Published on August 23, 2021
Read Time: Eight Minutes
What is heart failure?
“Heart failure is a condition in which the heart does not pump blood to the rest of the body and [does not pump] the way that it should,” Dr. Shaukat says. “The term is a little bit misleading because the heart does not actually stop beating or it does not completely fail, but it is just not quite doing the job that it's supposed to do in a normal fashion.”
What are the different forms of heart failure?
Systolic heart failure, or heart failure with reduced ejection fraction, occurs when the heart, or heart muscle, gets weak and does not squeeze as strongly as it should.
Diastolic heart failure, or heart failure with preserved ejection fraction, occurs when the heart can squeeze normally but does not relax as well as it should. “If [the heart] doesn't relax well, it can cause congestion and fluid backing up into the lungs,” he says.
About 65% of heart failure cases are those with reduced ejection fraction, and about 35% are those with preserved ejection fraction, according to Dr. Shaukat.
What happens to the heart during heart failure?
“The heart gets affected either by its ability to squeeze or pump [blood] forward [or] its ability to relax,” Dr. Shaukat says. Most of the time, the structure of the heart changes. The heart can become thick and stiff, or thin and more stretched out.
How common is heart failure?
An estimated six million to seven million people in the US currently have heart failure by the clinical definition, according to Dr. Shaukat.
The chances of getting heart failure increases with age. “If you compare a 40-year-old person to a 70-year-old person, there's a much higher prevalence in someone who is 70 years old or older,” he says. “Overall, [about] one in five people will develop [heart failure] during [their] lifetime.”
Heart failure is one of the most common reasons for hospital readmissions, Dr. Shaukat says. “In fact, 20% of all…hospital admissions for someone who is over 65 years of age happens because of heart failure, so the magnitude of the problem is very large. It's only increasing with time, which is why I think the most important thing to do is to try and prevent it from happening. Or if it's starting to happen, [make sure] that it's treated early, so that you can get better control of the disease.”
Who does heart failure affect?
Heart failure affects both men and women. “In the older population, we actually see women getting a little bit more affected, especially with heart failure with preserved ejection fraction where the heart is stiff,” Dr. Shaukat says.
What are common symptoms of heart failure?
Common symptoms of heart failure include shortness of breath or trouble breathing. “You [may] start to wake up at night because you're out of breath, [and] you may feel like you need to prop yourself up [with a pillow],” Dr. Shaukat says.
Other symptoms people experience with heart failure may include swelling of the legs, fatigue or a reduced ability to walk. “[Heart failure patients may] feel like they're getting tired or worn out faster,” Dr. Shaukat says.
Other symptoms may include increased pressure or heaviness in the chest, palpitations (fluttering of the heart) or weight gain. “Sometimes people will start to notice that their abdomen or their belly area is getting more swollen,” he says.
What are the stages of heart failure?
People with Stage A or B heart failure generally have risk factors or a predisposition to develop heart failure. Some people in these stages “have developed some…structural abnormality in the heart but have not yet started having symptoms of heart failure,” he says.
“[People in Stage C of] heart failure will start to have symptoms, which is usually the stage that we [cardiologists] often see people come into us,” he says. People with advanced heart failure fall into Stage D, where more advanced treatment options, like a heart pump, heart transplant and other care is needed.
What are the risk factors for heart failure?
Blockages in the arteries or the heart as well as high blood pressure, high cholesterol, diabetes, smoking and sleep apnea can increase a person’s risk for heart failure. A person’s weight and how much alcohol they drink can be risk factors, too.
How is heart failure diagnosed?
A healthcare provider, such as a primary care physician or provider, will make a diagnosis based on the patient’s medical history and a physical exam.
What tests help diagnose heart failure?
Chest X-rays are one test used to see if the person has any fluid buildup in their chest. Blood tests also can help support a diagnosis of heart failure.
