Heart failure

Heart failure is a condition in which the heart has lost ability to pump enough blood to the body's tissues. With too little blood, the organs and other tissues do not receive enough oxygen and nutrients to function properly.

Heart failure happens when disease affects the heart's ability to deliver blood. Often, a person with heart failure may have a buildup of fluid in the tissues, called edema. Heart failure with this kind of fluid buildup is called congestive heart failure. According to the American Heart Association, about 4.9 million Americans are living with congestive heart failure. Ten out of every 1,000 people over age 65 have this condition.

Where edema occurs in the body depends on the part of the heart affected. Heart failure caused by abnormality of the lower left chamber of the heart (leftventricle) means that the ventricle cannot pump blood to the body as fast asit returns from the lungs. Because blood cannot get back to the heart, it begins to back up in the lungs. Some of the fluid in the blood is forced into the breathing space of the lungs, causing pulmonary edema. A person with pulmonary edema has shortness of breath, which may be severe and life threatening.A patient with congestive heart failure feels tired.

In right-sided heart failure, the lower right chamber of the heart (right ventricle) cannot pump blood to the lungs as fast as it returns from the body through the veins. Blood then engorges the right side of the heart and the veins. Fluid backed up in the veins is forced out into the tissues, causing swelling, usually in the feet and legs.

When the heart cannot pump enough blood, it tries to make up for this by becoming larger. Enlarged, the ventricle can contract more strongly and pump moreblood. The heart also compensates by pumping more often to improve blood output and circulation. The kidneys try to compensate for a failing heart by retaining more salt and water to increase the volume of blood. This extra fluidcan also cause edema. Eventually, as the condition worsens, these measures are not enough to keep the heart pumping enough blood. Kidneys often weaken under these circumstances, further aggravating the situation.

The most common causes of heart failure are coronary artery disease and heart attack (which may be "silent"), disease of the heart muscle (cardiomyopathy), high blood pressure (hypertension), heart valvedisease, congenital heart disease (present at birth), alcoholism and drug abuse.

A person with heart failure may experience the following: shortness of breath; frequent coughing (especially when lying down); swollen feet,ankles, and legs; abdominal swelling and pain; fatigue, dizziness or fainting; or sudden death. Pulmonary edema may cause the person to cough up bubbly phlegm that contains blood.

To diagnose heart failure, a doctor may use a chest x ray, electrocardiogram (ECG; also called EKG) or other imaging tests, or heart catheterization.

Shortness of breath while engaging in activities or that wakes a person fromsleep are classic symptoms of heart failure. Rapid breathing or other changesin breathing may also be present. Patients with heart failure may also havea rapid pulse The skin of the fingers and toes may have a bluish tint and feel cool.

Heart failure usually is initially treated with lifestyle changes and medicines. Dietary changes may be needed to maintain proper weight and reduce salt intake. Appropriate exercise may also be recommended, but it is important thatheart failure patients only begin an exercise program with the adviceof their doctors. Walking, bicycling, swimming, or low-impact aerobic exercises may be recommended. There are good heart rehabilitation programs at mostlarger hospitals.

Other lifestyle changes that may reduce the symptoms of heart failure includestopping smoking or other tobacco use, eliminating or reducing alcohol consumption, and not using harmful drugs.

Medicines that may be prescribed for heart failure include diuretics,digitalis, vasodilators, beta blockers, angiotensin convertingenzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), andcalcium channel blockers.

Surgery is used to correct certain heart conditions that cause heart failure.Congenital heart defects and abnormal heart valves can be surgically repaired. Blocked coronary arteries can usually be treated with angioplasty or coronary artery bypass surgery.

With severe heart failure, the heart muscle may become so damaged that available treatments do not help. Patients with this end-stage heart failure may beconsidered for heart transplantation when all other treatments have stoppedworking.

Most patients with mild or moderate heart failure can be successfully treatedwith dietary and exercise programs and the right medications. Many people are able to participate in normal daily activities and lead relatively active lives.

Patients with severe heart failure may eventually have to consider transplantation. Approximately 50% of patients diagnosed with congestive heart failurelive for five years with the condition. Women with heart failure usually livelonger than men with heart failure.

The best way to try to prevent heart failure is to eat a healthy diet and getregular exercise, but many causes of heart failure cannot be prevented. People with risk factors for coronary disease (such as high blood pressure and high cholesterol levels) should work closely with their doctor to reduce theirlikelihood of heart attack and heart failure.

Finally, diagnosing and treating heart failure before the heart becomes severely damaged can improve the prognosis. With proper treatment, many patients may continue to lead active lives for a number of years.

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