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About This Condition

Heart Failure

What is heart failure?

The heart is a muscle that pumps oxygen-rich blood to all parts of the body. When you have heart failure, the heart can’t pump as well as it should. Or the heart muscle can’t relax and fill the pumping chamber with blood. Blood and fluid may back up into the lungs. This causes congestive heart failure. And it causes pulmonary edema. Some parts of the body also don’t get enough oxygen-rich blood. This means they can't work well. These problems lead to the symptoms of heart failure.

What causes heart failure?

Heart failure may result from:

  • Heart valve disease

  • High blood pressure

  • Active infections of the heart valves or heart muscle, such as endocarditis

  • A past heart attack

  • Coronary artery disease

  • Disease of the heart muscle (cardiomyopathy)

  • Heart disease or problems that are present at birth (congenital)

  • Heart rhythm problems (arrhythmias) that lead to ongoing fast heart rates

  • Long-term (chronic) lung disease and pulmonary embolism

  • Some medicines

  • A reaction to medicines such as those used for chemotherapy

  • Anemia and too much blood loss

  • Complications of diabetes

  • Obstructive sleep apnea

  • Alcohol and drug abuse

  • Certain viral infections

What are the symptoms of heart failure?

The most common symptoms of heart failure are:

  • Shortness of breath while resting, exercising, or lying flat

  • Weight gain from water retention

  • Visible swelling of the legs and ankles from fluid buildup. Sometimes the belly (abdomen) may swell.

  • Severe tiredness (fatigue) and weakness

  • Loss of appetite, nausea, and belly pain

  • Cough that doesn’t go away. It can cause blood-tinged or frothy sputum.

The severity of the condition and symptoms depends on how much of the heart's pumping ability has been affected. The first step in managing heart failure symptoms is knowing your baselines or what’s normal for you. How much do you weigh? Are you gaining weight but eating the same amount? How much can you do before you feel short of breath? Do your socks and shoes fit comfortably? Knowing what’s normal for you will help you see when symptoms are getting worse. Once you know your baselines, watch for changes daily.

The symptoms of heart failure may look like other health problems. Always see your healthcare provider for a diagnosis.

How is heart failure diagnosed?

Your healthcare provider will ask about your health history. He or she will give you a physical exam. You may need tests such as:

  • Chest X-ray. This test makes images of internal tissues, bones, and organs on film. This test shows the size and shape of your heart. Fluid in the lungs will also show up on X-ray.

  • Echocardiogram. This test is also called echo. It uses sound waves to assess the motion of the heart’s chambers and valves. The sound waves make an image on the screen as an ultrasound transducer is passed over the heart. This shows how well the heart pumps and relaxes. It also shows the thickness of the heart walls, and if the heart is enlarged. It is one of the most useful tests because it shows a lot of information about the heart’s function. And it helps guide treatment choices.

  • Electrocardiogram (ECG). This test records the electrical activity of the heart. It shows abnormal rhythms. It can sometimes find heart muscle damage.

  • BNP testing. B-type natriuretic peptide (BNP) is a hormone released from the ventricles that occurs with heart failure. BNP levels are useful in the quick assessment of heart failure. The higher the BNP levels, the worse the heart failure. BNP is measured from a blood sample.

  • Cardiac MRI. This test uses a magnetic field to make images of the heart and its nearby tissues. It can assess how the heart muscle and valves are working.

How is heart failure treated? 

The cause of heart failure will guide the treatment plan. If heart failure is caused by a valve problem or coronary heart disease, then you may need a procedure. This may be a percutaneous coronary intervention. Or it may be surgery. If heart failure is caused by a problem such as anemia or an infection, you may need medicine to treat this problem.

Some causes of heart failure are reversible or short-term, such as in an acute infection. For many causes of heart failure there is no cure. But many forms of treatment can help with symptoms. They are listed below.

Lifestyle changes

These healthy habits may help with heart failure:

  • Controlling blood pressure

  • Controlling blood sugar if you have diabetes

  • Quitting smoking

  • Losing weight, if needed

  • Exercising more

  • Limiting salt and fat in your diet

  • Not drinking alcohol or using illicit drugs

  • Getting enough rest

  • Other important lifestyle habits include getting vaccines such as for the flu and pneumococcal pneumonia.

