Heart Failure

What is heart failure?

Heart failure occurs when the heart cannot pump enough oxygen-rich blood to meet the body’s needs. It does not mean the heart has stopped, but reduced blood flow can impair organ function and cause serious health issues.

Heart failure may affect one or both sides of the heart:

• Right-sided heart failure: the heart is too weak to pump blood into the lungs.
• Left-sided heart failure: the heart cannot pump enough oxygen-rich blood to the body. This may occur when the heart muscle is either too weak or too stiff to fill properly. Left-sided heart failure is more common than right-sided.

Causes

Heart failure can develop suddenly from heart damage or more often gradually from long-term conditions. Contributing factors include:

• Arrhythmia (irregular heartbeat)
• Cardiomyopathy
• Congenital heart defects
• Coronary artery disease
• Endocarditis
• Heart attack
• Heart valve diseases
• High blood pressure
• Blood clot in the lung
• Diabetes
• Severe lung diseases such as COPD
• Obesity

Over time, left-sided failure can progress to right-sided failure.

Risk factors

Heart failure can affect anyone, though risk increases if you:

• Are age 65 or older
• Have a family history of heart failure or genetic changes affecting heart tissue
• Smoke, eat a high-fat/high-salt diet, live a sedentary lifestyle, or misuse alcohol or drugs
• Have conditions such as high blood pressure, diabetes, sleep apnea, lung disease, kidney disease, thyroid disease, anemia, or infections (e.g., HIV, COVID-19)
• Received cancer treatments such as chemotherapy or radiation
• Are African Americans, as risk tends to be higher and cases more severe at younger ages

Symptoms

Reduced blood flow and fluid buildup cause the main symptoms, which may include:

• Shortness of breath, especially during activity
• Fatigue or weakness even at rest
• Swelling in ankles, legs, or abdomen (edema)
• Rapid weight gain from fluid buildup
• Persistent cough
• Difficulty sleeping while lying flat
• Nausea or loss of appetite
• Neck vein swelling
• Frequent urination

Symptoms may start mild and worsen over time.

Complications

Heart failure can lead to:

• Congestive heart failure (fluid in or around lungs)
• Kidney or liver damage
• Malnutrition
• Irregular heartbeat or sudden cardiac arrest
• Pulmonary hypertension

Diagnosis

Providers may evaluate heart failure using:

• Medical and family history review
• Physical exam
• Heart and blood tests, such as BNP (brain natriuretic peptide)
• Referral to a cardiologist for specialized testing if needed

Treatment

While there is no cure, treatment helps reduce symptoms and improve survival. Care usually includes:

• Medicines to manage symptoms and fluid buildup
• Sodium restriction and limiting fluids
• Lifestyle changes: quit smoking, manage stress, and engage in safe physical activity
• Treating related conditions

In some cases, procedures or surgery may be recommended:

• Repairing heart defects or damage
• Devices such as an implantable defibrillator, pacemaker, or mechanical heart pump (VAD or total artificial heart)
• Heart transplant for severe, life-threatening cases

Prevention

You may lower your risk by:

• Managing conditions like high blood pressure and diabetes with your provider’s guidance
• Maintaining heart-healthy habits in diet, exercise, and lifestyle

NIH: National Heart, Lung, and Blood Institute (NHLBI)

Heart disease is the leading cause of death and disability in the U.S. Detecting heart problems early makes treatment more effective. Blood tests and heart health tests can identify heart disease or risk factors. The right test depends on your symptoms, risk factors, and medical history.

Cardiac Catheterization

A procedure where a thin tube (catheter) is inserted into a blood vessel in your arm, groin, or neck and guided to the heart. It can be used to:

• Perform coronary angiography with dye and X-rays to check for coronary artery disease (CAD).
• Take blood and heart muscle samples.
• Examine heart valves.
• Perform procedures like angioplasty or minor heart surgeries.

Cardiac CT Scan

A painless test that uses X-rays and computer imaging to create 3D pictures of the heart. It can detect:

• Coronary artery disease and calcium buildup
• Congenital heart defects
• Aortic problems
• Heart valve or function issues
• Pericardial diseases

A contrast dye is injected before the scan. You lie on a table that slides into a tunnel-like CT machine.

Cardiac MRI

Uses magnets, radio waves, and a computer to create detailed pictures of the heart. It helps diagnose and evaluate:

• Congenital heart defects
• Coronary artery disease
• Valve disease
• Pericarditis
• Cardiac tumors
• Heart attack damage

The MRI machine is tunnel-shaped and may involve a contrast dye injection.

Chest X-Ray

Provides images of the chest, including heart, lungs, and blood vessels. It can show:

• Signs of heart failure
• Lung problems
• Other causes of chest symptoms

Coronary Angiography

Uses dye and X-rays to check inside the coronary arteries for blockages. Often performed during cardiac catheterization, it shows how blood flows through the heart and vessels.

Echocardiography (Echo)

A painless ultrasound test that shows moving pictures of the heart. It evaluates:

• Heart size and shape
• Chamber and valve function

The most common type, transthoracic echo, uses gel and a transducer placed on the chest.

Electrocardiogram (EKG/ECG)

A painless test that records the heart’s electrical activity. It shows:

• Heart rate and rhythm
• Signs of a heart attack, arrhythmia, or heart failure

Electrodes are placed on the chest, arms, and legs to capture activity.

Stress Testing

Assesses how the heart functions under physical stress. It helps diagnose:

• Coronary artery disease
• Valve disease
• Heart failure

The test involves exercise (or medicine if unable to exercise) while monitoring EKG and blood pressure. Imaging, such as echocardiography or a nuclear scan with a radioactive tracer, may also be used.

NIH: National Heart, Lung, and Blood Institute (NHLBI)

What is AFib?

