Heart failure is the most common inpatient diagnosis in patients older than 65.
While heart failure is a progressive disease, early diagnosis and treatment can improve your quality of life and life expectancy. Heart failure starts slowly and gets worse over time, though medicine and lifestyle changes can slow or even reverse heart failure for some people.
Knowing that your health may get worse can be hard. It’s normal to sometimes feel sad or hopeless. But if these feelings last, talk to your doctor. Antidepressant medicine, counseling, or both may help you cope. You may want to think about planning for the future. A living will lets doctors know what type of life-support measures you want if your health gets much worse. You can also choose a health care agent to make decisions in case you aren’t able to. It can be comforting to know that you’ll get the type of care you want.
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Anything that damages your heart or affects how well it pumps can lead to heart failure. Common causes include:
- High blood pressure
- Heart attack
- Coronary artery disease
- Excessive alcohol intake
Other conditions that can lead to heart failure include:
- Diseases of the heart muscle
- Heart valve disease
- Disease of the sac around the heart (pericardial disease), such as pericarditis
- A slow, fast or uneven heart rhythm (arrhythmia)
- A heart problem that you were born with (congenital heart defect).
In the earliest stages of heart failure, your symptoms may be mild. You may feel tired easily, be short of breath when you exert yourself, feel like your heart is pounding or racing, feel weak or dizzy and have an increased heart rate.
As heart failure gets worse, fluid starts to build up in your lungs and other parts of your body. This may cause you to:
- Feel short of breath, even at rest
- Have swelling, especially in your legs, ankles and feet
- Gain weight (over just a day or two, or more slowly)
- Cough or wheeze, especially when you lie down
- Need to urinate more at night
- Feel bloated or sick to your stomach.
If your symptoms suddenly get worse, call 911.
Your doctor may diagnose heart failure based on your symptoms and a physical exam. But you’ll need tests to find the cause and type of heart failure so you can get the right treatment. These tests may include:
- Blood tests
- Chest X-ray
- Electrocardiogram (EKG or ECG)
- Cardiac catheterization
- Stress test
An echocardiogram is the best and simplest way to find out if you have heart failure, what type it is and what’s causing it. Your doctor can also use it to see if your heart failure is getting worse.
Most people with heart failure need to take several medications. These medications may:
- Help keep your heart failure from getting worse. These drugs include ACE inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers and vasodilators like hydrazine and nitroglycerin.
- Reduce your symptoms so you feel better. These drugs include diuretics (water pills), digoxin and potassium.
- Treat the cause of your heart failure, such as valve replacement or repair.
It’s important to take your medication exactly as your doctor tells you to. If you don't, your heart failure could get worse.
Depending on the cause of your heart failure, you may need surgery to help your heart work better. You might have bypass surgery or angioplasty to open clogged arteries, or you may need surgery to repair or replace a heart valve. You might need to have a pacemaker or a defibrillator if you have a problem with your heart rhythm.
Lifestyle changes can help slow down heart failure, and are an important part of your treatment. These changes may also help control other diseases that make heart failure worse, such as high blood pressure, diabetes and coronary artery disease. There are several steps you can take to help:
- Eat less salt (sodium) and limit how much fluid you drink. Sodium causes your body to retain water and makes it harder for your heart to pump. Limit sodium to 1500mg /day and fluid consumption to 64 oz/day.
- Get regular exercise. Your doctor can tell you what level of exercise is safe for you, how to check your pulse and how to know if you’re doing too much.
- Take rest breaks during the day.
- Lose weight if you’re overweight. Even a few pounds can make a difference.
- Stop smoking. Smoking damages your heart and makes it harder to exercise.
- Limit alcohol. Ask your doctor how much, if any, is safe.
To stay as healthy as possible, work closely with your doctor. Have all your tests and go to all your appointments. Talk to your doctor before you take any new medicine, including nonprescription and prescription drugs, vitamins and herbs. Some of them could make your heart failure worse. Be sure to keep track of your symptoms. Weigh yourself at the same time every day, and write down your weight. Call your doctor if you have a sudden weight gain (more than 2 pounds per day or 5 pounds per week), a change in your ability to exercise or any sudden change in your symptoms.