness of breath.
  • A dry, hacking cough or wheezing.
  • Swollen ankles, legs, and abdomen, and weight gain. Less blood to the kidneys causes you to retain fluid and water, resulting in edema (swelling) and water weight gain.
  • Need to urinate while resting at night. Gravity causes more blood to get to the kidneys when you are lying down.
  • Tiredness (fatigue) and weakness during exercise or activities occur because the heart is not pumping enough oxygen-rich blood to major organs and muscles.
  • Dizziness, confusion, difficulty concentrating, or fainting may occur because the heart is not pumping enough oxygen-rich blood to the brain.
  • Rapid or irregular heartbeats (palpitations): When the heart muscle does not pump well, the heartbeat speeds up to help the heart get enough oxygen-rich blood to major organs and muscles, or the heartbeat may become abnormal.
  • A feeling of fullness (bloating) in your stomach, loss of appetite, or nausea.

If you have heart failure, you may have one or all of these symptoms. Sometimes, people with heart failure do not have any symptoms.

What Are Types of Heart Failure?

Systolic left ventricular dysfunction (or systolic heart failure) occurs when the muscle in the heart’s left ventricle doesn’t contract with enough force, so less oxygen-rich blood is pumped throughout the body.

Heart failure with preserved left ventricular function (diastolic heart failure) occurs when the heart contracts normally, but the ventricles do not relax properly or are stiff, and less blood enters the heart during normal filling.

  • Coronary artery disease (coronary atherosclerosis) — A disease of the arteries that supply blood and oxygen to the heart. Coronary artery disease occurs when the normal lining of the arteries breaks down, the walls of the arteries thicken, and deposits of fat and plaque block the flow of blood through the arteries. The arteries that supply blood to the heart become very narrowed and the heart can no longer respond to increased activity. Extra strain on the heart may result in chest pain (angina pectoris) and other symptoms of heart disease.
  • Heart attack — Occurs when a coronary artery becomes blocked, stopping the flow of blood to the heart muscle and damaging it. All or part of the heart muscle becomes cut off from its supply of oxygen. A heart attack can damage the heart muscle, resulting in a scarred area that does not function.
  • Cardiomyopathy – Damage to the heart muscle from causes other than artery or blood flow problems. Causes include viruses, alcohol or drug abuse, and genetics.
  • Heart defects present at birth
  • Diabetes
  • High blood pressure (hypertension) – Blood pressure is the force of blood pushing against blood vessel walls. High blood pressure means the pressure in the arteries is above the normal range.
  • Arrhythmia (abnormal heart rhythms)
  • Kidney disease
  • Obesity (being overweight)
  • Medications – Some chemotherapy agents

How Is Heart Failure Treated?

For heart failure, the goal is to:

  • Decrease the likelihood of disease progression, which decreases the risk of death and the need for hospitalization
  • Lessen symptoms
  • Improve quality of life

How to Decrease the Likelihood of Disease Progression

  • Keep your blood pressure low. In heart failure, the release of hormones causes the blood vessels to constrict or tighten. The heart must work hard to pump blood through the constricted vessels. It is important to keep your blood pressure as low as possible, so that your heart can pump effectively without extra stress.
  • Schedule regular visits with your heart failure doctor or nurse to monitor your progress
  • Monitor symptoms
  • Check for changes in your fluid status (daily weight and checking for swelling)
  • Schedule regular follow-up visits with your special team of doctors and nurses. If you have questions, write them down and bring them to your appointment. Call your doctor if you have urgent questions.
  • Notify all your doctors about your heart failure, medications, and any restrictions. Check with your heart failure doctor about any new medications prescribed by another doctor.
  • Keep good records and bring them with you to each doctor visit.

How to Decrease Further Heart Damage

  • Stop smoking.
  • Reach and maintain your healthy weight.
  • Control high blood pressure, high blood cholesterol, and diabetes.
  • Exercise regularly.
  • Do not drink alcohol.

What to Bring to Your Doctor Visit

  • Medication list
  • Daily weight
  • List of symptoms – what they are, when they occur, how long they last, and what relieves them
  • Test and lab results
  • Records from all doctor or emergency room visits
  • Questions

How to Lessen Symptoms of Heart Failure

  • Maintain fluid balance
  • Decrease sodium in your diet
  • Weigh yourself daily
  • Keep your weight within four pounds of your dry weight. This is your weight without extra water (fluid).

Your doctor may ask you to:

  • Drink or eat less fluids
  • Keep a record of the amount of fluids you drink or eat and your urine output
  • Monitor your symptoms

Call your doctor if:

  • New symptoms occur
  • Your symptoms worsen
    • Do not wait for your symptoms to become so severe that you need to seek emergency treatment


Take your medications as prescribed by your heart specialist. Medications are used to improve your heart’s ability to pump blood, decrease stress on your heart, decrease the progression of heart failure, and prevent fluid retention.

Many heart failure medications are used to decrease the release of harmful hormones. These drugs will cause your blood vessels to dilate or relax, which will lower your blood pressure.

Common Medications

  • ACE-inhibitors
  • Beta-blockers
  • Digoxin
  • Diuretics
  • Anticoagulants (blood thinners)

Medications to Avoid

If you are taking any of these medications, discuss this with your doctor:

  • Non-steroidal anti-inflammatory drugs
  • Most antiarrhythmic agents
  • Most calcium antagonists
  • Some nutritional supplements and growth hormone therapies
  • Antacids that contain sodium
  • Decongestants

Check the drug search to find out more about your medications. It is important to know:

  • The names of your medications
  • What they are for
  • How often and at what times to take them

Keep a list of your medications and bring them to each of your doctor visits. Never stop taking your medications without discussing it with your doctor. Even if you have no symptoms, your medications decrease the work of your heart so that it can pump more effectively.

Improving Your Quality of Life

  • Eat a healthy diet
  • Eat less than 2,000 milligrams (2 grams) of sodium each day
  • Eat foods high in fiber and potassium
  • Reach and maintain a healthy weight
  • Limit foods high in fat, cholesterol, and sugar
  • Manage your fluids
  • Weigh yourself daily
  • Keep your weight within two pounds lower or higher than your dry weight
  • Limit fluid intake to 2 liters or less per day
  • Exercise regularly, but avoid heavy exercise or activities
  • Prevent respiratory infections
  • Ask your doctor about flu and pneumonia vaccines
  • Get emotional or psychological support, if you need it