Frequently Asked Questions The most commonly asked questions about heart failure are listed below. If you have a question that you would like added to this list, send it to lblank@humed.com New questions are added periodically based on reader requests. Click on the number of a question to read the answer. 1. What is heart failure? 2. Does a diagnosis of heart failure mean that my heart is failing? 3. What is the difference between a heart attack and heart failure? 4. What are the signs and symptoms of heart failure? 5. How is heart failure diagnosed? 6. What are the causes of heart failure? 7. What is the treatment for heart failure? 8. Why did my physician prescribe high blood pressure pills even though I do not have hypertension? 9. Is there a cure for heart failure? 10. Why must I limit my salt and fluid intake if I have heart failure? 11. Is there any research being done for heart failure? 1. What is heart failure? Heart failure is a progressive disorder that occurs as a result of damage to the heart muscle. The heart then weakens and attempts to compensate by beating more rapidly (to increase circulation), thickening (to increase the force of contractions), and enlarging (to allow more blood into the heart). These compensatory mechanisms mask the symptoms of heart failure, but do not prevent worsening of the underlying disease. How does the weak heart affect blood circulation? When the heart is weak, its pumping power is diminished and blood circulation is decreased. The body does not get the full supply of oxygen that it needs to thrive. When this happens, your heart must work even harder to keep up with the demands of the body, and, as a result, many heart failure patients experience extreme fatigue and exhaustion. (See Symptoms of Heart Failure. ) Why is good blood circulation important? Blood is rich with oxygen and nutrients that keep our cells alive and functioning, so a strong circulation of blood throughout the body is vital to staying alive. When the heart is strong and healthy, it continuously pumps blood to nourish and energize the body. How does the heart control blood circulation? The heart is a muscular pump that serves as the master control station for blood circulation. The heart is divided into 4 chambers. The upper chambers are called the right and left atrium, and the lower chambers are called the right and left ventricle. Blood from all parts of the body drains into the right atrium, passes through a valve and reaches the right ventricle. The right ventricle contracts with each heartbeat and blood is pushed into the lungs, where it gives off carbon dioxide, takes up oxygen and returns via the pulmonary veins to the left atrium. During relaxation of the left ventricle, the blood passes from the left atrium to the left ventricle where, with each heartbeat, it is ejected through the aortic valve into the aorta. From the aorta, blood flows through the circulatory system to nourish the organs and tissues of the body. How does the healthy heart circulate blood? Normally, this powerful muscle pumps 5 to 6 quarts of blood per minute during rest and more than 20 quarts per minute during exercise, such as walking or climbing stairs. When healthy, the heart automatically adjusts to the changing demands of exercise by pumping faster and more forcefully, which brings more nourishment and energy to the muscles and organs. Return to Top 2. Does a diagnosis of heart failure mean that my heart is failing? A diagnosis of heart failure does not mean that your heart is going to stop working or that you are about to die. Rather, heart failure is a common, chronic condition that occurs when your heart has become weakened due to injury to the heart muscle (see Causes of Heart Failure ). If you have this condition, your heart pumps too little blood to meet your body’s needs. Most people with heart failure can lead normal, active lifestyles. (See Learning to Live with Heart Failure. ) 3. What is the difference between a heart attack and heart failure? A heart attack is a critical medical situation that occurs when the blood supply to the heart is blocked and there is death of heart muscle. Although the heart’s pumping power is diminished and its blood circulation is decreased if you have heart failure, the blood supply to the heart is not blocked. Return to Top 4. What are the signs and symptoms of heart failure? When the heart pumps with less power and force than normal and cannot pump enough blood to organs and muscles, the symptoms of heart failure occur. Blood and fluids may collect or pool in the lungs, which can cause breathing problems when you lie down. Fluids can also collect in other parts of the body, swelling the feet, ankles, legs or abdomen. Most common symptoms include: Breathing Difficulties (shortness of breath from simple activities, trouble breathing when resting or lying down, waking up breathless at night, needing more than 2 pillows to sleep) Tiredness/Exercise Intolerance (getting tired easily, general feeling of exhaustion and weakness) Fluid Retention (swollen feet, ankles, and legs; nausea; abdominal swelling, pain and tenderness; weight gain from fluid build-up) Coughing (frequent coughing, coughing that produces mucus, dry cough when lying flat in bed) Dizziness or Fainting Loss of Appetite Return to Top 5. How is heart failure diagnosed? Early and accurate diagnosis is very important because heart failure that is left untreated can cause irreversible progression of the disease. Once accurately diagnosed, doctors have effective treatment options that help heart failure patients prevent or halt progression of their disease, improve their quality of life and reduce hospitalizations. A delay in diagnosis often occurs when heart failure symptoms, such as feeling tired and short of breath, are mistaken as normal signs of aging. Sometimes, the early signs of heart failure are even misdiagnosed by experienced healthcare professionals because the body’s natural defense mechanisms mask the symptoms. Heart failure symptoms are masked when the heart:   attempts to compensate by beating more rapidly (to increase circulation)   