HEART FAILURE

The term heart failure suggests a sudden and complete stop of heart activity. Actually, the heart does not suddenly stop. Rather, heart failure usually develops slowly, often over years, as the heart gradually loses its pumping ability and works less efficiently. Some people may not become aware of their condition until symptoms appear years after their heart began its decline.

What is Heart Failure?

Heart failure occurs when the heart loses its ability to pump enough blood through the body. Usually, the loss in pumping action is a symptom of an underlying heart problem, such as coronary artery disease.

What Causes Heart Failure?

As stated, the heart loses some of its blood-pumping ability as a natural consequence of aging. However, a number of other factors can lead to a potentially life-threatening loss of pumping activity.

As a symptom of underlying heart disease, heart failure is closely associated with the major risk factors for coronary heart disease: smoking, high cholesterol levels, hypertension (persistent high blood pressure), diabetes and abnormal blood sugar levels, and obesity. A person can change or eliminate those risk factors and thus lower their risk of developing or aggravating their heart disease and heart failure.

What are the Symptoms of Heart Failure?

A number of symptoms are associated with heart failure, but none is specific for the condition. Perhaps the best known symptom is shortness of breath ("dyspnea"). In heart failure, this may result from excess fluid in the lungs. The breathing difficulties may occur at rest or during exercise. In some cases, congestion may be severe enough to prevent or interrupt sleep.

Fatigue or easy tiring is another common symptom. As the heart's pumping capacity decreases, muscles and other tissues receive less oxygen and nutrition, which are carried in the blood. Without proper "fuel," the body cannot perform as much work, which translates into fatigue.

Fluid accumulation, or edema, may cause swelling of the feet, ankles, legs, and occasionally, the abdomen. Excess fluid retained by the body may result in weight gain, which sometimes occurs fairly quickly.

Persistent coughing is another common sign, especially coughing that regularly produces mucus or pink, blood-tinged sputum. Some people develop raspy breathing or wheezing.

How is Heart Failure Diagnosed?

In many cases, physicians diagnose heart failure during a physical examination. Readily identifiable signs are shortness of breath, fatigue, and swollen ankles and feet. The physician also will check for the presence of risk factors, such as hypertension, obesity, and a history of heart problems. Using a stethoscope, the physician can listen to a patient breathe and identify the sounds of lung congestion. The stethoscope also picks up the abnormal heart sounds indicative of heart failure.

If neither the symptoms nor the patient's history point to a clear-cut diagnosis, the physician may recommend any of a variety of laboratory tests, including, initially, an electrocardiogram, which uses recording devices placed on the chest to evaluate the electrical activity of a patient's heartbeat.

How is Heart Failure Treated?

Heart failure caused by an excessive workload is curable by treating the primary disease, such as anemia or thyrotoxicosis. Also curable are forms caused by anatomical problems, such as a heart valve defect. These defects can be surgically corrected. However, for the common forms of heart failure--those due to damaged heart muscle--no known cure exists. But treatment for these forms may be quite successful. The treatment seeks to improve patients' quality of life and length of survival through lifestyle change and drug therapy.

Patients can minimize the effects of heart failure by controlling the risk factors for heart disease. Obvious steps include quitting smoking, losing weight if necessary, abstaining from alcohol, and making dietary changes to reduce the amount of salt and fat consumed. Regular, modest exercise is also helpful for many patients, though the amount and intensity should be carefully monitored by a physician.

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