Advanced Heart Failure

The term heart failure means that the heart is struggling to keep up with its workload. Your body depends on the heart’s pumping action to deliver oxygen and nutrient-rich blood to your cells. With heart failure, the heart muscle is unable to pump enough blood to meet your body’s needs.

Causes of heart failure

Most people who develop heart failure have (or have had) another heart condition. The most common conditions that can lead to heart failure are:

• Coronary artery disease
• High blood pressure
• Previous heart attack

What are the risk factors that can lead to heart failure?

Some risk factors are irreversible and cannot be changed, the more risk factors you have, the greater your chance of developing heart failure, these include:

• Family history (genetics)
• History of heart attacks

Other factors can be modified, treated, or controlled through medication or lifestyle changes, such as:

• Diabetes
• Excessive consumption of alcohol over the years
• Obesity or having a body mass index “BMI” of 30 or greater
• Smoking and/or drug use

Additional conditions that contribute to the development of heart failure:

• Cardiomyopathy
• Congenital heart disease
• Heart valve disease
• Heart arrhythmias (irregular beats)
• Low red blood cell count
• Myocarditis
• Severe lung disease
• Thyroid disease

What is ejection fraction?

An important term to understand is ejection fraction (EF). Your EF reflects how well your left ventricle (or right ventricle) is pumping blood with each heartbeat. Your EF can go up and down based on your heart condition and how well your treatment is working.

• Ejection fraction (55-70%): Heart’s pumping ability is normal. However, even though heart function is normal you may have heart failure with preserved EF (HFpEF).
• Ejection fraction (40-54%): Heart’s pumping ability is slightly below normal.
• Ejection fraction (35-39%): Heart’s pumping ability is moderately below normal. This could mean that you have heart failure with reduced EF (HFrEF).
• Ejection fraction (less than 35%): Heart’s pumping ability is severely below normal. Severe heart failure with a low EF increases the risk of life-threatening conditions.

Symptoms of heart failure can range from mild to severe and can come and go. There may be times when you have no symptoms at all, but be aware, this doesn't mean your heart failure is gone. Unfortunately, it will continue to get worse over time. You may experience more (or different) signs and symptoms. If this happens, it is essential to let your doctor know! Symptoms can include, but are not limited to:

• Confusion or impaired thinking.
• Decreased appetite.
• Persistent cough or wheezing with white or pink blood-tinged phlegm.
• Rapid weight gain from fluid.
• Rapid heart rate (tachycardia) of more than 100 beats per minute.
• Shortness of breath.
• Swelling of the legs, ankles, feet and abdomen.

To diagnose heart failure, your doctor will carefully review your medical history, symptoms and perform a physical examination.  Using a stethoscope, your doctor can also listen to your lungs for signs of congestion and for any abnormal heart sounds.  They may examine the veins in your neck and check for fluid buildup in your abdomen and legs as well.  After that you may have:

• Blood tests
• X-rays
• Echocardiogram (ECHO)
• Electrocardiogram (EKG/ECG)
• Stress test
• Cardiac catheterization
• Magnetic resonance imaging (MRI)

Heart failure is a chronic disease that will need lifelong management.  With treatment, signs and symptoms of HF can improve and your heart may even become stronger.  Here's what you can do:

• Track your daily fluid intake.
• Participate in our cardiac rehabilitation program
• Get no more than 7-8 hours of sleep per night
• Avoid or limit caffeine consumption
• Keep track of your symptoms
• Manage your stress
• Make and keep appointments to see your doctor.
• Avoid alcohol and smoking
• Eat a heart-healthy diet
• If you are overweight, talk to your doctor about weight loss options.