Heart Failure

Types of heart failure

There are two types of heart failure — systolic heart failure and diastolic heart failure.

Systolic heart failure

Systolic heart failure is a type of heart failure that occurs when the heart does not effectively pump blood to the rest of the body. If you have systolic heart failure, blood can pool in the lungs, hands, abdomen, legs and feet. When this occurs, it is called congestive heart failure.

Diastolic heart failure

Diastolic heart failure occurs when the heart muscle has thickened and the ventricle is unable to relax so the heart can’t fill with blood completely. When this occurs, fluid could build up in the lungs, legs and abdomen.

Causes of heart failure

Heart failure can develop after other heart conditions weaken the heart. Conditions that can weaken the heart and lead to heart failure include:

• Coronary artery disease
• Cardiomyopathy
• High blood pressure
• Heart arrhythmias
• Congenital heart disease
• Myocarditis
• Faulty heart valves

Risk factors for heart failure

Risk factors or other conditions that could contribute to systolic heart failure include:

• Arrhythmias — patients who suffer from abnormal heart rhythms are at higher risk of developing systolic heart failure because the irregular heart rhythm can create extra work for the heart.
• High blood pressure — if you have high blood pressure, your heart must work harder to pump blood.
• Heart attack — if you have had a heart attack, your heart is less effective and this can raise your risk for heart failure.
• Chemotherapy — some chemotherapy drugs can damage the heart and put you at higher risk for heart failure.
• Diabetes — diabetes can increase the risk of high blood pressure, coronary artery disease or heart failure.
• Coronary artery disease — when you have narrowed arteries, the heart will not receive as much oxygen-rich blood that can weaken your heart muscle and lead to heart failure.

Symptoms of heart failure

Symptoms of systolic heart failure are often due to the blood backing up in the limbs (congestive heart failure) or due to the weak heart. The symptoms can start suddenly or gradually.

Heart failure symptoms include:

• Chest pain
• Fatigue or weakness
• Nausea or lack of appetite
• Difficulty concentrating
• Irregular heartbeat
• Shortness of breath caused by exertion or that can cause you to wake up
• Abdomen swelling
• Coughing up blood or foamy mucus
• Sudden weight gain from fluid retention

Diagnosis of heart failure

Early diagnosis of systolic heart failure is crucial. Your cardiologist can diagnose heart failure after taking your medical history, performing a physical exam and reviewing your results of diagnostic tests.

During the physical exam, your cardiologist may listen to your heart and lungs, feel for the presence of fluid that can indicate heart or lung problems or evaluate skin tone.

Advanced diagnostic technology is used to diagnose and inform treatment for systolic heart failure.

Diagnostic testing includes:

• Blood test — checks for certain chemicals that may aid in diagnosing heart failure.
• Chest x-ray — can show if your heart is enlarged or if there is fluid buildup in the lungs.
• Coronary angiography — doctors may recommend a coronary angiography for patients with worsening heart failure; can determine which patients are candidates for coronary artery bypass grafting (CABG). 
• Echocardiogram — allows your doctor to see the size and shape of the heart and how effective it is pumping by using sound waves to produce images of the heart.
• Electrocardiogram (EKG or ECG) — an EKG can detect heart rhythm problems or damage to the heart after a heart attack through monitoring the electrical impulses of the heart. 
• Stress test — a stress test is used to evaluate how your heart responds to exercise.
• Cardiac CT (Computed tomography) — looks at the large vessels, heart anatomy and coronary circulation to diagnose heart failure. 
• Cardiac MRI (Magnetic resonance imaging) — can determine the severity of your heart failure to guide your doctor’s treatment plan.
• Myocardial biopsy — to diagnose certain cardiac disorders, including heart failure, your doctor may remove a small piece of your heart muscle to evaluate in a laboratory.

Treatment for heart failure

Although heart failure can be treated with medications and lifestyle modifications, it is a chronic condition that does not completely go away.

Treatments for heart failure include:

Lifestyle modifications

People with mild to moderate heart failure can lead normal lives if they make changes to their lifestyles. Lifestyle modifications that can slow the progression of heart disease include:

• Quitting smoking
• Losing weight
• Avoiding alcohol
• Avoiding caffeine
• Eating a healthy diet
• Becoming physically active
• Managing stress
• Monitoring blood pressure

Medication

There are several classes of medications that treat heart failure. Many doctors use some sort of combination of the following medications to treat the condition:

• Angiotensin-converting enzyme inhibitors (ACE) — help patients with systolic heart failure improve blood flow, lower blood pressure and ultimately live longer. 
• Angiotensin II receptor blockers — provide similar benefits as ACE inhibitors, typically used as an alternative when patients don’t respond well to ACE inhibitors.
• Beta blockers — slow the heart, reduce blood pressure and potentially reverse damage to the heart.
• Diuretics — eliminate excess fluid from the body by causing your body to urinate more often. 
• Aldosterone antagonists — are potassium-sparing diuretics used to help people with systolic heart failure live longer. 
• Inotropes — IV medications that are used in a hospital setting for patients who suffer from severe heart failure.
• Digoxin — helps the heart pump blood more effectively by slowing and strengthening the heart’s contractions.  

