Heart Failure

What is heart failure?

Heart failure occurs when the heart muscle is weak or stiff and cannot pump enough oxygen-rich blood to the body, causing important organs to receive less blood.   Because the heart is not pumping well, fluid can back up in the lungs and other parts of the body.

Although it can develop suddenly, it is a progressive disease, so symptoms typically build gradually over time.  Proper treatment can improve heart failure symptoms and may help people to feel better, live longer and improve quality of life.

Heart Failure can also be life threatening.  Some people may need a heart transplant or a device to assist the heart to pump blood to the body. 

Two types of heart failure

There are two types of Heart Failure.  The type of heart failure you have is determined by your ejection fraction or EF.  Your EF is the amount of blood the heart pumps out with each heartbeat.  A normal EF is 55-70%. 

• Left-side heart failure with reduced ejection fraction (HFrEF): The left ventricle is weak can’t pump hard enough to circulate blood through your body (systolic failure).  EF is lower than normal.
• Left side heart failure with preserved ejection fraction (HFpEF):   The left ventricle is stiff stiffens and can't does not properly refill fill with blood between heartbeats (diastolic failure).  EF is normal.

Risk factors for heart failure

A family history of heart failure increases your risk of developing it. Age alone isn't a risk factor, but it's more commonly seen in older adults (age 65+).

Risk factors for heart failure include:

• Coronary artery disease and heart attack can restrict blood flow to the heart muscle.
• Congenital heart disease can result in elevated pressure that gradually weakens the heart muscle.
• Diabetes has the potential to damage blood vessels over time which could lead to coronary artery disease and high blood pressure.
• High blood pressure (hypertension) forces your heart to work harder to pump blood, causing the lower left ventricle to thicken and enlarge.
• Heart valve disease prevents the heart from pumping blood effectively, making it work harder and weaken over time.
• Arrhythmias (Irregular heartbeats, may occur often or be fast). If the heart beats too fast the muscle can weaken over time, leading to cardiomyopathy and heart failure. 
• Chemotherapy medications may affect your heart's ability to pump blood efficiently. This may lead to a weakening of the heart muscle.
• Obesity and inactivity increase the risk of heart failure by putting a bigger strain on the heart that can diminish its ability to effectively pump blood over time.
• Sleep Apnea causes interruptions in your breathing, making oxygen levels to drop while you sleep. This condition leads to high blood pressure that puts a strain on your heart that may cause it to weaken over time.
• Viral Infections cause your body to produce special cells to fight off the disease. These cells may produce chemicals that can damage your heart muscle causing it to become thick, swollen and weak.

Other issues that may increase your risk of developing heart failure include:

• Alcohol and drug abuse
• Smoking or significant second-hand smoke exposure
• Advancing Age

Heart failure symptoms

Not everyone has signs and symptoms of heart failure. When symptoms occur, they can vary in duration and intensity. Your symptoms may include:

• Sudden weight gain
• Shortness of breath or wheezing
• Stomach issues (bloating, loss of appetite, nausea)
• Unexplained cough (can be a dry, hacky cough or brings up white, foamy mucus)  
• Fatigue
• Difficulty sleeping at night
• Reduced ability to exercise
• Chest discomfort, heaviness or pain

Heart failure diagnosis

After evaluating your family history and current lifestyle, your primary care provider may refer you to a cardiologist to determine the necessary tests. These can include one or more of the following:

• Coronary Angiogram
• Chest X-ray
• Cardiac MRI
• CT Scan of heart
• Blood tests
• Echocardiogram 
• Cardiac Catheterization
• Electrocardiogram (EKG)
• Stress test (physical or pharmacological)
• Myocardial biopsy
• Genetic Testing

Treatments for Advanced Heart Failure

Mechanical circulatory support

We can help some patients with advanced heart failure, including HFrEF and candidates for durable ventricle assist devices (VADs) or heart transplants, if they do not have the following conditions:

• A history of noncompliance, or ignoring your care team’s prescribed therapies
• Irreversible advanced/end stage disease in other organs, unless they are potential candidates for dual organ transplant
• Other terminal illness, such as metastatic cancer
• Active use of cocaine or other drugs
• Severe untreated or uncontrolled psychiatric disorders
• Dementia or other debilitating neurologic disorders
• Advanced age (more than 80 years old)
• Active systemic infection
• Other condition that would significantly limit quality and/or quantity of life even if heart failure was corrected

We can help some patients with advanced heart failure, including HFrEF and candidates for durable ventricle assist devices (VADs) or heart transplants, if they do not have the following conditions:

• A history of noncompliance, or ignoring your care team’s prescribed therapies
• Irreversible advanced/end stage disease in other organs, unless they are potential candidates for dual organ transplant
• Other terminal illness, such as metastatic cancer
• Active use of cocaine or other drugs
• Severe untreated or uncontrolled psychiatric disorders
• Dementia or other debilitating neurologic disorders
• Advanced age (more than 80 years old)
• Active systemic infection
• Other condition that would significantly limit quality and/or quantity of life even if heart failure was corrected

What is a Left Ventricular Assist Device (LVAD)?

An LVAD is sometimes called a "heart pump." it is a mechanical device that supports your heart's function. It is surgically attached to the heart, helping to pump blood from the left side of the heart to the aorta. The blood from the left side of the heart carries oxygen to the rest of your body. Your blood moves through the aorta and out to your body.

Why are LVADS Used?

The goal of LVAD therapy support is to improve your overall quality of life. LVADs are used for patients with end-stage heart failure. End-stage heart failure is defined by three conditions:

1. There is a continuous decline in your EF below 25%
2. Low cardiac output on your right heart catheter
3. You are not responding or getting better with medications

Making healthcare decisions while living with a long-term diagnosis

Novant Health has many resources for patients living with a chronic illness. Everything from understanding the choices you have regarding your healthcare journey, to understanding difficult concepts like advanced directives or granting a loved one power of attorney is available to you on the Healthcare Decisions pages on Novanthealth.org.