What is HF?

 

Heart Failure (HF) is a very common problem in the United States. It affects over 550,000 Americans each year. It is the leading cause for adults over the age of 65 to be admitted to the hospital. The most common cause for a visit to the emergency room for someone with HF is fluid retention. In the past we have called this fluid retention congestive HF. Many times this fluid or congestion is due to eating too much salt.

There is much that you can do to stay well and healthy if you have HF. This series will give you the tools to do just that. Before we give you those tools to stay healthy, let us tell you how the heart works.

Overview of the Heart

The heart is a four chamber organ in the middle of the chest beneath the breast bone. The purpose of the heart is to pump blood, rich in oxygen, to the rest of the body. The heart has its own blood supply. These coronary arteries surround the outside of the heart like a hand.

Chambers of the heart

The right side of the heart receives blood from the body that is low in oxygen. It then moves it to the lungs to be refilled with oxygen and then returns to the left side of the heart. The left side is the pumping side which moves blood out to the rest of the body, vital organs, and brain.

Blood Vessels of the Heart: Coronary Arteries

When HF occurs it can affect the left or right side of the heart, or both sides.

RIGHT HF- This occurs when the right side of the heart cannot pump the blood very well to the lungs. This can happen due to problems in the lungs or because the left side of the heart has become too big and is pushing on the right side of the heart. When the right side loses its pumping power, it can cause blood to back up in the body’s veins causing swelling in the abdomen, legs, and ankles.

LEFT HF- The left side of the heart moves blood filled with oxygen to the rest of the body. The left side of the heart is a very strong muscle and is bigger than the right side.

There are two types of left-sided HF. The first type, systolic, is a pumping problem where the left side of the heart does not pump blood well to the organs of the body. This is due to a weak muscle. The left side of the heart can become weak from many reasons such as a heart attack, an infection, taking toxic medications, pregnancy, or a problem with one of the heart valves. There are also times when the cause is unknown. Simply put, systolic failure is when the left side of the heart cannot pump with enough force to push blood to the body.

The second type of left HF is called diastolic failure. Diastolic failure occurs when the heart is not able to rest between heart beats. This happens because the heart muscle has become stiff. Normally, the heart rests between each heartbeat and fills with blood. With this type of HF, the blood cannot fill the chamber well causing a lower amount of blood to be pumped out to the body.

You can see that systolic and diastolic HF have the same end results. The causes and the actions of the heart differ though. This is important because the treatment for types of HF also differ.

CAUSES OF HF- The risk factors for HF include high blood pressure, high blood sugar, obesity, blood clots or plaque in the vessels, stroke, virus , a family history, and some types of toxic medications.
Stages of HFhelp to highlight the risks that can be controlled before HF occurs.

SYMPTOMS OF HF- may be hard to know and just as hard to treat. The first step in treating HF is to know the symptoms so they can be treated quickly. Common symptoms of HF include:

• Having trouble thinking or being sleepy
• Feeling dizzy
• Feeling weak
• Unable to walk or do activity like in the past
• Being short of breath
• Cough
• Unable to lay flat
• Having chest pain or tightness
• Feeling heart beat fast
• Gaining weight
• Having abdomen swell or feeling sick to stomach
• Ankle swelling
• Cold hands and feet

This section will explain the changes within your organs and how they cause the symptoms of HF. The symptoms of HF occur when the heart cannot pump the blood to major organs such as the brain, heart, stomach, liver, kidneys and lower limbs.

As the brain gets less blood it can make you feel confused. Weakness occurs as HF becomes more severe, and the heart cannot pump enough blood to meet the body’s needs. To try and help, the body moves blood from the arms and legs to more crucial organs such as the heart and brain. In turn, because the limbs receive less blood, you will often feel weak and tired even when just walking or climbing stairs.

Failure of the left side of the heart is most common and it can lead to increased pressure in the veins of the lungs, forcing fluid into the little air sacs of the lungs. Normally, the air we breathe mixes with blood in these air sacs. But as the air sacs fill with fluid, they can no longer mix blood and air leading to feeling short of breath, coughing, and wheezing. You may also have mucous or phlegm

A fast heart rate may occur when the heart is trying to keep up with the body’s needs. The heart pumping faster and stronger may feel like fluttering in the chest or a heartbeat that feels fast or out of rhythm. This helps the body meets the demands for a short term, but causes harmful long term effects such as a rapid heart rate. The rapid heart rate causes less time for the heart to refill with blood, and thus less blood is pumped out to the body. The extra effort by the heart makes it also need more oxygen and the heart rhythm can become even worse and fatal.

Rapid weight gain occurs when fluid builds up in the body. Because blood flow to the kidneys is less, hormones cause the kidneys to hold on to salt and water. This causes swelling in the feet, ankles, legs, hands, and abdomen. These hormones help meet the body’s needs in the short term, but cause harmful late effects on the body. This cycle causes more swelling in the body. You may be prescribed medicines such as ACE inhibitors to treat HF and/or high blood pressure. An ACE inhibitor works by blocking the effects of these harmful hormones.

Another part of the heart not pumping well is blood backing up to the stomach and liver. This causes a sick stomach, a feeling of fullness, or not wanting to eat.

When to call your Doctor or Nurse- You need to call your doctor or nurse when you have any of these problems. People often think they can wait a few days before calling their doctor or nurse because the symptoms will get better on their own. But waiting only makes it harder to stop the problem and could lead to a hospital stay. One treatment could be taking extra water pills, but only do this as your doctor or nurse tells you because your kidneys and blood need to be closely watched.

Your doctor or nurse need to decide if your symptoms can be treated at home, if you need to be seen in the clinic, or need to go straight to the hospital. No one likes to go to the hospital, but waiting often will make your symptoms harder to treat. Talk often and closely with your HF team.

AHA/ACC heart failure staging compared with NYHA classification team

Stage A

Patients at high risk for heart failure but without structural heart disease or symptoms of heart failure

Examples:Hypertension, diabetes mellitus, obesity, CAD (post-MI or revascularization), peripheral vascular disease, CVA, family history, exposure to cardiac toxins

Stage B

Patients with structural heart disease but without signs and symptoms of heart failure

Examples: Prior Ml, left ventricular hypertrophy or reduced LVEF, asymptomatic valvular disease

Stage C

Patients with structural heart disease with prior or current symptoms of heart failure

Examples: Known structural heart disease and dyspnea, fatigue, reduced exercise tolerance

NYHA Class: IV

Stage D

Patients with refractory heart failure requiring specialized interventions

Examples: Marked symptoms at rest despite maximal medical therapy, with recurrent hospitalizations

NYHA Class: III - IV