Implantable heart failure monitoring system

An implantable heart failure monitoring system is designed to provide doctors with daily information on the heart’s function. The device is a small, wireless monitoring sensor that is implanted in the pulmonary artery. Patients can transmit information for their device directly to their doctor. This information allows doctors to monitor the patient remotely and proactively implement treatment options that may improve the patient’s condition.

Annuloplasty (mitral valve annuloplasty)

An annuloplasty is a surgical procedure performed to repair a leaking mitral valve caused by mitral regurgitation. Mitral regurgitation is one of the most common heart valve issues. It occurs when the blood leaks backward through the mitral valve as the left ventricle contracts. During a mitral valve annuloplasty procedure, a device is implanted around the mitral valve to restore mitral valve function.

An annuloplasty is typically performed during minimally invasive heart surgery or open-heart surgery.

Cardiac pacemaker

A cardiac pacemaker may be indicated for congestive heart failure patients to help the heart maintain heart rate and rhythm. A pacemaker is a device implanted in the chest that sends electrical impulses to the heart when there are irregular heart beat patterns.

You'll work with your cardiovascular team to determine what type of pacemaker is right for you.

Different types of cardiac pacemakers include:

• Single chamber pacemakers
• Dual chamber pacemakers
• Biventricular pacemaker

Using a pacemaker to treat heart failure is called biventricular pacing or cardiac resynchronization therapy.

Implantable cardioverter defibrillator (ICD)

Patients with severe heart failure and/or serious arrhythmias are candidates for an implantable cardioverter defibrillator (ICD). An ICD is implanted under the skin in the chest and monitors heart rhythm. If your heart stops, an ICD can shock your heart back into a normal rhythm.

Left ventricular assist device (LVAD)

An LVAD, also called implantable ventricular assist device, is recommended for advanced heart failure patients whose hearts are unable to pump blood effectively.

An LVAD is a mechanical pump that is surgically implanted in the upper abdomen and attached to the heart. An LVAD helps the heart pump more effectively by moving blood from the left ventricle to the aorta. The aorta will then pump oxygen-rich blood to the rest of the body.

In some patients, an LVAD will be implanted while the patient waits for a heart transplant. In other patients where heart transplant is not an option, an LVAD is used as long-term therapy.

Surgical valve repair or replacement

If an aortic valve or mitral valve issue is causing your heart failure, you may need a surgical valve repair or replacement. There are a variety of surgical options for valve replacement including:

• Transcatheter aortic valve replacement — minimally invasive aortic valve replacement surgery
• Tissue valve — valve replacement using tissue valves made from animal tissue that is strong and flexible
• Mechanical valve — replacing the valve with strong durable materials
• Ross procedure — moving a healthy valve into the damaged aortic valve

Coronary bypass surgery

Your surgeon will recommend coronary bypass surgery if blocked arteries are causing your heart failure. In a coronary bypass surgery, your surgeon will take a part of a blood vessel from another body part and build a bypass around the blocked artery so that the blood can flow through the heart freely.

Heart transplant

In some advanced heart failure patients, a heart transplant is the only treatment option. A cardiothoracic surgeon will replace your heart with a healthy one taken from an organ donor.

Heart transplants are used as a last resort option as they are high risk and finding a heart match is very challenging. During the transplant surgery, your cardiothoracic surgery will connect you to a heart-lung machine to keep your blood flowing throughout the body. The surgeon will then remove the diseased heart and replace it with the healthy donor heart and reconnect the blood vessels to the heart.

Most people (90%) who have heart transplants live more than a year after their transplant.

Cardiac rehabilitation (rehab)

Cardiac rehab is an important step in the recovery process for heart failure patients. The Mercy Health cardiac rehab team is a comprised of doctors, nurses, nutritionists, exercise counselors and others medical professionals who all work together for you. The medically supervised rehab program includes exercise training and education on heart healthy living and stress reduction.

Cardiac rehab could help increase a heart failure patient’s life span by stabilizing or reversing the progression of heart failure.