What Is Heart Failure, Exactly? What Cardiologists Want You to Know

Heart failure doesn’t mean your heart has stopped working.

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Many people hear the term “heart failure” and immediately think it means the heart has stopped working. “People think of heart failure as a condition where it’s ‘doom and gloom,’ and you’re just going to be bedridden,” says cardiologist Nieca Goldberg, MD, medical director at NYU Langone Health, Joan H. Tisch Center for Women’s Health. “That’s not the way it is anymore.”

More than 6 million Americans are living with heart failure; over 900,000 new cases are diagnosed each year. Heart failure is a very manageable and treatable condition.

So, What Is Heart Failure?

Heart failure occurs when the heart muscle has become weak and can’t pump blood well enough to meet the body’s needs. Basically, it can’t keep up with its workload. “Heart failure is a condition where either your heart doesn’t pump well, or your heart doesn’t relax well,” says Michelle Weisfelner Bloom, MD, cardiologist at Stony Brook University Medical Center.

Half of heart failure patients have reduced ejection fraction, which means the heart doesn’t pump well. The other half have what’s called preserved ejection fraction, which means the pump works, but the heart has a problem relaxing.

Symptoms of Heart Failure

There are no routine screenings for diagnosing heart failure; the initial doctor’s visit is often due to a patient’s concern about unusual symptoms. These symptoms of heart failure stem from two key issues: congestion and perfusion.

During congestive heart failure, blood flows too slowly out of the heart, and the blood trying to return to the heart gets backed up and causes congestion. This causes blood to pool and collect around the heart and in the veins. This can lead to:

  • Shortness of breath
  • Discomfort while lying flat and needing extra pillows
  • Gasping for air in the middle of the night
  • Edema, or swelling in the legs and belly
  • “Pitting” in the swelling (when you press down on a swollen skin area and are left with an indentation)

Perfusion from heart failure can lead to other symptoms. “Perfusion is the amount of blood that’s getting to all the organs in the body,” says Dr. Bloom. “If that pump isn’t working well, then you might not be getting enough blood supply to the different organs.”

Not enough blood supply translates to not enough oxygen, and all the organs, including the brain, can be affected by poor perfusion. This may cause:

  • Fatigue
  • Dizziness
  • Fainting

Heart Failure Risk Factors and Causes

“In America, the most common cause of heart failure is heart disease,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital. Coronary artery disease can lead to heart failure by blocking blood flow to your heart muscle. “Not having blood flow to your heart muscle weakens that muscle and can even kill that muscle,” says Satjit Bhusri, MD, a cardiologist at Lenox Hill Hospital in New York City. “And now you don’t have that part of the muscle contributing to the ejection fraction, or the strength of that pump, to push blood forward.”

If coronary artery disease isn’t the problem, there are many other factors that can lead to heart failure, including:

  • Heart valve problems
  • Arrhythmia (abnormal heart rhythm)
  • Excessive drug or alcohol use
  • Heart attack
  • High blood pressure
  • Diabetes

Certain cancer therapies can lead to heart failure as well. “If a patient is on a chemotherapy agent, particularly for breast cancer for example, that can also weaken the heart,” says Dr. Bond.

Treatments for Heart Failure

After you’re diagnosed with heart failure, your doctor will likely suggest a treatment regimen. This may include a series of lifestyle changes and medications to treat heart failure, or devices or surgery.

The success of heart failure treatment greatly depends on your commitment to managing the condition by following your doctor's recommendations and making the necessary changes in diet, exercise, and lifestyle to give you the highest possible quality of life.

“Heart failure can be heart success,” says Dr. Bhusri. “And it gets to be heart success if you really make it into a life event.”