Congestive Heart Failure

Heart failure is a condition in which the heart does not pump enough blood to meet the needs of the body’s tissues. It has many causes.

Heart failure can develop slowly over time as the result of other conditions (such as high blood pressure and coronary artery disease) that weaken the heart. It can also occur suddenly as the result of damage to the heart muscle or an acute valve problem.

Common signs and symptoms of heart failure include:

  • Fatigue
  • Shortness of breath
  • Wheezing or cough
  • Fluid retention and weight gain
  • Loss of appetite
  • Abnormally fast or slow heart rate

Treatment for heart failure depends on its severity. All patients need dietary salt restriction and other lifestyle adjustments, medication, and monitoring. People with severe heart failure may need implanted devices (such as pacemakers, implantable cardiac defibrillators, or devices that help the heart pump blood) or surgery, including heart transplantation.

Decision Making in Advanced Heart Failure

For patients with advanced heart failure, symptom relief, quality of life, and personal values are as important to consider as survival, advises the American Heart Association (AHA). The AHA notes that while technology has increased the treatment options for advanced heart failure, “doing everything is not always the right thing.” AHA guidelines emphasize a patient-centered approach to treatment and the importance of patients discussing with their doctors their preferences, expectations, and goals.

Heart failure is a clinical syndrome, not a single disease. The heart doesn’t “fail” in the sense of ceasing to beat (as occurs during cardiac arrest). Rather, inefficient pumping can be caused by a number of factors.

In classic heart failure, the heart muscle weakens, sometimes acutely (as with a big heart attack) or it weakens over the course of months or years, so that it is unable to pump out enough of the blood that enters its chambers. As a result, fluids build up in the lungs and tissues, causing congestion. This is why heart failure is also sometimes referred to as “congestive heart failure.

Causes

Heart failure has many causes and can evolve in different ways.

  • It can be a direct, latest-stage result of heart damage from one or more heart or circulation diseases.
  • It can occur over time as the heart tries to compensate for abnormalities caused by these conditions, a condition called remodeling.

In all cases, the weaker pumping action of the heart means that less blood is sent to the kidneys. The kidneys respond by retaining salt and water. This in turn increases edema (fluid buildup) in the body, which causes widespread damage.

Uncontrolled high blood pressure (hypertension) is a major cause of heart failure even in the absence of a heart attack. In fact, about 75% of cases of heart failure start with hypertension. It generally develops as follows:

  • The heart muscles thicken to make up for increased blood pressure
  • The force of the heart muscle contractions weakens over time, and the muscles have difficulty relaxing. This prevents the normal filling of the heart with blood

Hypertension is a disorder characterized by consistently high blood pressure. In adults, high blood pressure is diagnosed when the systolic blood pressure (the “top” number, which represents the pressure generated when the heart beats) is 130 or higher or the diastolic blood pressure (the “bottom” number, which represents the pressure in the vessels when the heart is at rest) is 80 or higher.

Coronary artery disease is the result of a process called atherosclerosis (commonly called “hardening of the arteries”). It is the most common cause of heart attack and involves the buildup of cholesterol in the arteries, with inflammation and injury in the cells of the blood vessels. The arteries narrow and become brittle. Heart failure in such cases most often results from a pumping defect in the left side of the heart. But both sides can be affected.

People often survive heart attacks. But many eventually develop heart failure from the damage the attack does to the heart muscles. 

Valvular Heart Disease 

The valves of the heart control the flow of blood leaving and entering the heart. Abnormalities can make it more difficult to get through a valve (stenosis) or cause blood to leak back through a valve (regurgitation or leaking).

In the past, rheumatic fever, which scars the heart valves and prevents them from functioning properly, was a major cause of death from heart failure. Fortunately, antibiotics and other advances have now made this disease a minor cause of heart failure in industrialized nations. Birth defects may also cause abnormal valvular development. Although more children born with heart defects are now living to adulthood, they still face a higher than average risk for heart failure as they age. 