An echocardiogram -- an ultrasound of the heart -- can provide information about the heart’s structure and function as well as how the valves are working. Through cardiac catheterization, cardiologists also may check heart patients for any blockages of the heart or arteries.
What are the possible outcomes for patients with heart failure?
Patients who have issues with the squeezing function of their heart will likely be put on medication to help strengthen the heart muscle. Once people start these medicines, they should not be stopped because the heart function can get worse again, Dr. Shaukat says. These medicines also can help reduce fluid buildup, so people don’t become congested or short of breath.
“People can feel much better once they're on medical therapy. Usually, that's one of the primary goals -- to help people feel better,” he says. “A lot of people, especially if they get treated at an earlier stage, can expect a pretty good outcome. A lot of people can live for a long time.”
In some cases, the heart function remains the same. In a small number of cases, the heart function can worsen. In these cases, “we need to end up discussing some more advanced options [for treatment and care],” Dr. Shaukat says.
What are some common heart medications that might be prescribed to a patient with heart failure?
Beta blockers, which help slow the heartbeat, can help restructure and strengthen the heart. Beta blockers are mainly used for people who have a weak squeezing function of the heart.
People with heart failure may be prescribed an ACE inhibitor or an ARB inhibitor, which can help relax blood vessels and lower blood pressure. Dr. Shaukat also noted that a class of medications that previously were generally used for diabetes have been approved for heart failure.
In addition, heart failure patients may be given water pills to control fluid levels and prevent fluid buildup.
“For people who have a preserved ejection fraction, which means that it's more of a [heart] relaxation issue, the main thing is to try and [reduce the fluid] and prevent congestion,” he says. However, he noted no medicine so far has shown to improve long-term survival in patients with preserved ejection fraction.
For patients with reduced ejection fraction (squeezing function issue), medicines such as beta blockers, ACE inhibitors, ARB inhibitors and others have been shown to significantly improve a person’s chances of living longer and having an overall better quality of life as well as less chances of being hospitalized.
Can heart failure be treated with alternative medicines?
“Outside of approved medications, there is really not much in terms of alternative medicines or those sorts of things that have been rigorously studied, so I generally do not recommend those,” he says. “There's not extensive research that goes into [alternative medicines]. We don't know about their potential side effects and how it could actually impact their heart health.”
Can people live with heart failure?
“[Heart failure] is a long-term, chronic problem, similar to high blood pressure or diabetes. You can live with it, but I think that you definitely need to see a specialist and have it treated appropriately,” Dr. Shaukat says. “Otherwise, [it can] continue to get worse and cause problems, including ending up in the hospital.”
Dr. Shaukat advises people with heart failure to have regular follow-ups with their doctors and continue taking their medicines.
When should somebody call their doctor for their heart?
Dr. Shaukat recommends people to call their doctor if they experience the following concerning symptoms:
- Chest pain, pressure or heaviness
- Shortness of breath
- Palpitations (fluttering of the heart) or heart racing
- Sudden dizziness or passing out
- Swelling of the legs
What lifestyle changes do you recommend for people with heart failure?
Dr. Shaukat suggests the following lifestyle changes for individuals with heart failure:
- Stay as active as possible.
- Eat a heart healthy diet (more vegetables, fruits and greens; less processed foods, meats and fried foods).
- Keep your high blood pressure and diabetes under control, if you have those conditions.
- Use salt in moderation on foods.
- Alcohol intake should be kept to a minimum. “There are more studies now that tell us that even any amount of alcohol intake can be detrimental to the heart,” he says.
- Do not smoke. If you currently smoke, quit.
What affect has COVID-19 had on people’s overall heart health?
“Overall, I can say that COVID-19, in general, has led to more heart issues. We have seen a direct effect of the viral infection on the heart and [the virus] actually causing heart failure,” Dr. Shaukat says.
Viral infections can cause heart failure and the heart to weaken. “We call [this] viral myocarditis,” he says.