Despite the name, heart failure does not mean the heart is quitting on you. It does mean, though, that the heart is not pumping efficiently enough to meet the demands of your body. It’s a serious condition that can severely damage your quality of life.
The most common symptoms include: shortness of breath, fatigue and weakness, reduced ability to exercise and a rapid heartbeat.
These occur because of the impaired pumping action of the heart. Even a young, healthy person will feel these symptoms after running a 100-yard dash at full speed, but a person with heart failure might feel them when walking a bit faster than usual or, in later stages, simply rising from a chair.
One result of the reduced pumping capacity of the heart is fluid retention in the cells of the body, causing swelling in the legs, feet, ankles or, sometimes in your abdomen. You might notice this as a sudden weight gain and an increased need to urinate at night.
Heart failure is not the only reason for fluid retention. It can also occur because of hormonal changes women experience as part of their monthly cycle, vitamin deficiencies, kidney problems or eating too much salty food. In most cases, all that’s needed is just a little physical activity and, perhaps, a change of diet.
If fluid retention lingers for too long, however, it places extra stress on the heart–making worse any damage that already exists in that muscle.
When there is fluid retention, as there often is, the disorder is often known as congestive heart failure (CHF). And it’s dangerous because the retention can cause blood to back up into the liver, abdomen or lungs.
One reason your clinician listens to your lungs is to look for signs of fluid there, a more serious complication. The condition can cause a persistent cough, usually one that’s worse at night or when you are lying down.
Any of these symptoms are easy to overlook in the early stages. You may think you’re out of shape, gaining weight or just getting old. Heart failure, of course, co-exists with all of those conditions.
At least in the early stages, heart failure affects only one side of the heart. The left ventricle is the chamber of the heart that pumps blood out to the body, and weakness of this chamber–often a result of uncontrolled high blood pressure–is usually what leads to heart failure.
When the left side is weak, blood backs up into the lungs, causing shortness of breath, fatigue, coughing and congestion in the lungs.
The right side of the heart collects blood that is returned from the body and sends it to the lungs to be refreshed with oxygen. Right-sided heart failure usually occurs as a result of left-sided failure. As blood backs up, the right ventricle has a harder time pumping blood to the lungs. The result is even greater congestion throughout the body, and, eventually, the right ventricle becomes overworked and damaged. In some cases, often because of lung disorders, the right side can fail even when the left side is healthy.
If you’re at risk of heart failure, your clinician might want to know your ejection fraction. This is basically a measurement of how much blood is pumped out of the left ventricle with every beat. An ejection fraction of 55 to 60 percent is considered normal. When it drops much below 50 percent, you are at risk of heart failure.
What’s known as heart failure with preserved (or normal) ejection fraction can happen, however. This is right-sided heart failure that occurs not because of a weak pumping action but because the heart has become stiff and unable to fill properly.
There is no cure for heart failure, but it can be managed with exercise and several different classes of medications. In the worst case scenario, a heart transplant may be needed.
Heart failure can be prevented, though, with well-known measures: exercise, a heart-healthy diet and control of blood pressure, cholesterol and other cardiovascular risk factors.
Noel Pupp, APNP is a board-certified family practice nurse practitioner at Ministry Medical Group in Schofield, part of Ascension.