Cardiomyopathy is a disorder in which something has made the heart muscle abnormal and weakened, generally resulting in heart failure. There are several different types of cardiomyopathy. Injury to the heart muscles may cause the heart muscles to thin out (dilate) or become too thick (become hypertrophic). In either case, the heart doesn’t pump correctly. A viral infection involving the heart muscle (viral myocarditis) is a rare viral infection that involves the heart muscle and can produce either temporary or permanent heart muscle damage. 

Risk Factors 

Coronary artery disease, heart attack, and high blood pressure are the main causes and risk factors of heart failure. Other diseases that damage or weaken the heart muscle or heart valves can also cause heart failure. Heart failure is most common in people over age 65, African-Americans, and women. 

Age 

Heart failure risk increases with advancing age. Heart failure is the most common reason for hospitalization in people age 65 years and older. 

Gender 

Men are at higher risk for heart failure than women. However, women are more likely than men to develop diastolic heart failure (a failure of the heart muscle to relax normally). 

Ethnicity 

African-Americans are more likely than white people to develop heart failure before age 50 and die from the condition. 

Family History and Genetics 

People with a family history of cardiomyopathies (diseases that damage the heart muscle) are at increased risk of developing heart failure. Researchers are investigating specific genetic variants that increase heart failure risk. 

Diabetes 

People with diabetes are at high risk for heart failure, particularly if they also have coronary artery disease and high blood pressure. Some types of diabetes medications, such as rosiglitazone (Avandia) and pioglitazone (Actos), may cause or worsen heart failure. Chronic kidney disease caused by diabetes also increases heart failure risk. 

Obesity 

Obesity is associated with high blood pressure, high cholesterol levels, and type 2 diabetes, conditions that place people at risk for heart failure. Evidence strongly suggests that obesity itself is a major risk factor for heart failure, particularly in women. 

Lifestyle Factors 

Smoking, sedentary lifestyle, and alcohol and drug abuse can increase the risk for developing heart failure. 

Medications Associated with Heart Failure 

Certain drugs can potentially damage the heart and increase the risk for heart failure. Long-term use of high-dose anabolic steroids (male hormones used to build muscle mass) increases the risk for heart failure. The cancer drug imatinib (Gleevec) has been associated with heart failure. Other chemotherapy drugs, such as doxorubicin (Adriamycin), can increase the risk for developing heart failure years after cancer treatment. 

Cancer radiotherapy to the chest also increases the risk for heart disease and heart failure. 

Complications 

The complications caused by heart failure influence a patient’s chance for survival. Although heart failure produces very high mortality rates, treatment advances are improving survival rates. 

Cardiac Cachexia 

If patients with heart failure are overweight to begin with, their condition tends to be more severe. Once heart failure develops, an important indicator of a worsening condition is the occurrence of cardiac cachexia, which is unintentional rapid weight loss (a loss of at least 7.5% of normal weight within 6 months). 

Impaired Kidney Function 

Heart failure weakens the heart’s ability to pump blood. This can affect other parts of the body including the kidneys (which in turn can lead to fluid buildup). Decreased kidney function is common in patients with heart failure, both as a complication of heart failure and other diseases associated with heart failure (such as diabetes). Studies suggest that, in patients with heart failure, impaired kidney function increases the risks for heart complications, hospitalization, and death. 

Congestion (Fluid Buildup) 

In left-sided heart failure, fluid builds up first in the lungs, a condition called pulmonary edema. Later, as right-sided heart failure develops, fluid builds up in the legs, feet, and abdomen. Fluid buildup is treated with lifestyle measures, such as reducing salt in the diet, as well as drugs, such as diuretics. 

Arrhythmias (Irregular Beatings of the Heart) 

There are several types of arrhythmias: 

  • Atrial fibrillation. A rapid quivering beat in the upper chambers of the heart. It is a major cause of stroke, especially for people with heart failure. Atrial fibrillation can also make other aspects of a patient’s heart failure more difficult to manage. 
  • Left bundle branch block. While not an arrhythmia per se, it is an abnormality in electrical conduction in the heart. It develops in about 30% of people with heart failure. 
  • Ventricular tachycardia and ventricular fibrillation. Life-threatening arrhythmias that can occur in people when heart function is significantly impaired. Some people with heart failure may be offered an implanted defibrillator to protect them from these arrhythmias. 

