Heart Failure

There are various contributing factors that can cause heart damage and lead to heart failure.

Common causes of heart failure include:

• Coronary artery disease
• High blood pressure, also called hypertension
• Heart valve disease
• Cardiomyopathy, including dilated cardiomyopathy, hypertrophic cardiomyopathy and restrictive cardiomyopathy
• Cardiac amyloidosis 
• Myocarditis
• Heart arrhythmia

There are two main types of heart failure:

• Systolic heart failure, also called heart failure with reduced ejection fraction
• Diastolic heart failure, also called heart failure with preserved ejection fraction

The classification of these types is based on the ability of your heart to pump blood, as calculated by a measurement called ejection fraction. A normal ejection fraction is greater than 50%.

Distinguishing between systolic and diastolic heart failure is important because the method of treating each differs significantly.

Systolic Heart Failure

Systolic heart failure occurs when the heart's lower chambers (ventricles) become too weak to contract and pump enough blood. This results in an ejection fraction of 40% or less.

Systolic heart failure can be caused by various situations that lead to heart damage. While the cause needs to be identified and treated, a combination of medications is needed to treat this type of heart failure once diagnosed.

Diastolic Heart Failure

Diastolic heart failure occurs when the heart muscle becomes too stiff to relax and expand to fill with enough blood. However, in this type of heart failure, the heart can maintain an ejection fraction of 50% or more.

There are some other heart conditions that can mimic diastolic heart failure, such as hypertrophic cardiomyopathy and cardiac amyloidosis. This means that symptoms need to be appropriately investigated before confirming a diagnosis.

In addition, some people have an ejection fraction between 40 and 50% and are diagnosed as having heart failure with preserved ejection fraction borderline. For the most part, we treat these individuals in the same way we treat people with diastolic heart failure.

Finally, some individuals start off as being diagnosed with systolic heart failure, but show improvement in ejection fraction over the course of being treated. In these instances, we  recategorized these individuals as having heart failure with preserved ejection fraction improved.

There are four stages of heart failure:

• Stage A – pre-heart failure characterized by elevated risk
• Stage B – pre-heart failure but with visual impact on the heart identifiable
• Stage C – symptomatic heart failure
• Stage D – end-stage heart failure

Stage A Heart Failure

A person with Stage A heart failure is high risk for developing heart failure in the future due to one or more pre-existing conditions, including:

• High blood pressure, also called hypertension
• Coronary artery disease (CAD)
• Heart attack
• Diabetes
• A family history of cardiomyopathy
• Undergoing chemotherapy

Stage B Heart Failure

A person with Stage B heart failure has no heart failure symptoms, but cardiac imaging — such as an electrocardiogram (ECG/EKG) or echocardiogram— shows evidence of heart abnormalities. The most common changes are a thickening of the heart muscle or reduced heart function with evidence of damage to one or more areas of the heart.

This stage of heart failure is also correlated with having one or more of the heart failure risk factors listed above.

Stage C Heart Failure

A person with Stage C heart failure is experiencing common heart failure symptoms, and cardiac imaging and other tests show heart dysfunction.

Stage D Heart Failure

A person with Stage D heart failure continues to show progressive signs and symptoms of heart failure, despite treatment with medications, devices or surgery.

Stage D heart failure is not the same as advanced heart failure. In fact, individuals in between Stage C and Stage D can be classified as having advanced heart failure. These people require close attention and a multidisciplinary approach to treat and potentially avoid progression to Stage D heart failure.

A person with Stage A or Stage B heart failure typically experiences no symptoms.

However, Stage C heart failure may include some of the following common symptoms:

• Shortness of breath, especially during physical exertion
• Persistent cough or wheezing, especially if it produces white or pink mucus
• Swelling in the feet, ankles or legs (edema)
• Swelling in the abdomen (ascites)
• Fatigue or weakness
• Lack of appetite
• Nausea
• Confusion, disorientation or memory loss
• Rapid or irregular heartbeat

If you experience more than one of these symptoms, even if you haven’t been diagnosed with any heart problems, contact your doctor as soon as possible and ask for an evaluation of your heart.

Diagnosing heart failure begins with diagnostic testing, but it’s equally important to investigate and identify the cause of heart failure.

Our highly specialized physicians not only appropriately diagnose heart failure, but also use the following sophisticated techniques to understand the cause of heart failure:

• Echocardiography
• Nuclear stress tests
  
• CT coronary angiogram
  
• Cardiac MRI
• Cardiac PET scan
• Cardiac catheterization

If you’re diagnosed with symptomatic heart failure, your doctor will begin working with you on a course of treatment.

Depending on the severity of your condition, one or more of the following treatments may be recommended:

• Lifestyle changes, such as quitting smoking, maintaining a healthy weight, limiting alcohol and caffeine consumption, eating a heart-healthy diet, being physically active and managing stress 
• Medications, such as a blood thinner, antiplatelet agent, ACE inhibitor, Angiotensin II receptor blocker, Beta blocker, calcium channel blocker, diuretic, vasodilator or cholesterol-lowering drug

In some cases, correcting the cause of and/or managing heart failure may require a catheter-based procedure, implantable device or open-heart surgery:

• Coronary bypass surgery is an open-heart surgery that may be recommended if your heart failure is caused by a blockage in an artery around the heart. 
• Heart valve repair or replacement is required if heart failure occurs due to a damaged heart valve.
• Implantable cardioverter defibrillator (ICD) monitors for an abnormal heart rate and transmits an electrical shock to jolt the heart back to its normal rhythm. 
• Angioplasty is a nonsurgical, catheter-based procedure that opens blocked arteries and restores normal blood flow to the heart. 
• Pacemaker helps the heart maintain an adequate pace to keep up with the body's need for oxygen-rich blood.

Sometimes heart failure progresses to a point where these treatments are no longer effective. At this stage, a person typically needs either a left ventricular assist device (LVAD) or a heart transplant. 

A left ventricular assist device (LVAD) is an implanted mechanical device that helps a heart that cannot effectively work on its own.

A heart transplant replaces a person’s failing heart with a healthy heart from a generous donor who has recently died. This is generally reserved for those who have tried medications or other surgeries, but their heart failure has not improved.

Once you return home from the hospital after treatment for heart failure, it is important to closely follow the instructions of your doctor and other members of your medical team. You can take the following additional steps on your own after discharge.