Guide to Heart Failure

Causes | Symptoms | Medications | Device and Surgical Therapy | Daily Care

In congestive cardiomyopathy, also called dilated cardiomyopathy, the heart becomes stretched and weakened and is unable to pump effectively.

Heart failure occurs when the heart does not pump strongly enough to meet the needs of the body. If the heart doesn't pump with the force needed, the body's tissues do not get enough oxygen.

Heart failure develops gradually as the heart muscle weakens. If the right side of the heart is affected, the heart is unable to pump adequate blood to the lungs to be oxygenated. If the left side of the heart is affected, it is unable to pump enough blood to the rest of the body. In most cases, heart failure affects both left and right side, but it can occur on just one side.

About 5.8 million people in the United States suffer from heart failure and nearly 700,000 new cases are diagnosed each year. Heart failure usually develops slowly over time, and some loss in pumping capacity is natural as people age. With end-stage heart failure, however, that loss becomes life-threatening and is no longer manageable through medical therapies.

Heart failure and cardiomyopathy

One of the many causes of heart failure is cardiomyopathy. There are two major types of cardiomyopathy: primary cardiomyopathy, defined as changes in the structure or function of the heart muscle that cannot be attributed to a specific cause, and secondary, which is associated with disorders of the heart or other organs. Congestive cardiomyopathy is the most common primary form of heart muscle disease. Other types include hypertrophic and restrictive cardiomyopathy. Heart muscle disease related to coronary artery disease is called ischemic cardiomyopathy.

The exact frequency of cardiomyopathy is difficult to determine as many cases are not severe, but about 500,000 new cases develop each year in the United States. Instead of afflicting the elderly like most other heart diseases, heart muscle disease more commonly strikes younger people. This group of disorders directly damages the muscle, impairing its ability to pump blood to other parts of the body.

Treatment usually includes lifestyle changes, medications, and continual care. If symptoms progressively worsen and can not be controlled through these measures, surgical procedures may be necessary.

Causes of Heart Failure

The primary causes of heart failure include diseases that damage the heart, such as coronary heart disease, high blood pressure, and diabetes. Other causes may include cardiomyopathy, congenital heart defects, heart valve disease, and arrhythmias.

In addition to these conditions, the heart may be injured by factors such as radiation and chemotherapy treatments, thyroid disorders, drug or alcohol abuse, HIV/AIDS, and others; these may also lead to heart failure. Obstructive sleep apnea may worsen heart failure by depriving the heart of oxygen and increasing its workload.

Symptoms of Heart Failure

Your symptoms depend on how weak your heart is and how well your heart failure is controlled. You may have one or all of the following symptoms of heart failure. Or you may have no symptoms at all. Some symptoms are:

  • feeling tired; not able to carry out usual activities
  • shortness of breath, even at rest or when lying flat at night
  • you may need to sleep on 2 to 3 pillows in order to breathe comfortably at night
  • swelling in your ankles, legs and abdomen (belly) or quick weight gain without eating more than usual You may suddenly gain as much as 2-3 pounds in one day
  • your belly may feel tender or painful and you may have some nausea
  • pounding heart beats or a fast or irregular rhythm at times (especially when lying on your left side)
  • dizziness and weakness; you may even feel faint

Medications for Heart Failure

Medications are needed for many reasons. The medicines you are taking will most likely include:

  • ACE Inhibitors: These drugs lower blood pressure and open and relax blood vessels.
  • Vasodilators: These drugs lower blood pressure as well as open and relax blood vessels.
  • Diuretics or Water Pills: These drugs help the body get rid of extra water and salt.
  • Digoxin: Helps the heart pump better

Your doctor may order other medicines for you and it is very important to take your them as directed and to report any unusual side effects.

Keep track of your medicines and when you take them. Call your doctor or pharmacist if you have any questions about your prescriptions.

Device and Surgical Therapy

If heart failure is severe and can not be managed with medications, an implantable device may be needed. Options include:

If medical and device therapy are insufficient to manage end-stage heart failure, heart transplantation may be indicated.

Daily Care for Patients with Heart Failure

  • Weigh yourself daily, and record your weight. You may be told to limit the amount of fluids you drink. Call the doctor if your ankles or feet become swollen or if you gain 2-3 pounds in one day or more than 5 pounds in 5 days.
  • Eat healthily. Read food labels for fat and sodium content. Fresh, natural foods usually have less salt, cholesterol or fats.
  • Know when to rest. STOP when you are tired, clammy, dizzy or experiencing chest pain or discomfort.
  • Don't smoke! Avoid all types of tobacco.
  • If possible, learn to take your pulse and blood pressure, or have them checked regularly.

When do I need to call my health care provider?

Call your doctor or other health care provider when you notice:

  • Weight gain of 2-3 pounds in one day
  • Shortness of breath
  • Increase in fatigue
  • Swelling in your ankles or belly
  • Faintness or dizziness
  • Changes in pulse and blood pressure
  • Pounding heart beat
  • If you have chest pain—call 911!

Here's a handy place to record your weight, pulse and blood pressure. (PDF File)

Next Steps

If you have heart disease and need help, we’re here for you. To get started today, call (212) 305-7600 or use our appointment request form.

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