Angina and Heart Attacks 

While coronary artery disease is a major cause of heart failure, people with heart failure are at continued risk for angina and heart attacks. Special care should be taken with sudden and strenuous exertion, particularly during colder months, with activities such as snow shoveling. 

Symptoms 

Many symptoms of heart failure result from the congestion that develops as fluid backs up into the lungs and leaks into the tissues. Other symptoms result from inadequate delivery of oxygen-rich blood to the body’s tissues. Since heart failure can progress rapidly, it is essential to consult a doctor immediately if any of the following symptoms are detected: 

Fatigue 

Patients may feel unusually tired. 

Shortness of Breath (Dyspnea) 

Symptoms and types of dyspnea include: 

  • Feeling out of breath after exertion. While this may begin only when climbing stairs or taking longer walks, it can eventually be present even when walking around the home. (People who have chest pain or feel like a heavy weight is pressing on the chest should also be evaluated for possible angina.) 
  • Orthopnea refers to the shortness of breath felt when lying flat. People may report that they need to use one or two pillows underneath their head and shoulders in order to be able to sleep. Sitting up with legs hanging over the side of the bed often relieves symptoms. 
  • Paroxysmal nocturnal dyspnea (PND) refers to sudden episodes that cause awakening at night. Symptoms include severe shortness of breath and coughing or wheezing, which generally occur 1 to 3 hours after going to sleep. Unlike orthopnea, symptoms are not immediately relieved by sitting up. It usually takes more time to recover from an episode. 

Fluid Retention (Edema) and Weight Gain 

Heart failure can cause foot, ankle, leg, or abdominal swelling. In rare cases, swelling can occur in the veins of the neck. Fluid retention can cause sudden weight gain and frequent urination. 

Wheezing or Cough 

Heart failure can cause asthma-like wheezing, or a dry hacking cough that occurs a few hours after lying down and stops after sitting up. 

Loss of Muscle Mass 

Over time, patients may lose muscle weight due to low cardiac output and a significant reduction in physical activity. 

Gastrointestinal Symptoms 

Problems include loss of appetite or a sense of feeling full after eating small amounts. People may also have abdominal pain. 

Pulmonary Edema 

When fluid in the lungs builds up, it is called pulmonary edema, which produces severe symptoms. These symptoms may develop suddenly or gradually build up over a matter of days: 

  • In addition to shortness of breath, people sometimes have a cough that produces a pinkish froth. 
  • People may experience a bubbling sensation in the lungs and feel as if they are drowning. 
  • Typically, the skin is clammy and pale, sometimes nearly blue. This is a life-threatening situation, and the person must go immediately to an emergency room. 

Abnormal Heart Rhythms 

Heart failure can cause episodes of abnormally fast or slow heart rate. People may need to have a pacemaker or defibrillator implanted. 

Central Sleep Apnea 

This sleep disorder results when the brain fails to signal the muscles to breathe during sleep. It occurs in up to half of people with heart failure. Sleep apnea causes disordered breathing at night. If heart failure progresses, the apnea may be so acute that a person, unable to breathe, may awaken from sleep in panic. Treatment with continuous positive airway pressure (CPAP) can be beneficial for people with heart failure and sleep apnea. 

Diagnosis 

Doctors can often make a preliminary diagnosis of heart failure by medical history and careful physical examination. 

A thorough medical history may identify risks for heart failure that include: 

  • High blood pressure 
  • Diabetes 
  • Abnormal cholesterol levels 
  • Heart disease or history of heart attack 
  • Thyroid problems 
  • Obesity 
  • Lifestyle factors (such as smoking, alcohol use, and drug use) 
  • Family history of dilated cardiomyopathy (disease of the heart muscle) 

The following physical signs, along with medical history, strongly suggest heart failure: 

  • Enlarged heart 
  • Abnormal heart sounds 
  • Abnormal sounds in the lungs 
  • Swelling or tenderness of the liver 
  • Fluid retention in legs and abdomen 
  • Elevation of pressure in the veins of the neck 

Laboratory Tests 

Both blood and urine tests are used to check for problems with the liver and kidneys and to detect signs of diabetes. Lab tests can include: 

  • Complete blood counts to check for anemia. 
  • Blood and urine tests to check kidney function. 
  • Sodium, potassium, and other electrolyte levels. 
  • Cholesterol and lipid levels. 
  • Blood sugar (glucose) levels. 
  • Thyroid function. 
  • Brain natriuretic peptide (BNP) levels. BNP is a hormone that increases during heart failure. BNP testing can be very helpful in correctly diagnosing heart failure in people who come to the emergency room complaining of shortness of breath (dyspnea). 