If you have sleep problems, getting a sleep study get help find out what’s causing them. You may need to wear a C-PAP mask while you sleep. This will make sure you get enough oxygen. Too little oxygen can put stress on your heart.

Medicines

Many types of medicines are available for heart failure. They include:

  • Angiotensin converting enzyme (ACE) inhibitors. These lower the pressure inside the blood vessels. This reduces the pressure that the heart has to pump against. They can also help the heart have better pumping ability over time.

  • Angiotensin receptor blockers (ARB). Some people get a cough and need to stop taking ACE inhibitors. If that happens, an ARB may work for you. These help relax blood vessels and reduce stress on the heart.

  • Angiotensin receptor-neprilysin inhibitors (ARNIs). This medicine combines an ARB and a neprilysin inhibitor. This can help the heart as noted above. And it can promote salt and water loss.

  • Sinus node I-f channel blocker. This may be used to lower your heart rate. Then then puts less stress on your heart.

  • Diuretics. These reduce the amount of fluid in the body. They are among the most important medicines in helping control fluid buildup in the body.

  • Vasodilators. These include hydralazine and nitroglycerin. These widen (dilate) the blood vessels. They reduce the workload on the heart.

  • Digitalis. This medicine helps the heart beat stronger. It may help with controlling heart rate if there is an abnormal heart rhythm.

  • Antiarrhythmics. These help keep normal heart rhythm.

  • Beta-blockers. These reduce the heart’s tendency to beat faster. They can also help the heart pump better over time.

  • Aldosterone blockers. This blocks the effects of the hormone aldosterone. This hormone causes sodium and water retention.

  • Statins or PCKS9 inhibitors. These lower the amount of bad cholesterol in your blood. They are not used to treat heart failure. But you may take one if you have high cholesterol. Or you may take one if you have had a past heart attack and are at risk for heart failure. People who have inherited forms of high cholesterol (familial hypercholesterolemia) may get help from PCKS9 inhibitors. These medicines lower cholesterol.

Heart procedures

These include opening blocked arteries in the heart. This brings back blood flow to the heart muscle. It helps the ventricles squeeze as they should. The procedure can be done in the cardiac catheterization lab. It uses balloons to push plaque and blood clots out of the artery. It also uses stents to keep the artery open. This can also be done by bypassing blockages during surgery (coronary artery bypass surgery).

Heart valve repair or replacement

In some cases medicines can’t help heart failure caused by heart valves that are narrowed (stenosed) or leak (regurgitant). The heart valve can be repaired or replaced. This can be done as an open-heart procedure. Or it can be done by going through a small tube (catheter) that is put into an artery or vein.

Pacemaker

If your heart failure has also damaged your heart’s electrical wiring system, a pacemaker can be implanted. This is done to restore normal heart rate and regularity. A cardiac resynchronizing pacemaker is used when 1 of the heart wires is damaged. This is often the wire located in the left ventricle. These pacemakers use implanted left and right sided wires to restore normal timing of the heart contraction in order to improve heart function.

ICD (implantable cardioverter defibrillator)

When heart muscle is damaged, dangerous heart circuits can form in the heart muscle. This leads to heart rhythms that can cause death. An ICD is implanted in the body to sense and treat these cardiac arrest rhythms. It does this by overdrive pacing the heart rhythm. Or it sends an energy shock to the heart.

VAD (ventricular assist devices)

This device is put in the chest during a surgery. It connects to an outside motor. The motor helps pump blood from the heart to the rest of the body. VADs can allow people with advanced heart failure to improve their overall symptoms and to walk more. This can be used as a long-term treatment. Or it can be used while someone waits for a donor heart for a transplant.

Heart transplant

In some cases, the diseased heart must be replaced with a healthy one from a donor.

Talk with your healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are possible complications of heart failure?

Complications of heart failure include:

  • Fluid buildup in the lungs (pulmonary edema)

  • Kidney and liver failure

  • Stroke

  • Abnormal heart rhythms

  • Death

Key points about heart failure

  • When you have heart failure, the heart can’t pump as well as it should.

  • Heart failure may result from health problems that affect the heart, such as high blood pressure, coronary artery disease, and heart attack.

  • Some common symptoms are shortness of breath, weight gain, and visible swelling of the legs and ankles.