Atrial fibrillation (AFib or AF) is one of the most common types of arrhythmias (irregular heart rhythms). In AFib, the upper and lower chambers of the heart don’t work together as they should, causing the heartbeat to become irregular and often much faster than normal.

Because the lower chambers may not fill or pump properly, blood flow to the body is reduced, leading to symptoms like dizziness, fatigue, and heart palpitations. AFib can occur in short episodes or become permanent. It is important to treat AFib because it increases the risk of stroke and other heart conditions.

Causes

AFib usually develops due to changes in heart tissue or electrical signaling. Causes and risk factors include:

• High blood pressure
• Coronary artery disease
• Congenital heart defects
• Heart infections
• Aging
• Sometimes, the cause is unknown

Risk Factors

Anyone can develop AFib, but risks increase if you:

• Are age 65 or older
• Have a family history of AFib or heart disease
• Drink excessive alcohol, use drugs (cocaine, methamphetamines), or smoke
• Have health conditions such as:
  • High blood pressure
  • Diabetes
  • Heart failure
  • Heart valve disease
  • Obesity
  • Hyperthyroidism
  • Chronic kidney disease
  • COPD or other lung diseases
  • Sleep apnea
• Are of European ancestry
• Recently had surgery on the heart, lungs, or esophagus

Symptoms

Some people with AFib have no symptoms, while others may experience mild to severe signs that come and go or become persistent. Common symptoms include:

• Extreme fatigue (most common)
• Heart palpitations (fluttering, pounding, irregular heartbeat)
• Shortness of breath, especially when lying down or exercising
• Chest pain
• Dizziness or fainting
• Low blood pressure

Complications

If untreated, AFib can lead to serious problems such as:

• Stroke
• Heart failure
• Blood clots
• Sudden cardiac arrest
• Cognitive decline or dementia

Diagnosis

Your provider may use:

• Medical and family history review
• Physical exam and blood tests
• Heart tests such as:
  • Electrocardiogram (EKG/ECG)
  • Echocardiogram
  • Wearable heart monitor

Treatment

Treatment depends on your health and the severity of AFib. Options include:

Medicines:

• Blood thinners (to prevent clots)
• Rhythm- and rate-control medicines

Lifestyle changes:

• Heart-healthy eating plan (e.g., DASH diet)
• Limit or avoid alcohol
• Maintain a healthy weight
• Regular physical activity
• Manage stress
• Quit smoking

Procedures:

• Electrical cardioversion – low-energy shocks to restore rhythm
• Catheter ablation – scarred heart tissue to block abnormal signals

Surgeries:

• Pacemaker insertion
• Maze procedure (scar tissue pattern to guide signals)
• Left atrial appendage closure (for those who cannot take blood thinners)

Prevention

You may lower your risk of AFib by:

• Following a heart-healthy diet
• Avoiding alcohol, smoking, and illegal drugs
• Managing stress and maintaining a healthy weight
• Staying physically active
• Treating related health conditions
• Taking preventive medicines if recommended before heart surgery

NIH: National Heart, Lung, and Blood Institute (NHLBI)

Overview

Coronary artery disease (CAD) is the most common type of heart disease and the leading cause of death in both men and women in the U.S.

CAD develops when cholesterol and other material (plaque) build up inside the coronary arteries. This process, called atherosclerosis, narrows and hardens the arteries, reducing blood and oxygen flow to the heart muscle.

Complications

• Chest pain (angina)
• Heart attack (most occur when a clot blocks blood flow to the heart, causing permanent damage)
• Heart failure (weakened pumping ability)
• Arrhythmias (irregular heart rhythms)

What is Endocarditis?

Endocarditis (infective endocarditis) is a rare but serious inflammation of the inner lining of the heart and valves. It happens when germs (bacteria or fungi) enter the bloodstream and attach to the heart’s lining or valves, causing infection.

If untreated, endocarditis can damage the heart and lead to severe complications.

Causes

• Bacterial infections (most common) – germs may enter the bloodstream through cuts, dental work, or surgery.
• Fungal infections – usually in people with weakened immune systems (e.g., HIV).

Risk Factors

Higher risk if you:

• Have heart valve disease, congenital heart defects, or implanted devices (pacemaker, valve replacement, defibrillator)
• Are older, with valve changes such as calcium deposits or mitral valve prolapse
• Use intravenous (IV) drugs with unclean needles
• Have a weakened immune system
• Have poor dental health
• Use long-term central venous lines
• Had endocarditis before

Symptoms

May start suddenly or gradually and vary in severity. Possible symptoms:

• Fever, chills, night sweats
• Chest pain, cough, shortness of breath
• Muscle, joint, or back pain
• New or worsening heart murmur
• Skin changes (broken blood vessels, red/purple bumps, flat red spots on hands or feet)

Complications

• Clumps of germs and blood cells may travel, blocking blood flow or damaging organs (brain, lungs, kidneys, spleen)
• Sepsis (life-threatening immune response)
• Heart failure, heart valve damage, arrhythmias

Diagnosis

• Medical history and physical exam
• Blood tests for infection
• Chest x-rays
• Heart tests (e.g., echocardiogram, EKG)

Treatment

• Medicines:
  • IV antibiotics for bacterial infections
  • Antifungal drugs (sometimes lifelong to prevent recurrence)
• Surgery: to repair or replace damaged valves, or remove infected tissue
• Dental care: regular cleanings to reduce oral bacteria

Prevention

• Daily dental care and dentist visits every 6 months
• A healthy lifestyle to reduce heart disease risk
• Immediate medical attention if symptoms appear
• Antibiotics before certain dental/medical procedures for those at highest risk (ask your provider)

NIH: National Heart, Lung, and Blood Institute (NHLBI)