thickens (to increase the force of contraction)   enlarges (to allow more blood into the heart). These compensatory mechanisms do not prevent worsening of the underlying disease and are very detrimental to the patient’s heart. Advanced Diagnostic Capabilities: BNP Blood Testing Hemodynamic Monitoring BNP Blood Testing The medical center's heart failure program is on the forefront of diagnostic technology with the availability of a blood test for BNP (B-type natriuretic peptide) — the first blood test that provides an early and accurate diagnosis of the disease. BNP is a cardiac hormone that is produced by the heart ventricles in response to volume and pressure overload. (Click Causes of Heart Failure and Types of Heart Failure for descriptions of fluid backup and how it can cause pressure in the heart.) Benefits of BNP blood testing include:   Provides a definitive diagnosis for patients with dyspnea (difficulty breathing or breathlessness) and edema (swelling), symptoms that have a broad range of differential diagnoses (indications of other diseases)   Determines the severity of heart failure, which makes it extremely useful in the ongoing management of the disease. BNP concentrations increase with the severity of the disease.   Rapid point of care testing enables results in 15 minutes. Hemodynamic Monitoring Hemodynamic monitoring, which is the study of the movement of blood circulation, is considered to be one of the most advanced technologies to diagnose and monitor heart failure. The Heart Failure Program has a Thoracic Electrical Bioimpedance (TEB) monitor, which works by applying sensors to the neck and chest to transmit and measure the resistance to a small painless electrical signal. Capabilities and benefits of this type of monitoring include:   measurement of blood circulation   measurement of the amount of blood pumped from your heart   evaluation of fluid levels   earlier, more accurate diagnosis   earlier intervention, and   optimal treatment. Your physician also may order an echocardiogram, blood work, or some other tests, depending on his or her diagnostic plan for your individual case. Return to Top 6. What are the causes of heart failure? Although heart failure may strike at any age, it is more common in people over the age of 65. The risk of developing heart failure increases with age and with several other factors. The most common causes and risk factors of heart failure are:   high blood pressure   coronary artery disease   heart attack   heart muscle disorders, such as cardiomyopathy   damage to the heart valves or history of a heart murmur   enlargement of the heart, and   diabetes. Sometimes, the exact cause of heart failure cannot be found. However, the actual cause is not as important as diagnosing your heart’s reduced pumping power and learning how to manage your disease. 7. What is the treatment for heart failure? An appropriate treatment plan includes medication, diet and exercise. The goal of treatment is to improve symptoms, prevent progression of the disease and improve quality of life and longevity. (See Learning to Live with Heart Failure. ) Return to Top 8. Why did my physician prescribe high blood pressure pills even though I do not have hypertension? The cornerstone treatment for heart failure generally includes prescribed medications to help the heart pump as efficiently as possible. Some of the more common medications used to treat heart failure include:   ACE Inhibitors or AR Blockers Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin-receptor blockers (ARB) work by relaxing your blood vessels and lowering blood pressure, making your heart’s workload easier over time. These drugs inhibit or block the body’s reaction to angiotensin, which is a hormone that tightens the arteries. They have become the mainstay treatment for congestive heart failure, and they are usually the first lines of defense for those just diagnosed with this condition.   Diuretics Diuretics, often called water pills, allow your heart to pump more efficiently by limiting the amount of fluid you retain and decreasing the fluid in your lungs so that you can breathe easier. This medication makes you urinate more frequently, and, as a result, your body loses potassium and magnesium. Your doctor may prescribe supplements of these minerals and monitor this side effect by ordering regular blood tests to check your levels of potassium and magnesium.   Spironolactone (Aldactone®) Spironolactone (Aldactone®) is a type of diuretic that limits the amount of potassium that is lost during frequent urination and blocks aldosterone, a hormone that is often too high in heart failure patients.   Digoxin Also referred to as digitalis, this drug increases the strength of your heart muscle contractions so more blood is pumped with each beat. It also tends to slow the heart rate and helps the kidneys work better.   Beta-blockers Beta-blockers slow your heart rate and reduce blood pressure by blocking many of the effects of the hormone adrenaline. These medicines also reduce the risk of some abnormal heart rhythms. Return to Top 9. Is there a cure for heart failure? There is no cure for heart failure. However, with good medical treatments and follow-up care, most people can lead normal lives and maintain active lifestyles. 10. Why must I limit my salt and fluid intake if I have heart failure? Limiting your intake of salt is very important because sodium attracts water and makes the body hold fluid. Limitation of fluids is important because your body already holds too much fluid, which leads to swelling. To pump the extra fluid from your body, the heart must work harder. 11. Is there any research being done for heart failure? The medical center's heart failure program is actively involved with the Division of Cardiac Services’ Clinical Cardiovascular Research efforts. Clinical trials with FDA-approved medications and/or devices for heart failure are currently being conducted and participants are being recruited for these studies. For more information about participating in a clinical research study, see Clinical Cardiovascular Research. Return to Top