  • A chest X-ray can help diagnose lung congestion.

  • Treatment varies based on the cause of heart failure. Most people are advised to make certain lifestyle changes and to take certain medicines, often for life. Procedures such as coronary intervention and surgery may be needed.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

Clinical Trials

The following related clinical trials and research studies are currently seeking participants at Massachusetts General Hospital. Search for clinical trials and studies in another area of interest.

News

  • The Promise of Ventricular-Assist Devices - 1/17/2017, Mass General

    Ventricular circulatory assist devices (VADs) now almost rival heart transplantation in terms of their impact on patient survival and quality of life. VADs are becoming smaller and more durable, and the associated risks are declining.

  • New Strategies for Heart Failure Patients - 1/17/2017, Mass General

    Cardiac resynchronization therapy (CRT) is one of the most common treatments for patients with moderate to severe heart failure, and it involves placing a biventricular pacing device to resynchronization contraction of the heart’s ventricles.

  • A second chance - 11/20/2015, Mass General

    It’s not every day you get a second lease on life. Emma Morgan, however, received that second chance 10 years ago thanks to a procedure performed by the MGH Heart Failure and Cardiac Transplant Program.

  • A walk down the aisle on Ellison 9 - 10/31/2014, Mass General

    It was not part of their job description, but that did not stop nurses on the MGH Cardiac Intensive Care Unit from taking on the role of wedding planners so that a father could walk his daughter down the aisle.

  • The journey home - 8/1/2014, Mass General

    Lacy Neff, a radio broadcaster from West Virginia, recently underwent a heart transplant as part of his treatment plan for amyloidosis, a rare disease that occurs when amyloid proteins accumulate in the organs. The MGH is one of only seven hospitals in the United States studying cardiac amyloid transplants – and the only one in the Northeast.

  • Improved Clinical Outcomes for CRT Patients - 6/6/2012, Mass General

    Jagmeet Singh, MD, Director of the Cardiac Resynchronization Therapy Program at the Massachusetts General Hospital Heart Center, discusses his team’s recent study about multidisciplinary care (MC) versus conventional care (CC) in CRT (cardiac resynchronization therapy) patients.

  • MGH goes red for women's heart health - 2/18/2011, Mass General

    MGH Hotline 2.18.11 Just in time for Valentine’s Day, the MGH Heart Center and Corrigan Women’s Heart Health Program brought attention to hearts everywhere by celebrating “Go Red for Women” month with a series of events and activities to raise awareness of heart disease in women.

  • At home heart failure care - 7/21/2009, Mass General

    A new clinical trial at the Massachusetts General Hospital Heart Center gives patients the power to monitor their hearts and change their medication dosing daily to prevent the symptoms of heart failure.

  • A strongman's second chance - 6/4/2009, Clinical

    In 2008, the Massachusetts General Hospital Transplant Center completed the most heart transplants in the region. Personal trainer and strongman competitor, Jim Murphy, is one shining example of the great successes of the program.

Patient Education

  • Frequently Asked Questions About Cardiac Anesthesia

    The Massachusetts General Hospital Heart Center offers a patient guide to cardiac anesthesia. Our dedicated clinicians believe it is important for you to know what to expect before, during and after a cardiac anesthesia.

  • Connected Cardiac Care

    Connected Cardiac Care is a program offered to heart failure patients at risk for frequent hospitalizations. The program aims to reduce re-hospitalizations by improving patient's understanding of their condition and providing ongoing nursing support and review of key physiologic parameters while the patient is at home.

Video

  • Stephanie Moore, MD

    Stephanie Moore, MD, describes your risk for heart failure if you have a family history of this condition

    Stephanie Moore, MD, cardiologist in the Heart Failure and Cardiac Transplant Program at the Mass General Heart Center says if a close relative suffered from heart failure, you should be screened for other health issues that can put you at higher risk. Learn more about the early signs of heart failure and the various treatments available, from medications to pacemakers to transplants.

  • An Athlete at Heart: Chris’s Story

    An Athlete at Heart: Chris's Story

    Chris Duffy, a professional cyclist, was diagnosed with heart failure at just 23. At age 29, he underwent a heart transplant. In this video, Chris talks about the Mass General Cardiovascular Performance Program and how Dr. Aaron Baggish and his team have been able to keep him on his bike.