Electrocardiogram 

An electrocardiogram (ECG) is a test that measures and records the electrical activity of the heart. It is also called an EKG. An ECG cannot diagnose heart failure. But it may indicate underlying heart problems. The test is simple and painless to perform. It may be used to diagnose: 

  • Previous heart attack. 
  • Abnormal cardiac rhythms. 
  • Thickening of the heart muscle, which may help to determine long-term outlook. 

A finding called a prolonged QT interval may indicate people with heart failure who are at risk for severe complications and therefore need more aggressive therapies or medication adjustments.

The electrocardiogram (ECG, EKG) is used extensively to diagnose heart disease, from congenital heart disease in infants to myocardial infarction and myocarditis in adults. There are several different types of electrocardiograms. 

Echocardiography 

The best diagnostic test for heart failure is echocardiography. Echocardiography is a noninvasive test that uses ultrasound to image the heart as it is beating. Cardiac ultrasounds provide the following information: 

  • Evaluations of valve function 
  • Information about how well the heart is pumping, especially a measurement called left ventricle ejection fraction (LVEF) 
  • Information about how well the heart relaxes (fills) with blood 
  • Type of heart failure 
  • Changes in the structure of the heart that may be a result of heart failure 

Doctors use information from the echocardiogram for calculating the EF (ejection fraction, a measurement of how much blood is pumped out during each heartbeat), which is important for diagnosing heart failure and determining its severity. Stress echocardiography may be needed if coronary artery disease is suspected. 

Angiography 

Doctors may recommend angiography if they suspect that blockage of the coronary arteries is contributing to heart failure. This procedure is invasive.

  • A thin tube called a catheter is inserted into one of the large arteries in the arm or leg. 
  • It is gently guided through the artery until it reaches the heart. 
  • The catheter measures internal blood pressure at various locations, giving the doctor a picture of the extent and severity of the heart failure. 
  • Dye is then injected through the tube into the heart. 
  • X-rays called angiograms are taken as the dye moves through the heart and arteries.
  • These images help locate problems in the heart’s pumping action or blockage in the arteries.

Other Imaging Tests 

Chest x-rays can show whether the heart is enlarged. Computed tomography (CT) and magnetic resonance imaging (MRI) may also be used to evaluate the heart valves and arteries. Myocardial PET scans may be performed on certain patients to evaluate blood flow to the heart muscle. 

Exercise Stress Test 

The exercise stress test measures heart rate, blood pressure, and electrocardiographic changes while a patient is performing physically, usually walking on a treadmill. It can help determine heart failure symptoms. Doctors also use exercise tests to evaluate long-term outlook and the effects of particular treatments. A stress test may be done using echocardiography or may be done with nuclear imaging (called myocardial perfusion imaging). 

Treatment 

Heart failure is classified into four stages (Stage A through Stage D) that reflect the development and progression of the condition. Treatment depends on the stage of heart failure. 

Stage A is not technically heart failure but indicates that a patient is at high risk for developing it. In Stage B, the patient has had damage to the heart (for example, from a heart attack), but no symptoms of heart failure. In Stage C, heart failure symptoms manifest. 

Stage D is advanced heart failure accompanied by symptoms that may be difficult to manage with standard drug treatments and may require more technologically complex care (defibrillators, mechanical pumps, heart transplantation). The American Heart Association (AHA) emphasizes the importance of a patient-centered approach to treatment decisions. People with advanced heart failure should have ongoing honest discussions with their health care providers concerning their personal preferences and quality of life goals. 

Management of Risk Factors and Causes 

Stage A 

In Stage A, people are at high risk for heart failure, but do not show any symptoms or have any structural damage of the heart. The first step in managing or preventing heart failure is to treat the primary conditions that cause or complicate heart failure. Risk factors include high blood pressure, heart diseases, diabetes, obesity, metabolic syndrome, and previous use of medications that damage the heart (such as some chemotherapy). 

