What is Heart Failure?

Heart failure is a condition in which the heart isn’t pumping as well as it should. While the term “heart failure” (also known as congestive heart failure) may sound like the heart has stopped working, that isn’t actually the case. Still, heart failure is a serious condition that is often the end stage or final outcome of many cardiovascular conditions. The American Heart Association (AHA) reports that the number of adults living with heart failure in the United States increased from 5.7 million people from 2009 to 2012 to approximately 6.5 million in 2011 to 2014. The AHA estimates that by 2030, more than 8 million Americans will have heart failure. While there’s no cure for heart failure, medication and healthy lifestyle changes can help manage the condition and allow people to maintain a good quality of life.

When the Heart Doesn’t Pump Effectively

Congestive heart failure occurs when there’s a reduction in blood flow to the body and a backup (congestion) of fluid into the lungs, liver, abdomen, and lower extremities. But not all heart failure is congestive: A person might have shortness of breath or weakness due to heart failure and not have any fluid buildup. During heart failure, the body tries to compensate for reduced blood flow in other ways by: 

  • Enlarging the Heart Chamber Doing so, it can stretch more and contract more strongly in order to pump more blood. An enlarged heart can cause your body to retain fluid, your lungs to become congested with fluid, and your heart to beat irregularly.
  • Developing More Muscle Mass This happens because the contracting cells of the heart get bigger. This initially lets the heart pump more strongly.
    Pumping Faster This is to increase your heart’s output.
  • Diverting Blood This means taking blood away from other tissues and organs such as the kidneys, the heart, and brain.
    These compensations may mask heart failure temporarily, but eventually heart failure gets worse, and people start to experience fatigue, breathing problems, and other symptoms. This may explain why it takes some people years to realize that they have heart failure.

Which Chambers of the Heart Are Affected?

The heart’s left side, right side, or both sides can be affected by heart failure. But the left side is usually affected first. Left-Sided Heart Failure The left ventricle is larger than the other chambers and essential for normal function because it provides most of the heart’s pumping power. In left-sided (also called left ventricular) heart failure, the left side of the heart must work harder to pump the same amount of blood. There are two types of left-sided heart failure:

  • Systolic Failure Also called heart failure with reduced ejection fraction (HFrEF), this occurs when the left ventricle’s ability to contract declines. The heart can’t pump with enough force to maintain adequate circulation for a given demand.
  • Diastolic Failure Also called diastolic dysfunction, heart failure with preserved ejection fraction, or HFpEF, diastolic failure occurs when the left ventricle becomes so stiff the heart can’t properly fill with blood during the resting period between each beat.
  • Right-Sided Heart Failure Right-sided (also called right ventricular) heart failure usually occurs because of left-sided failure.

When the left ventricle fails, increased fluid pressure is transferred back through the lungs, causing increased stress and ultimately damage to the heart’s right side. When the right side loses pumping power, blood backs up in the body’s veins, causing swelling or congestion in the legs, ankles, gastrointestinal tract, and liver. 

What Causes the Condition?

The following conditions can cause heart failure, yet many people aren’t aware that they have them: 

  • Coronary artery disease is the most common cause of heart failure. Coronary artery disease causes narrowing of the arteries that supply blood to the heart muscle.
  • Previous heart attack can leave scar tissue that interferes with the heart muscle’s ability to pump normally.
  • High blood pressure (also called hypertension) makes your heart work harder than it should to circulate blood throughout your body.
  • Abnormal heart valves that can result from disease or infections force your heart to work harder to keep blood flowing as it should. Over time this extra work weakens the heart.
  • Congenital heart disease or defects that you’re born with can cause healthy parts of your heart to work harder to pump blood through your heart. This extra strain can lead to heart failure.
  • Heart muscle damage (such as cardiomyopathy) brought on by many causes, including diseases, infections, alcohol abuse, and drugs use, can lead to heart failure.
  • Irregular heartbeats (called heart arrhythmias) may cause your heart to beat too fast, which can weaken the heart and prevent it from getting enough blood to the body.
  • Chronic lung disease, such as chronic obstructive pulmonary disease (COPD) or emphysema can cause heart failure.
  • Blood clot in the lungs (called pulmonary embolism) may cause right heart failure.
  • Diabetes complications can contribute to heart failure because the condition tends to lead to hypertension and atherosclerosis, both of which have been linked to the disease.
  • Anemia and excessive blood loss can lead to heart failure.

Obesity can cause a cardiomyopathy, which is disease of the heart muscle. Being obese can also cause the heart to work much harder than it would for non-obese people. Long-term use of certain drugs and supplements may worsen heart failure or interfere with heart failure medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil or Motrin) and naproxen (Aleve) can elevate blood pressure and increase salt and fluid retention, putting you at risk of heart failure. Supplements like licorice and ginseng can raise your risk of high blood pressure and increase fluid retention, causing your heart to work harder.