Definition of Heart Failure

The inability of the heart to adequately pump blood – may affect the right heart (pulmonary circulation), left heart (body circulation), or total heart.

Heart failure, occasionally called by its antiquated name dropsy, is a consequence of longstanding cardiovascular disease (cvd) that has damaged the structure of the heart.

About 5 million Americans live with heart failure

Conditions That Can Cause Heart Failure

certain arrhythmiascongenital heart disease
coronary artery disease (cad)heart attack
hypertension (high blood pressure)long-term alcohol abuse
primary pulmonary hypertensionvalvular heart disease

Symptoms of Heart Failure and Diagnosis

The key symptoms are shortness of breath (dyspnea) and fluid retention (edema).

Because symptoms come on gradually as the heart failure progresses, many people are unaware of them until they notice fatigue, weakness with exertion, rapid or unexplained weight gain, and frequent urination.

Right heart failure tends to produce peripheral edema (swelling of the lower legs, ankles, and feet). Left heart failure tends to produce central edema (fluid accumulation in the lungs), also known as congestive heart failure.

Progressive heart failure generally affects the total heart, though right or left failure may be dominant. The diagnostic path typically includes chest X-RAY, which shows fluid accumulation in the lungs and enlargement of the heart, as well as electrocardiogram (ecg) to assess the heart’s electrical activity.

Heart failure often causes arrhythmiaEchocardiogram shows the heart’s function and size.

Treatment Options and Outlook

Treatment targets any causative cardiovascular conditions, such as coronary artery disease (cad) and hypertension. Surgery may correct valve dysfunctions or previously undetected congenital abnormalities such as septal defect.

Medications can effectively manage heart failure for many years, allowing people to work and enjoy recreational activities. However, as heart failure progresses, it imposes greater restrictions on physical activity.

People who have end-stage heart failure may benefit from a ventricular assist device (VAD), a mechanical pump implanted in the chest cavity that aids the heart in pumping blood.

This allows the heart to rest and sometimes to recuperate. The VAD also can serve as a bridge to heart transplantation, another treatment option for end-stage heart failure.

Medications to Treat Heart Failure

Medication TypeRepresentative MedicationsEffects
angiotensin II receptor inhibitorslosartan, valsartan, telmisartandilate arteries; lower blood pressure
angiotensin-converting enzyme (ACE) inhibitorscaptopril, enalapril, ramipril, benazepril, monoprildilate arteries; lower blood pressure; slow progression
anticoagulantswarfarin, heparin, aspirinreduce blood’s tendency to clot
beta blockerscarvedilol, metoprolol, propranolol, sotalol, timololregulate heart rate
calcium channel blockersamlodipinedilate arteries; lower blood pressure
diureticshydrochlorothiazide, furosemide, bumetanide, metolazonereduce fluid accumulations (edema)
inotropicsdigoxin, digitoxinstrengthen heart MUSCLE; decrease heart’s workload
vasodilatorsnitroglycerin, isosorbide, hydralazine, minoxidilrelax and open blood vessels

Risk Factors and Preventive Measures

Underlying cardiovascular conditions are the most important risk factors, particularly those that are undiagnosed or poorly managed (notably hypertension and CAD). Lifestyle measures to prevent cardiovascular disease, such as daily physical exercise and not smoking, reduce the likelihood of heart failure as well.

Cardiac rehabilitation following heart attack can restore heart function to the extent possible. Other preventive measures include careful management of conditions such as diabetes and obesity (including weight loss and weight management) that can lead to cardiovascular disease.


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