Important risk factors to manage include: 

  • Coronary artery disease. Treatment includes a healthy diet, exercise, smoking cessation, medications, and possibly bypass surgery or angioplasty/stenting. 
  • Cholesterol and lipid problems. Treatments include lifestyle management and medications, especially statin drugs. 
  • High blood pressure. A normal systolic blood pressure is considered below 120 mm Hg, and a normal diastolic blood pressure is below 80 mm Hg. High blood pressure is diagnosed when measurements are 130/80 mm Hg or above. Reducing blood pressure can reduce the risk for developing heart failure. 
  •  The treatment of type 1 diabetes and type 2 diabetes is extremely important for reducing the risk for heart disease. ACE inhibitors are especially beneficial, particularly for people with diabetes. Research suggests that metformin, a drug used to treat diabetes, may also help prevent heart failure. 
  •  Obesity affects cardiovascular health and should be considered and treated as a disease. Guidelines recommend that doctors create individualized weight loss plans forvpeople who are overweight or obese. 
  • Valvular abnormalities, such as aortic stenosis and mitral regurgitation. Surgery may be required. 
  • Abnormal health rhythms (arrhythmias). Ventricular assisted devices, notably biventricular pacers (BVPs), can help prevent hospitalizations for patients with these conditions. 
  •  People with heart failure and underlying anemia should have their anemia corrected. On occasion, this may require erythropoiesis-stimulating drugs. 
  • Thyroid function. Various medications are used to treat overactive thyroid (hyperthyroidism) or underactive thyroid (hypothyroidism). 
  •  Avoid drugs that can worsen heart failure symptoms or cause damage to the heart muscle. Talk with your doctor about your heart failure before taking nonsteroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers (verapamil and diltiazem), thiazolidinediones (drugs used for diabetes), anti-tumor necrosis factor medications, and most drugs used to treat irregular heart rhythms (arrhythmia). Choice of cancer drugs (or whether to use radiation therapy) may be altered due to the presence of heart failure. 
  • Diet and Exercise. It is particularly important to reduce sodium (salt) intake to less than 2,400 mg a day (ask your doctor for specific sodium intake goals). People should engage in medically supervised exercise programs. Dietary changes and exercise are important for treating all stages of heart failure. 

Treatment Based on Heart Failure Stage 

Stage B 

Patients have a structural heart abnormality — seen on echocardiogram or other imaging tests — but no symptoms of heart failure. Abnormalities include left ventricular hypertrophy and low EF, asymptomatic valvular heart disease, and a previous heart attack. In addition to the treatment guidelines for Stage A, the following types of drugs and devices may be recommended: 

  • Angiotensin-converting enzyme (ACE) inhibitors are recommended for all patients with reduced EF to prevent heart failure. ACE inhibitors are also recommended for many people who have a history of heart attack. Angiotensin-receptor blockers (ARBs) are appropriate for patients who cannot tolerate ACE inhibitors. 
  • Beta blockers are recommended for all patients with reduced EF or a history of heart attack. They are also recommended for people who have not had a heart attack, but who do have reduced LVEF identified in diagnostic tests. 
  • An implantable cardiac defibrillator (ICD) may be appropriate for people who have had a heart attack at least 40 days prior and have reduced LVEF. 

Stage C 

Patients have a structural abnormality and current or previous symptoms of heart failure, including shortness of breath, fatigue, and difficulty exercising. Treatment includes those for Stage A and B plus: 

