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Heart Failure

Heart failure sounds so frightening. What is it?

Heart failure is a serious problem, but it does not mean that the heart has failed or is not working at all. Heart failure usually develops when another problem makes the heart weak. With heart failure, the heart is unable to adequately pump blood out of the heart to meet the needs of the body. Heart failure is a chronic disease and is not cured, but can be managed by proper medications and lifestyle changes.

What causes heart failure?

It is very important to determine the cause of heart failure. Heart failure due to coronary artery disease should be evaluated for possible treatment of the underlying disease.

Causes of heart failure include:

• Coronary artery disease (including a heart attack)
• Heart valve disease
• Heart muscle disease (cardiomyopathy)
• High blood pressure
• Chronic lung disease (emphysema and chronic bronchitis)

What are the symptoms?

In heart failure, a weakened heart works hard to keep pumping blood from the heart to the rest of the body. But when the heart is overwhelmed with too much fluid or too much exertion, the pumping action of the heart is further decreased. This causes blood (fluid) to back up into the left atrium and then the lungs. Excess fluid can also back up in the liver, abdomen, ankles or feet.

How is heart failure evaluated?

It can be evaluated in several ways. A history and clinical exam is a key component of the evaluation of heart failure.

The "ejection fraction" plays an important role in determining the extent of heart failure and to providing appropriate therapies. An ejection fraction is a measurement of the amount of blood expelled from a contracting heart using an echocardiogram, Thallium stress test or cardiac catheterization.

• Echocardiogram
• Thallium stress test
• Cardiac Catheterization including a left ventriculography, and/or a myocardial biopsy

How is heart failure treated?

The sooner the diagnosis and treatment for heart failure is started, the better the chances to control symptoms and prevent further damage to the heart. In addition, the early treatment must include education about living with heart failure, managing lifestyle changes and maximizing medications.

Heart failure is treated with a variety of medications, most importantly ACE inhibitors (angiotensin converting enzyme) and diuretics. ACE inhibitors treat the symptoms of heart failure. Diuretics eliminate excess water in the body. A salt-(sodium) restricted diet must be initiated along with daily weight measurement. Regular activity or exercise has been shown to improve overall health functioning and quality of life, so discuss this with your Inova physician. For the appropriate patients, weight reduction and smoking cessation will improve the heart's functioning significantly. It is extremely important that all patients with heart failure continue to follow up with their Inova physician on an ongoing basis.

When should I call the doctor?

For your well-being, keep regular appointments with your Inova physician. He or she will monitor your condition and make necessary adjustments in your treatment.

In the event of severe shortness of breath, unrelieved chest discomfort or mental confusion, call 911.
Do not drive to the hospital.

The Inova Health System has identified heart failure as a major focus in their efforts to improve quality of patient care. A continuum of care program has been developed to educate individuals with heart failure and provide follow-up. These components aim to improve quality of life, and reduce unnecessary hospitalization for these individuals.