Heart Failure, Diagnosis

Heart failure is a condition in which the heart has trouble pumping blood. This may mean that the heart cannot pump enough blood out to the body or that the heart does not fill up with enough blood. For some people with heart failure, fluid may back up into the lungs. There may also be swelling (edema) in the lower legs. Heart failure is usually a long-term (chronic) condition. It is important for you to take good care of yourself and follow the treatment plan from your health care provider.

Different stages of heart failure have different treatment plans. The stages are:

Stage A: At risk for heart failure.
- Having no symptoms of heart failure, but being at risk for developing heart failure.
Stage B: Pre-heart failure.
- Having no symptoms of heart failure, but having structural changes to the heart that indicate heart failure.
Stage C: Symptomatic heart failure.
- Having symptoms of heart failure in addition to structural changes to the heart that indicate heart failure.
Stage D: Advanced heart failure.
- Having symptoms that interfere with daily life and frequent hospitalizations related to heart failure.

What are the causes?

This condition may be caused by:

High blood pressure (hypertension). Hypertension causes the heart muscle to work harder than normal.
Coronary artery disease, or CAD. CAD is the buildup of cholesterol and fat (plaque) in the arteries of the heart.
Heart attack, also called myocardial infarction. This injures the heart muscle, making it hard for the heart to pump blood.
Abnormal heart valves. The valves do not open and close properly, forcing the heart to pump harder to keep the blood flowing.
Heart muscle disease, inflammation, or infection (cardiomyopathy or myocarditis). This is damage to the heart muscle. It can increase the risk of heart failure.
Lung disease. The heart works harder when the lungs are not healthy.

What increases the risk?

The risk of heart failure increases as a person ages. This condition is also more likely to develop in people who:

Are obese.
Use tobacco or nicotine products.
Abuse alcohol or drugs.
Have taken medicines that can damage the heart, such as chemotherapy drugs.
Have any of these conditions:
- Diabetes.
- Abnormal heart rhythms.
- Thyroid problems.
- Low blood counts (anemia).
- Chronic kidney disease.
Have a family history of heart failure.

What are the signs or symptoms?

Symptoms of this condition include:

Shortness of breath with activity, such as when climbing stairs.
A cough that does not go away.
Swelling of the feet, ankles, legs, or abdomen.
Losing or gaining weight for no reason.
Trouble breathing when lying flat.
Waking from sleep because of the need to sit up and get more air.
Rapid heartbeat.

Other symptoms may include:

Tiredness (fatigue) and loss of energy.
Feeling light-headed, dizzy, or close to fainting.
Nausea or loss of appetite.
Waking up more often during the night to urinate (nocturia).
Confusion.

How is this diagnosed?

This condition is diagnosed based on:

Your medical history, symptoms, and a physical exam.
Blood tests.
Diagnostic tests, which may include:
- Echocardiogram.
- Electrocardiogram (ECG).
- Chest X-ray.
- Exercise stress test.
- Cardiac MRI.
- Cardiac catheterization and angiogram.
- Radionuclide scans.

How is this treated?

Treatment for this condition is aimed at managing the symptoms of heart failure.

Medicines

Treatment may include medicines that:

Help lower blood pressure by relaxing (dilating) the blood vessels. These medicines are called ACE inhibitors (angiotensin-converting enzyme), ARBs (angiotensin receptor blockers), or vasodilators.
Cause the kidneys to remove salt and water from the blood through urination (diuretics).
Improve heart muscle strength and prevent the heart from beating too fast (beta blockers).
Increase the force of the heartbeat (digoxin).
Lower heart rates.

Certain diabetes medicines (SGLT-2 inhibitors) may also be used in treatment.

Healthy behavior changes

Treatment may also include making healthy lifestyle changes, such as:

Reaching and staying at a healthy weight.
Not using tobacco or nicotine products.
Eating heart-healthy foods.
Limiting or avoiding alcohol.
Stopping the use of illegal drugs.
Being physically active.
Participating in a cardiac rehabilitation program, which is a treatment program to improve your health and well-being through exercise training, education, and counseling.

Other treatments

Other treatments may include:

Procedures to open blocked arteries or repair damaged valves.
Placing a pacemaker to improve heart function (cardiac resynchronization therapy).
Placing a device to treat serious abnormal heart rhythms (implantable cardioverter defibrillator, or ICD).
Placing a device to improve the pumping ability of the heart (left ventricular assist device, or LVAD).
Receiving a healthy heart from a donor (heart transplant). This is done when other treatments have not helped.

Follow these instructions at home:

Manage other health conditions as told by your health care provider. These may include hypertension, diabetes, thyroid disease, or abnormal heart rhythms.
Get ongoing education and support as needed. Learn as much as you can about heart failure.
Keep all follow-up visits. This is important.

Where to find more information

American Heart Association: www.heart.org
Centers for Disease Control and Prevention: www.cdc.gov
NIH National Institute on Aging: www.nia.nih.gov

Summary

Heart failure is a condition in which the heart has trouble pumping blood.
This condition is commonly caused by high blood pressure and other diseases of the heart and lungs.
Symptoms of this condition include shortness of breath, tiredness (fatigue), nausea, and swelling of the feet, ankles, legs, or abdomen.
Treatments for this condition may include medicines, lifestyle changes, and surgery.
Manage other health conditions as told by your health care provider.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.