  • Restrict dietary sodium (salt). Lowering sodium in the diet can help diuretics work better. 
  • Exercise training and cardiac rehabilitation for appropriate patients. 
  • ACE inhibitor, or ARB as alternative. 
  • Beta blockers (bisoprolol, carvedilol, and sustained release metoprolol). 
  • Diuretics are recommended for most people, with loop diuretics such as furosemide generally being the first-line choice. 
  • Aldosterone inhibitors are recommended for many people. Digitalis may be prescribed for some people. 
  • A hydralazine and nitrate combination (BiDil) may be used for African-American patients who are taking an ACE inhibitor and beta blocker and who still have heart failure symptoms. 
  • Anticoagulants for people who have heart failure and atrial fibrillation and are at risk for stroke. 
  • ICDs may be considered for people with very low EF or those who have had dangerous arrhythmias. 
  • Cardiac resynchronization therapy (pacemaker), with or without ICD, for some people. 
  • Ivabradine (Corlanor) may help with heart failure by decreasing the heart rate. It is more likely to be used after treatment with an ACE inhibitor or ARB, beta blocker, and spironolactone have been maximized generally when the resting heart rate remains above 70 beats per minute. 
  • Sacubitril-valsartan (Entresto) is called an angiotensin-neprilysin inhibitor. This drug may be used when other heart failure medicines have been maximized, the EF is low, and BNP levels remain elevated. 

Stage D 

Patients have end-stage symptoms that do not respond to standard pharmacological treatments. Treatment focuses not only on survival, but on symptom relief and quality of life issues. Treatment includes appropriate measures used for Stages A, B, and C plus: 

  • Strict control of fluid retention. 
  • Heart transplantation referral for appropriate patients. 
  • Left-ventricular assist devices (LVADs) as permanent therapy for people who are not candidates for heart transplants. LVADs are surgically implanted to help pump blood through the body. 
  • Hospice and end-of-life care information for patients and families. 
  • Patients have the right to choose or decline treatments based on their personal preferences, values, and goals. Quality of life is as important a consideration as survival. 

Managing Triggers of Heart Failure Symptoms 

Whenever heart failure worsens, whether quickly or chronically over time, various factors must be considered as the cause: 

  • Dietary indiscretion. Sometimes as little as eating a sausage or some sauerkraut with a high sodium content is enough to precipitate an acute episode. Failure to comply with fluid and salt restrictions must be considered whenever heart failure worsens. 
  •  Depending on the severity of a person’s heart failure, one or more drinks may suddenly worsen symptoms. 
  • Medication compliance. People may forget or purposely skip a medication, or they may not be able to afford or have access to medications. 
  • Angina or heart attack. Worsening of coronary artery disease may make the heart muscle less able to pump enough blood. 
  •  Increases in the heart rate, or a slowing of the heart rate below normal, may also affect the ability of the heart to function. Likewise, an irregular heart rhythm such as atrial fibrillation may cause a flare-up. 
  •  It is unclear whether anemia causes heart failure or is a symptom of heart failure. Some anemias may be treated with iron replacement therapy. A more significant anemia can cause a worsening of heart failure and should be treated promptly. 

Medications 

Many different medications are used in the treatment of heart failure. They include: 

  • ACE inhibitors 
  • ARBs 
  • Beta blockers 
  • Diuretics 
  • Aldosterone blockers 
  • Digitalis 
  • Hydralazine and nitrates 
  • Statins 
  • Aspirin and warfarin 
  • Sacubitril-valsartan 
  • Ivabradine 
  • ACE Inhibitors 
  • Beta Blockers 
  • Diuretics 
  • Aldosterone Blockers 
  • Digitalis 
  • Hydralazine and Nitrates 
  • Statins 
  • Antiplatelet and Anticoagulant Drugs 

Surgery and Devices 

  • Revascularization Procedures 
  • Pacemakers 
  • Implantable Cardioverter Defibrillators (ICDs) 
  • Ventricular Assist Devices 
  • Heart Transplantation 

Lifestyle Changes 

Up to half of patients hospitalized for heart failure are back in the hospital within 6 months. Many people return because of lifestyle factors, such as poor diet, failure to comply with medications, and social isolation. 

Rehabilitation 

Programs that offer intensive follow-up to ensure that the patient complies with lifestyle changes and medication regimens at home can reduce rehospitalization and improve survival. Patients without available rehabilitation programs should seek support from local and national heart associations and groups. A strong emotional support network is also important. 

Medicare recently approved cardiac rehabilitation for some patients with heart failure. Ask your doctor if a program near you may be appropriate. 

Monitoring Weight Changes 

People should weigh themselves each morning and keep a record. Any changes are important: 

  • A sudden increase in weight of more than 2 to 3 pounds may indicate fluid accumulation and should prompt an immediate call to the doctor. 
  • Rapid wasting weight loss over a few months is a very serious sign and may indicate the need for intervention. 

