April 26, 2017 |

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

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

Loading the player...

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.”

Transcript:

1
00:00:00,086 --> 00:00:02,292
[MUSIC]

2
00:00:02,292 --> 00:00:06,232
Heart failure is a condition where
either your heart doesn't pump well or

3
00:00:06,232 --> 00:00:08,021
your heart doesn't relax well.

4
00:00:08,021 --> 00:00:13,658
[MUSIC]

5
00:00:13,658 --> 00:00:17,674
50% of patients that has heart failure
has something called heart failure with

6
00:00:17,674 --> 00:00:19,180
reduced ejection fraction.

7
00:00:19,180 --> 00:00:23,840
And that essentially means that the heart
doesn't pump well, the pump has failed.

8
00:00:23,840 --> 00:00:27,080
The other 50% of the patients have
something called heart failure with

9
00:00:27,080 --> 00:00:28,550
preserved ejection fraction.

10
00:00:28,550 --> 00:00:31,980
Meaning the pump is just fine,
but when the heart goes to relax

11
00:00:31,980 --> 00:00:35,831
there's a problem with the relaxing.
So the most common symptoms of heart

12
00:00:35,831 --> 00:00:39,926
failure are shortness of breath,
you may also have swelling in the legs,

13
00:00:39,926 --> 00:00:43,326
you may just feel very fatigued as well.
While you're asleep,

14
00:00:43,326 --> 00:00:45,834
you get up in the middle of
the night gasping for air.

15
00:00:45,834 --> 00:00:49,332
Or all of the sudden, you can't lay flat,
you need to adjust sleep with one pillow,

16
00:00:49,332 --> 00:00:51,000
two pillows, three pillows.

17
00:00:51,000 --> 00:00:54,120
And we always ask patients, how many
pillows are you sleeping with tonight?

18
00:00:54,120 --> 00:00:56,430
It's a weird question always,
and they always ask you why, but

19
00:00:56,430 --> 00:00:59,300
it gives us a lot of information.
The first thing we need to figure out,

20
00:00:59,300 --> 00:01:01,150
well, what caused the heart failure?

21
00:01:01,150 --> 00:01:04,440
In America the most common
cause of heart failure is heart

22
00:01:04,440 --> 00:01:07,040
disease.
Coronary artery disease leads to heart

23
00:01:07,040 --> 00:01:11,380
failure by blocking blood
flow to your heart muscle.

24
00:01:11,380 --> 00:01:14,430
Not having blood flow to your heart
muscle weakens that muscle and

25
00:01:14,430 --> 00:01:15,680
can even kill that muscle.

26
00:01:15,680 --> 00:01:20,240
And now you don't have that part of that
muscle contributing to that ejection

27
00:01:20,240 --> 00:01:24,110
fraction, or that strength of
that pump to push blood forward.

28
00:01:24,110 --> 00:01:25,088
And if it's not that,

29
00:01:25,088 --> 00:01:28,370
then there's an entire laundry list
of other things that can cause it.

30
00:01:28,370 --> 00:01:31,880
For example, a patient that has
a problem with their valves,

31
00:01:31,880 --> 00:01:35,080
a patient that has a problem with
arrhythmia, abnormal heart rhythms.

32
00:01:35,080 --> 00:01:37,770
Patients that have
excessive alcohol use or

33
00:01:37,770 --> 00:01:41,850
use drugs, patients that have
high blood pressure, diabetes.

34
00:01:41,850 --> 00:01:46,610
If a patient is on chemotherapy agent,
particularly for breast cancer, for

35
00:01:46,610 --> 00:01:51,240
example, that could also weaken the heart.
In order for us to treat you and

36
00:01:51,240 --> 00:01:54,930
help you have a full recovery
of the muscle of the heart,

37
00:01:54,930 --> 00:01:58,830
the goal is really to figure out the
cause, or the underlying etiology of why

38
00:01:58,830 --> 00:02:01,683
your heart muscle is so weak.
You can diagnose heart failure

39
00:02:01,683 --> 00:02:02,700
in many different ways.

40
00:02:02,700 --> 00:02:06,930
You can start just by doing a physical
exam to see whether or not there is

41
00:02:06,930 --> 00:02:10,340
evidence that the heart isn't pumping
well or the heart's not relaxing well.

42
00:02:10,340 --> 00:02:15,310
You can do an electrocardiogram that tells
you exactly how much the heart is pumping,

43
00:02:15,310 --> 00:02:19,330
how much blood is getting out with each
beat, how the heart is relaxing, and

44
00:02:19,330 --> 00:02:22,840
what those valves look like.
I think people think of heart failure

45
00:02:22,840 --> 00:02:28,350
as a condition where it's doom and gloom,
and you're just gonna be bedridden.

46
00:02:28,350 --> 00:02:32,608
And that's not the way it is anymore
because we have multiple medications that

47
00:02:32,608 --> 00:02:37,139
can work to improve symptoms and, in some
cases, improve heart muscle function.

48
00:02:37,139 --> 00:02:42,389
[MUSIC]

Transcript:

Sources: