Heart failure is a condition in which the heart muscle weakens, and it does not pump as strongly as it should. Many times the heart’s lower chambers (the ventricles) also do not contract or pump at the same time (called dyssynchrony). For these reasons, blood does not circulate as well as it should.
Despite its misleading name, “heart failure” does not mean that your heart suddenly stops working. Instead, heart failure develops slowly as your heart muscle gradually weakens. The term “failure” refers to your heart’s inability to pump enough blood to meet your body’s needs.
As the heart muscle weakens other problems can result:
Doctors use two standard systems- classes and stages-when describing heart failure. To learn more, look under the “What are the symptoms?” headline.
To learn more about how your heart works- and the role of your heart’s electrical system-go to the Heart & Blood Vessel Basics section.
Other names for heart failure: congestive heart failure (CHF), heart dropsy.
The causes of heart failure vary from one person to another. One person can be born with a disease that causes heart failure. Another person can catch a disease or have a tremendous strain on the heart that causes it to fail. The causes have one thing in common-they somehow damage the heart muscle so that it no longer pumps as well as it should. Nearly any form of heart or blood vessel disease can lead to heart failure.
Here are some of the contributing factors:
An enlarged heart itself can have a number of causes:
In addition, all of the risk factors that you can control (such as eating habits, exercise, smoking) make a difference in how likely you are to have a heart condition, including heart failure. To learn more, go to the Risk Factors section.
Symptoms of heart failure get worse over time. The most common symptoms include:
Other symptoms can include heart palpitations (feeling that your heart is racing or that your heartbeat is irregular). Some people also have nausea and lack of appetite, dizziness, fainting spells, or difficulty concentrating.
Doctors use two standard systems when describing heart failure. Each system describes heart failure in a slightly different way.
Some doctors use “stages” to describe whether someone is at risk of-or has heart failure. This is a relatively new system for describing heart failure and is based on structural heart disease.
More often, doctors describe a person’s heart failure according to “class.”
To find out if you have heart failure, your doctor may suggest one or more of the tests listed below. The test results can also help your doctor choose the best treatment(s) for you.
In some cases you may be sent to specialists for diagnosis and testing- and sometimes for treatment. To learn more, go to the Your Treatment Team section.
A cardiac catheterization is a procedure in which a small, flexible tube called a catheter is inserted into a blood vessel. The catheter is usually put into a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your heart, or toward a blood vessel that might be blocked. A cardiac catheterization is the first step in a number of heart and blood vessel tests and procedures.
For instance, a cardiac catheterization is often the first step in an angiogram. In an angiogram, your doctor injects dye through the catheter into your arteries to find any blockages. With a catheterization, your doctor can also:
During a cardiac catheterization, your doctor may also treat any blocked blood vessels with one or more of these procedures to improve blood flow:
A computerized (or computed) tomography (CAT, or CT) scan is a special type of x-ray. Although a CAT scan is used to get images of many parts of the body, let’s use the example of the heart. A traditional x-ray shows two-dimensional images
of the heart-its length and width. But a CAT scan uses an x-ray machine that moves around your body and takes multiple images of the heart. As small amounts of x-rays pass through your body, different types of tissue absorb different amounts of the x-rays. This helps provide a more precise image compared to a traditional x-ray.
The CAT scan images are viewed together on a video monitor, offering a three dimensional view- length, width, and depth. Because it is a three-dimensional image, a CAT scan offers a much better picture of the entire heart than a traditional two-dimensional x-ray can.
A CAT scan is used to detect many health conditions-tumors, for example, or bone problems like osteoporosis. As it relates to heart and blood vessel disease, a CAT scan is often used to identify:
When you have a computed tomography (CAT) scan, you typically undress and put on a hospital gown or sheet. You lie on an exam table. As the test begins, the table slowly moves inside a doughnut-shaped machine.
Sometimes you receive a contrast dye-usually through an intravenous (IV) line that is put into your arm. The dye allows your heart or blood vessels to show up as images on a monitor. For instance, if the test is being done to look at your
blood vessels, the dye makes them visible-almost like roads on a map. You might notice some effects from the dye:
Warm flushing feeling, and maybe nausea, for a minute or so Metallic taste when the dye reaches the blood vessels in your mouth
The technician asks you to hold your body still during the scan. Sometimes pillows and/or straps help you stay in the same position. As the x-ray tube rotates around your body, the table slowly moves through the machine. You might be asked to hold your breath at certain times during the scan. Although the CAT scan is generally not a painful test, you may feel uncomfortable from having to lie in one position during the test-anywhere from 15 to 60 minutes.
An echocardiogram (also called an echo) is a three-dimensional, moving image of your heart. An echo uses Doppler ultrasound technology. It is similar to the ultrasound test done on pregnant women. The echo machine emits sound waves at a frequency that people can’t hear. The waves pass over the chest and through the heart. The waves reflect or “echo” off of the heart, showing:
When you have an echocardiogram, you undress from the waist up, put on a hospital gown, and lie on an exam table. The technician spreads gel on your chest and side to help transmit the sound waves. The technician then moves a pen-like instrument (called a transducer) around on your chest or side. The transducer records the echoes of the sound waves. At the same time, a moving picture of your heart is shown on a special monitor. You may be asked to lie on your back or your side during different parts of the test. You may also be asked to hold your breath briefly so that the technician can get a good image of your heart. An echo is a painless test. You feel only light pressure on your skin as the transducer moves back and forth.
An electrocardiogram (ECG or EKG) reveals how your heart’s electrical system is working. The ECG senses and records your heartbeats, or heart rhythms. The results are printed on a strip of paper. An ECG can also help your doctor
diagnose whether:
In all, there are three kinds of tests that record your heart’s electrical activity, each for a different period of time:
The peaks on an electrocardiogram (ECG) strip are called waves. Together, all the peaks and valleys give your doctor important information about how your heart is working:
• The P-wave shows your heart’s upper chambers (atria) contracting
• The QRS complex shows your heart’s lower chambers (ventricles) contracting
• The T-wave shows your heart’s ventricles relaxing
When you have an electrocardiogram (ECG) you undress from the waist up, put on a hospital gown, and lie on an exam table. As many as 12 small patches called electrodes are placed on your chest, neck, arms, and legs. The electrodes, which connect to wires on the ECG machine, sense the heart’s electrical signals. The machine then traces your heart’s rhythm on a strip of graph paper.
Magnetic resonance imaging (MRI) uses magnets, radio waves, and computer technology to create images of different parts of your body. MRI is especially useful in creating clear images of soft tissues. For instance, many people have an MRI to check their heart and/or blood vessels.
MRI is done in a large, tube-shaped machine. Coils inside the machine’s walls produce a strong magnetic field. Other coils inside the machine’s walls send and receive radio waves. In response to the radio waves, your body produces faint signals. As the machine senses the faint signals, a computer creates three dimensional images of the inside of your body.
The images can reveal:
Before your magnetic resonance imaging (MRI) you undress and put on a hospital gown or sheet. Before entering the MRI room, it’s important to remove any jewelry, hearing aids, or anything else with metal in it. The magnets in the MRI machine are very strong, and if you have metal on your body you could possibly be injured. Most people with a cardiac device-a pacemaker, implantable defibrillator, or heart failure device-should typically avoid an MRI.
All cardiac device patients should check with their doctor before scheduling an MRI.
Once in the MRI room, you lie on a moveable table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. For instance, the technician may put contrast dye into the IV.
Patches called electrodes are put on your chest. The electrodes connect to wires on an electrocardiogram (ECG). The electrodes and ECG monitor your heart’s activity during the procedure. Often a blood pressure cuff on your arm also regularly takes your blood pressure. The table you are lying on slides into the MRI scanner, but there are no moving parts inside the machine. You wear headphones or earplugs to muffle some of the noises from the machine, which makes thumping sounds. The technician might ask you to lie very still or hold your breath for parts of the test. However, you may feel muscles twitching in your fingers or toes.
A stress test is a type of electrocardiogram (ECG or EKG). Regular ECGs examine how your heart beats at rest. Stress tests examine your heart’s response to exercise, or stress. There are many variations of stress tests. But the purpose of most stress tests is to find out if your heart is getting enough blood and oxygen.
Stress tests are often done to reproduce symptoms like chest pain or shortness of breath. The test looks at:
The test can show:
In one of the simpler types of stress tests, you walk on a treadmill or pedal a stationary bike. You begin at an easy pace. The machine is slowly adjusted to make you work harder. You continue exercising until you feel symptoms or until you get too tired. A stress test is also known as an exercise test, a treadmill test, or an exercise ECG.
During a nuclear stress test, the technician or nurse inserts an intravenous (IV) line-usually in your arm. A small amount of a radioactive substance called thallium is injected through the IV into your bloodstream. Usually a nuclear stress test is done as part of a regular stress test, since the thallium can give your doctor more information about whether your heart gets enough blood and oxygen. But a nuclear stress test can be done even if you are unable to exercise, since another medication can also be given to make your heart work harder.
After the thallium is injected, you lie on a table underneath a special camera. The camera then takes images of your heart. Any part your heart that doesn’t receive enough blood and oxygen also receives less thallium. Therefore that part of your heart shows up as a lighter color on the image.
When you have a stress test you undress from the waist up and put on a hospital gown. As many as 12 small patches called electrodes are placed on your chest, neck, arms, and legs. The electrodes connect to wires on the electrocardiogram (ECG). The machine then records the electrical activity in your heart from each of the electrodes. A blood pressure cuff is also put on your arm, and your blood pressure is checked often. If you have a nuclear stress test, you will also have an IV inserted (usually into your arm).
A stress test itself does not usually cause any pain, although sometimes it reproduces painful symptoms. However the test gives you a workout, since you exercise until you’re very tired. Usually a nurse talks to you and gives you instructions throughout the test. The nurse continues to monitor your symptoms, your blood pressure, and your heart rate for about 10-15 minutes after you stop exercising.
As part of your treatment, your doctor might suggest ways that you can live a healthier lifestyle. For instance, it’s important that people with heart failure eat low-fat foods–and especially low-salt (low-sodium) foods. To learn more, go to the Risk Factors section.
Your doctor may recommend cardiac rehabilitation as part of your treatment. In cardiac rehabilitation, you work with a team of healthcare experts that helps you recover. To help you learn how to avoid future heart-related problems, the team:
Also, check with your doctor about pain relievers you may need for aches and pains. Heart failure patients should avoid one type of pain reliever-nonsteroidal anti-inflammatory medications. This includes medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve), among others. Ask your doctor or nurse which pain relievers you can take.
Other types of treatment depend on your test results. As part of your treatment, your doctor may ask you to report the following on a regular (sometimes daily) basis:
If your doctor asks you to track and report this information, it is very important to do so. For example, if you report changes in blood pressure and weight, sometimes your doctor can act quickly to change your treatment. That change just may help you avoid a hospital stay.
There is no cure for heart failure. But medications and procedures can help relieve your symptoms.
If you have a heart or blood vessel condition, you might want to know more about some of the medications you take. The information in this section describes some medications commonly prescribed for heart or blood vessel conditions. It also includes some tips to help you take your medications as ordered.
Make sure you tell your doctor-or any new doctor who prescribes medication for you-about all the medications and supplements you take. Your doctor can then help make sure you get the most benefit from your medications. Telling your doctor this information also helps avoid harmful interactions between medications.
You may also want to discuss these topics with your doctor or nurse each time you get a new medication:
In some cases, your heart needs several months to adjust to new medications. So you may not notice any improvement right away. It also may take time for your doctor to determine the correct dosage.
Blood tests are sometimes necessary for people who take heart medications. The blood tests help your doctor determine the correct dosage- and therefore help avoid harmful side effects.
Never stop taking your medication or change the dosage on your own because you don’t believe you need it anymore, don’t think it’s working properly, or feel fine without it.
Be sure to talk to your doctor or nurse if you have:
And don’t hesitate to ask your pharmacist if you have questions about how and when to take your medications.
“ACE” is short for “angiotensin-converting enzyme.” ACE inhibitors are medications that help prevent your body from producing too much of a natural chemical called angiotensin II.
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To treat high blood pressure
To treat heart failure and related conditions, such as low ejection fraction (EF) To reduce damage after a heart attack and to help prevent further heart attacks
ACE inhibitors block an enzyme that is needed to produce angiotensin II. The body uses angiotensin II to maintain proper blood pressure and fluid balance. But angiotensin II can have harmful long-term effects on your heart and blood vessels. It can cause blood vessels to narrow and can also raise blood pressure.
Taking ACE inhibitors can:
Angiotensin receptor blockers (ARBs) are medications that help block the effects of a natural chemical-called angiotensin II-that your body produces. For that reason ARBs are also called angiotensin II inhibitors. ARBs and ACE inhibitors have similar effects on your body. In fact, doctors often prescribe ARBs for people who cannot take ACE inhibitors.
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To treat high blood pressure
To treat heart failure and related conditions
Angiotensin II is a chemical that causes the blood vessels to narrow (constrict). ARBs block the effect of this chemical. (ACE inhibitors, on the other hand, prevent your body from producing this chemical.) In this way, ARBs can allow blood vessels to remain wider (dilated), lowering blood pressure.
Taking ARBs can:
Beta blockers get their name because they “block” the effects of substances like adrenaline on your body’s “beta receptors.”
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To treat high blood pressure
To slow fast arrhythmias (abnormal heartbeats, or heart rhythms)
To prevent angina (chest pain due to blocked blood flow to parts of the heart) To prevent long-term damage after a heart attack
To treat heart failure and related conditions, such as low ejection fraction (EF)
These medications block activity of your sympathetic nervous system. The sympathetic nervous system reacts when you are stressed or when you have certain health conditions. When your system responds, your heart beats faster and with more force. Your blood pressure also goes up.
Beta blockers block signals from the sympathetic nervous system. This slows your heart rate and keeps your blood vessels from narrowing. These two actions can result in:
Diuretics remove excess water from your body.
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To lower blood pressure
To reduce edema (swelling caused by excess fluid in your body-often in the legs and feet) associated with conditions such as heart failure
Some diuretics work by causing the kidneys to release more sodium (salt) into urine. Sodium helps draw water out of the blood. With less fluid in your blood, your blood pressure decreases.
Diuretics also relieve symptoms like shortness of breath. That’s because excess fluid in your lungs can cause these symptoms.
The word “inotrope” refers to the strength of the heart muscle’s pumping action, or contractions.
Some generic (and Brand) names
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
digoxin (Digitek, Lanoxicaps, Lanoxin)
To improve symptoms of heart failure and related conditions, such as low ejection fraction (EF)
To slow the heart rate in response to atrial fibrillation (fast rhythm in the heart’s upper chambers)
The term “inotrope” usually describes the strength and force of the heartbeat. Taking lnotropic medications can:
Make the heart beat more strongly and efficiently Help slow and control the heart rate
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To lower cholesterol levels
To reduce the risk of conditions related to high cholesterol:
Statin medications affect three types of fats in the blood. They work by:
One purpose of vasodilators is to lower blood pressure. To understand how vasodilators work, imagine the same amount of water moving through a 1-inch diameter hose versus a 2-inch diameter hose. The bigger the hose, the less pressure on the walls of the hose.
Medications such as vasodilators can help relax and dilate blood vessels that have become narrowed (constricted).
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
You may have heard of other types of vasodilators. Beta blockers, which are a common heart and blood vessel medication, are one type of vasodilator. Another type is calcium channel blockers.
To treat high blood pressure
To treat/prevent angina (chest pain related to the heart) which can result from atherosclerosis (blocked blood vessels) and coronary artery disease (CAD)
Vasodilators help relax and dilate the blood vessels, so blood moves through them more easily. This helps to:
An implantable cardioverter defibrillator (ICD) is a small device that treats abnormal heart rhythms called arrhythmias. Specifically, an ICD treats fast arrhythmias in the heart’s lower chambers (ventricles). Two such arrhythmias are ventricular tachycardia (VT) and ventricular fibrillation (VF).
Arrhythmias result from a problem in your heart’s electrical system. Electrical signals follow a certain path through the heart. It is the movement of these signals that causes your heart to contract. To learn more about your heart’s electrical system, go to the Heart & Blood Vessel Basics section.
During VT or VF, however, far too many signals are present in the ventricles. In addition, the signals often do not travel down the proper pathways. The heart tries to beat in response to the signals, but it cannot pump enough blood out to your body. If you have either VT or VF, you are at high risk of sudden cardiac arrest (SCA). If not treated immediately with defibrillation, SCA can result in sudden cardiac death (SCD).
An ICD can treat VT and VF and restore your heart to a normal rhythm. So it reduces your risk of SCD. The device can deliver several types of treatment:
A device implant is a procedure that uses local numbing. General anesthesia is usually not needed.
An implanted device needs to be checked regularly to review information that is stored in the device and to monitor settings. These checks can happen in the clinic or from the comfort of the patient’s home using remote monitoring.
Remote monitoring uses a small piece of equipment that can sit on a bedside table to collect data from the cardiac device. Data is collected on a daily or weekly basis depending upon how the system is programmed and the type of device implanted. It sends information through a regular landline phone to a secure website that only the patient’s healthcare support team can access. In many cases, remote monitoring means that the patient needs to make fewer trips to the doctor’s office for device follow-up visits. Not all devices can be checked using remote monitoring.
An Implantable cardioverter defibrillator (ICD) system has two parts.
Device-the device is quite small and easily fits in the palm of your hand. It contains small computerized parts that run on a battery.
Leads-the leads are thin, insulated wires that connect the device to your heart. The leads carry electrical signals back and forth between your heart and your device.
Your doctor inserts the leads through a small incision, usually near your collarbone. Your doctor gently steers the leads through your blood vessels and into your heart. Your doctor can see where the leads are going by watching a video screen with real-time, moving x-rays called fluoroscopy.
The doctor connects the leads to the device and tests to make sure both work together to deliver treatment. Your doctor then places the device just under your skin near your collarbone and stitches the incision closed.
Usually you are told not to eat or drink anything for a number of hours before the procedure. You undress and put on a hospital gown or sheet. Your procedure will be performed in a “cath lab.” You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious.
The doctor makes a small incision near your collarbone to insert the leads. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the leads are inserted. You may be sedated when the device is tested, since it delivers a shock to your heart.
You may be in the hospital overnight, and there may be tenderness at the incision site. Afterwards most people have a fairly quick recovery.
A heart failure device, also called a CRT device, treats certain types of heart failure. When the heart’s lower chambers (ventricles) pump or contract in an uncoordinated way, it is called dyssynchrony. The CRT device treats dyssynchrony. CRT stands for cardiac resynchronization therapy. It gets its name because the device helps “resynchronize,” or re-coordinate, the pumping of the ventricles.
A device implant is a procedure that uses local numbing. General anesthesia usually is not needed.
There are two types of CRT devices:
In the CRT-D device, the ICD can treat dangerously fast abnormal heart rhythms (arrhythmias). Fast arrhythmias, like ventricular tachycardia (VT) or ventricular fibrillation (VF), put people at risk of sudden cardiac arrest (SCA). If not treated immediately with defibrillation, SCA can result in sudden cardiac death (SCD).
And in people with heart failure, SCD occurs at 6-9 times the rate of the general population.
Many people benefit from a CRT device because it helps relieve symptoms of heart failure. However, the device is not effective for everyone with heart failure.
An implanted device needs to be checked regularly to review information that is stored in the device and to monitor settings. These checks can happen in the clinic or from the comfort of the patient’s home using remote monitoring.
Remote monitoring uses a small piece of equipment that can sit on a bedside table to collect data from the cardiac device. Data is collected on a daily or weekly basis depending upon how the system is programmed and the type of device implanted. It sends information through a a standard analog phone line to a secure website that only the patient’s healthcare support team can access. In many cases, remote monitoring means that the patient needs to make fewer trips to the doctor’s office for device follow-up visits. Not all devices can be checked using remote monitoring.
A CRT-P or CRT-D system has two parts.
Device-the device is quite small and easily fits in the palm of your hand. It contains small computerized parts that run on a battery.
Leads-the leads are thin, insulated wires that connect the device to your heart. The leads carry electrical signals back and forth between your heart and your device.
Your doctor inserts the leads through a small incision, usually near your collarbone. Your doctor gently steers the leads through your blood vessels and into your heart. Your doctor can see where the leads are going by watching a video screen with real-time, moving x-rays called fluoroscopy.
The doctor connects the leads to the device and tests to make sure both work together to deliver treatment. Your doctor then places the device just under the skin near your collarbone and stitches the incision closed.
Usually you are told not to eat or drink anything for a number of hours before the procedure. You undress and put on a hospital gown or sheet. Your procedure will
be performed in a “cath lab.” You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious.
The doctor makes a small incision near your collarbone to insert the leads. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the leads are inserted. If you have a CRT-D device implant, you may be sedated when the device is tested, since it delivers a shock to your heart. Most people do not need to be sedated if they have a CRT-P device implanted.
You may be in the hospital overnight, and there may be tenderness at the incision site. Most people have a fairly quick recovery.
A heart transplant is the surgical replacement of a diseased heart with a healthy heart from a donor. A heart transplant can prolong the life of a person with life threatening heart disease. Heart transplants are typically done in people who have advanced heart failure that can’t be successfully treated with other procedures or medications.
The transplant involves transferring a healthy heart from a donor to the recipient. The donor is usually someone who has suffered brain death but whose heart is healthy. The donor must be a similar height and weight as the recipient, and the two must have the same blood type. However, the age, sex, and race of the two individuals can differ.
A transplant must take place within 4 hours of the time the healthy heart is removed from the donor. That’s why time-and location of the donor and recipient-are such critical factors. People on the transplant waiting list usually carry a pager at all times. They must be at the hospital shortly after being paged.
A heart transplant is a major surgery that involves general anesthesia and a fairly long recovery period. In the United States, just over 2,000 heart transplants are done every year. Doctors could save many more lives if more people were willing to be donors.
Sometimes a person has a surgery before the heart transplant. This initial surgery is the implantation of a device called a left ventricular assist device (LVAD). The LVAD is necessary because the left ventricle (lower heart chamber) can become very weak from damage to the heart muscle. In some people the weakened heart is increasingly unable to pump enough blood out to the body.
A LVAD helps by taking over the work of the left ventricle. A tube on the LVAD takes blood entering the left ventricle and sends it to the LVAD pump. The LVAD uses the right amount of force to pump the blood in a blood vessel, which then.
Our knowledgeable and courteous staff will help set up a consultation for you, schedule surgical procedures, discuss your insurance, and answer any questions you may have.
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Palm Springs, CA 92262
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La Quinta, CA 92253