Dietary Factors 

Sodium (Salt) Restriction 

All patients with heart failure should limit their sodium (salt) intake to less than 2,400 mg a day. (Check with your doctor for exact sodium limits.) DO NOT add salt to cooking and meals, and avoid foods high in sodium. These salty foods include ham, bacon, hot dogs, lunch meats, prepared snack foods, dry cereal, cheese, canned soups, soy sauce, and condiments. Some people may need to reduce the amount of water they consume. People with high cholesterol levels or diabetes require additional dietary precautions

Here are some tips to lower your salt and sodium intake: 

  • Look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.” Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels. 
  • DO NOT cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG) or too much potassium. 
  • Avoid processed meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami). 
  • Avoid foods that are naturally high in sodium, like anchovies, nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese. 
  • Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese. 
  • Use oil and vinegar, rather than bottled dressings, on salads. 
  • Eat fresh fruit or sorbet when having dessert. 

Exercise 

People with heart failure used to be discouraged from exercising. Now, doctors think that exercise, when performed under medical supervision, is extremely important for stable patients. The AHA recommends exercise (or regular physical activity) as safe and effective for patients with heart failure who are able to participate. Studies have reported that patients with stable conditions who engage in regular moderate exercise (three times a week) have a better quality of life and lower mortality rates than those who do not exercise. However: 

  • Exercise is not appropriate for all patients with heart failure. If you have heart failure, always consult your doctor before starting an exercise program. 
  • People who are approved for, but not used to, exercise should start with 5 to 15 minutes of easy exercise with frequent breaks. Although the goal is to build up to 30 to 45 minutes of walking, swimming, or low-impact aerobic exercises three to five times every week, even shorter times spent exercising are useful. 

Studies report benefits from specific exercises: 

  • Progressive strength training may be particularly useful for patients with heart failure since it strengthens muscles, which commonly deteriorate in this disorder. Strength training typically uses light weights, weight machines, or even the body’s weight (leg raises or sit-ups, for example). Even performing daily handgrip exercises can improve blood flow through the arteries. 
  • Patients who exercise regularly using supervised treadmill and stationary-bicycle exercises can increase their exercise capacity. Exercising the legs may help correct problems in heart muscles. Exercise has also been associated with reduced inflammation in blood vessels. 

Bed Rest 

Some people with severe heart failure need periods of bed rest. To reduce congestion in the lungs, the patient’s upper body should be elevated. For most patients, resting in an armchair is better than lying in bed. Relaxing and contracting leg muscles are important to prevent clots. As the patient improves, a doctor will progressively recommend more activity. 

Stress Reduction 

Stress reduction techniques, such as meditation and relaxation response methods, may have direct physical benefits. Anxiety can cause the heart to work harder and beat faster. 

Palliative Care 

The goal of palliative care is to help the patient with a serious illness feel better. It prevents or treats symptoms and side effects of disease and treatments. 

Palliative care can help treat symptoms such as pain, shortness of breath, trouble sleeping, and loss of appetite. Palliative care also treats emotional, social, practical, and spiritual problems that illness brings up. When the patient feels better in these areas, he or she has an improved quality of life. 

Palliative care can be given at the same time as treatments meant to cure or treat the disease. You may get palliative care when heart failure is diagnosed, throughout treatment, during follow-up, and at the end of life. 

Any provider can give palliative care, but some specialize in it. Palliative care may be given by a team of doctors, nurses, registered dietitians, social workers, psychologists, massage therapists, and chaplains. It may be offered by hospitals, home health agencies, or long-term care facilities. 

Both palliative care and hospice care provide comfort: 

  • Palliative care can begin at diagnosis and can be given at the same time as treatment.
  • Hospice care is usually offered when the patient is expected to live 6 more months or fewer

References

National Heart, Lung, and Blood Institute – www.nhlbi.nih.gov

American Heart Association – www.heart.org

Heart Failure Society of America (HFSA) – www.hfsa.org

United Network for Organ Sharing (UNOS) – unos.org

US government organ donor site – www.organdonor.gov