Understanding Heart Failure: Answers to Common Questions - UMHS Approved Clinical Care Guideline

Understanding Heart Failure:
Answers to Common Questions
Patient Education Handout associated with
UMHS Clinical Care Guideline

This information is not a tool for self-diagnosis or a substitute for medical treatment. You should speak to your health-care provider or make an appointment to be seen if you have questions or concerns about this information or your medical condition.

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What is heart failure?

Heart failure occurs if the heart muscle is unable to ("fails to") pump enough blood to meet the body's needs. The blood begins to back up because the heart is not pumping well and the veins, tissues, and lungs become congested with fluid. At first, pressure in the heart rises and blood and fluid back up into your lungs. You will feel short of breath and get tired easily. If the condition gets worse, the higher pressure causes a buildup of fluid in your veins. Your feet, legs, and ankles will begin to swell. The body cannot get rid of this fluid.

Heart failure is one of the most common causes of heart-related illness and death in the US.

How does it occur?
Heart failure may result from one or more of the following:

coronary artery disease (blockage in the coronary arteries)
an infection that may affect your heart
heart attack
high blood pressure
damage to the valves inside the heart
drinking too much alcohol
severe lung disease.

Often no cause can be found for heart failure.

The following factors may worsen or trigger heart failure in people with weakened hearts:

severe anemia (low levels of red blood cells or hemoglobin, the oxygen-carrying chemical in the blood)
hyperthyroidism (an overactive thyroid gland)
hypothyroidism (an underactive thyroid gland)
high fever
rapid heartbeat
too much salt in the diet
drinking too much fluid
being overweight
working your body too hard
emotional stress.

What are the symptoms?
The main symptoms of heart failure are:

tiredness
shortness of breath or trouble breathing, at first during exercise and later with any activity or even when you are resting
waking up at night with trouble breathing or having a hard time lying flat in bed because of shortness of breath
swollen ankles and feet and weight gain due to too much fluid in the body
loss of appetite.

How is it diagnosed?
Your health care provider will ask about your symptoms and examine you.
You may have some tests, such as:

chest x-ray to look for fluid in the lungs and to see the size of your heart
electrocardiogram (ECG), a recording of the electrical activity of your heart
blood tests
urine tests
echocardiogram, a sound-wave test that can show heart size, heart function, and possible heart valve disease.

How is it treated?
The goals of treatment are:

Reduce the workload on your heart.
Get rid of extra water in your body.
Improve the ability of your heart to pump.
Treat any problems that make your condition worse.

Limits on your activities will depend on how severe your heart failure is. Most people benefit from a gentle exercise program.

Medicines your health care provider may prescribe for heart failure are:

ACE (angiotensin-converting enzyme) inhibitor drugs and ARB's (angiotensin receptor blockers), which lower blood pressure and reduce the work the heart has to do, and which also block the harmful effects of certain hormones on the heart.
Beta blockers, which lessen the effects of the high levels of adrenaline caused by heart failure. If beta blockers are given in too high a dose, they may make heart failure worse. Your health care provider will increase your dose gradually over a few weeks. Although you may not feel better from these drugs, your heart may get stronger after several months of treatment.
Digitalis drugs, which slow your heart rate and help your heart to pump better.
Diuretics, which help you get rid of extra fluid in your body by urinating more.
Drugs other than ACE inhibitors that lower blood pressure to reduce the heart's workload.
Spironolactone, a diuretic that also may keep the heart muscle from getting worse by blocking the effects of a hormone called aldosterone.
Medicines that replace potassium lost from increased urination. (Potassium is a mineral that helps maintain normal heart rhythm.)
Though not a medication, certain devices such as defibrillators and pacemakers may also be recommended by your physician to help your heart pump better and to shock your heart if it goes into an abnormal rhythm.

Ask your health care provider about possible side effects of these drugs. Report any side effects to him or her right away. Take all the medicine prescribed, even when you feel better.

Your health care provider will also put you on a low-salt (low-sodium) diet. For example, many patients are asked to eat no more than 2000mg of sodium per day. Ask your physician how much sodium is right for you. Too much sodium causes your body to retain water, which increases the workload on your heart. You should be careful about taking nonprescription drugs because some are high in sodium. Ask your provider which nonprescription medicines are safe to use.

Your physician may also ask you to limit your daily fluid intake. Ask your physician how much fluid per day you should be drinking. To follow this, you will need to read the food labels on food containers, and keep track of your daily intake.

How long do the effects last?
Even with treatment, heart failure is a serious disease. It usually means a somewhat shortened life span. However, the proper mix of medicines, reduced salt in your diet, and reduced physical activity will greatly improve your symptoms. Proper treatment can usually allow you to return to relatively normal living.
The disease that caused your heart failure will continue to need close medical attention.

How can I take care of myself?
Learn to live within the limits of your condition. The following guidelines may help:

Get enough rest, shorten your working hours if possible, and try to reduce the stress in your life. Anxiety and anger can increase your heart rate and blood pressure. If you need help with this, ask your health care provider.
Check your pulse rate daily.
Learn how to take your own blood pressure or have a family member learn how to take it.
Accept the fact that you will need to take medicines for your heart and limit the salt in your diet for the rest of your life. Be careful with salt substitutes, however. Many contain high levels of potassium. Some of the medicines used to treat heart failure raise the levels of potassium in your blood. Salt substitutes may raise the potassium levels too high.
Develop a way to make sure that you take your medicines on time.
Weigh yourself at least every other day, at the same time of day if possible. Contact your health care provider if you gain more than 3 pounds in 1 week, or if you keep gaining weight over weeks to months. Weight gain may mean your body is having trouble getting rid of extra fluid.
Know the symptoms of potassium loss, which include muscle cramps, muscle weakness, irritability, and sometimes irregular heartbeat.
Follow your health care provider's advice on how much fluid you should drink.
Consult a written diet plan and list of foods before you prepare snacks or meals.
Try not to eat or drink too much.
Monitor your activities to make sure that they do not cause you to become too tired or short of breath.
Avoid extremes of hot and cold (including hot tubs), which may cause your heart to work harder.
Keep regular medical appointments.

Updated February 2006; adapted & modified for the FIG/ST project, January 2007.

Information maintained by the UMHS Clinical Care Guidelines Committee

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