Heart failure (or congestive heart failure) doesn’t mean your heart has failed or stopped beating. It means that your heart, which is a muscle that pumps blood to all parts of your body, is not working as well as it should be and can’t pump as much blood as your body needs. As your heart's pumping action lessens, blood may back up in your lungs, liver, or legs. This can cause shortness of breath, leg swelling (called edema), and other problems. In addition, organs in your body may not get the oxygen and nutrients they need, meaning that they also can’t function properly.

Heart failure is a chronic (ongoing) condition that usually develops over time. It is usually caused by underlying conditions such as high blood pressure or heart disease. These conditions damage your heart, making the heart muscle stiff or thick. The damaged muscle either can’t relax properly to let the pumping chambers of the heart – the ventricles – fill with enough blood, or it can’t contract properly to let the ventricles pump out enough blood. The left ventricle is the main pumping chamber, and heart failure usually starts on the left side. When the left ventricle can’t contract enough, it’s called systolic heart failure. When the left ventricle can’t fill with enough blood, it’s called diastolic heart failure. You can have a combination of both types of heart failure.

Although some conditions that cause heart failure are irreversible, you can manage the condition and improve your health and quality of life with a combination of lifestyle changes and medications.

You may experience one or more of the following symptoms of chronic heart failure:

• Swollen feet, ankles, and sometimes abdomen
• Weight gain from fluid retention
• Shortness of breath and cough
• Racing or skipping heart beat (palpitations)
• Stomach upset, nausea and vomiting, and loss of appetite
• Difficulty sleeping
• Fatigue, weakness, and a reduced ability to exercise
• Lightheadedness
• Difficulty concentrating or staying alert

The more advanced your heart failure, the more likely you are to have symptoms.

Acute heart failure occurs when something suddenly damages your heart (such as a heart attack, blood clot in the lungs, allergic reaction, or severe infection). Symptoms are similar to those for chronic heart failure, but are more serious and get worse quickly. Acute heart failure is life-threatening and you should seek immediate emergency medical attention.

The most common causes of heart failure are high blood pressure and coronary artery (heart) disease. Other causes of heart failure include:

• Heart attack
• Damaged heart valves (valves separate the chambers of the heart and keep blood flowing in the right direction)
• Cardiomyopathy (weakening of the heart muscle, which may be from infection, diseases such as rheumatoid arthritis or lupus, alcohol or drug abuse, or sometimes for unknown reasons)
• Congenital heart disease (heart defects at birth)
• Myocarditis (inflammation of the heart from a virus)
• Abnormal heart rhythms (arrhythmias)

You are at risk for developing heart failure if you:

• Have high blood pressure
• Have diabetes
• Have had a heart attack or have heart disease of any kind.
• Have high blood pressure or diabetes.
• Are overweight.
• Have sleep apnea
• Take certain medications
• Abuse alcohol, smoke cigarettes, or use cocaine.

Your doctor will take a detailed medical history and do a physical exam. He or she will examine your heart and lungs, checking for enlargement of the heart and fluid in the lungs. Other signs of heart failure that your doctor will look for include enlarged neck veins, swelling in your legs or abdomen, and tenderness of the liver. A chest x-ray can help to see if there is fluid on your lungs or enlargement of your heart – two factors that often go along with heart failure.

After the initial diagnosis, your doctor will look for the underlying cause of heart failure. He or she may order these tests:

• Blood tests, to check kidney or thyroid function
• Echocardiogram, to determine systolic heart failure or diastolic heart failure
• Ejection fraction, to see how much blood you heart is pumping out
• Electrocardiogram (ECG), to look for heart rhythm problems
• Coronary catheterization (angiogram), to look for narrowed arteries

With proper treatment, you can control symptoms of heart failure and improve your health. Many lifestyle changes, such as losing weight, cutting down on salt, and getting regular exercise can make a difference in your condition. Medications are also available to help your heart better pump blood. Some complementary and alternative therapies can be helpful, too, when used along with standard medical treatment. However, heart failure is a serious condition and you should always seek medical care; do not take any herbs or supplements without your doctor’s supervision.

Lifestyle

Carefully monitoring your health and helping to manage your condition makes a big difference in keeping heart failure under control. To do this, track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that the pump function of your heart is getting worse. Make sure you weigh yourself at the same time each day and on the same scale.

Other important measures include:

• Take your medications as directed. Carry a list of medications with you wherever you go.
• Cut down on salt. People with heart failure should consume no more than 2,000 mg per day. Keep in mind that most salt in your diet doesn’t come from the salt shaker, but from processed foods that already contains high levels of sodium. (See “Tips to lower your sodium intake” below.)
• If you smoke, quit.
• Exercise and stay active. Walk or ride a stationary bicycle, for example. One study showed that a walking program was safe for people with heart failure and helped improve symptoms. Talk to your doctor before starting any new exercise program; he or she can help you find one that’s right for you.
• Lose weight if you are overweight.
• Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest, too. Keep your feet elevated to decrease swelling.

Tips to lower your sodium intake

• Look for foods labeled "low-sodium," "sodium-free," "no salt added," or "unsalted." Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods.
• Don't cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).
• Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), olives, pickles, sauerkraut, soy and Worcestershire sauces, and cheese.
• Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.
• Use oil and vinegar instead of bottled dressings on salads.
• Eat fresh fruit or sorbet when having dessert.

Medications

ACE inhibitors — widen blood vessels and make it easier on your heart to pump blood. Side effects can include chronic cough. ACE inhibitors include

• Benazepril (Lotensin)
• Captopril (Capoten)
• Fosinopril (Monopril)
• Lisinopril (Zestril)
• Enlapril (Vasotec)

ARBs — also dilate blood vessels and may be used in people who can’t take ACE inhibitors. They include

• Irbesartan (Avapro)
• Candesartan (Atacand)
• Losartan (Cozaar)
• Valsartan (Diovan)

Digoxin (Lanoxin) — helps your heart pump more blood by increasing the strength of its contractions.

Beta blockers — slow heart rate and lower blood pressure. Beta blockers include

• Acebutolol (Sectral)
• Atenolol (Tenormin)
• Bisoprolol (Zebeta)
• Carvedilol (Coreg)
• Propanolol (Inderal)
• Metoprolol (Lopressor, Toprol-XL)

Diuretics (water pills) — keep fluid from building up in your body by making you urinate more. There are different types of diuretics that can affect potassium and magnesium levels in your body, so your doctor will check your levels frequently.

Isosorbide dinitrate and hydralazine hydrochloride (BiDil) — BiDil combines two drugs that dilate blood vessels. It is approved for use in African-Americans who have heart failure, as an addition to standard therapy.

Nutrition and Dietary Supplements

• Magnesium — Magnesium is essential to heart health. This mineral is particularly important for maintaining a normal heart rhythm and is often used by physicians to treat irregular heartbeat (arrhythmia). People with heart failure are often at risk for developing an arrhythmia. In addition, some diuretics (water pills) may cause your body to lose too much magnesium. For this reason, your doctor may recommend a supplement. Always ask your doctor before taking a magnesium supplement on your own if you have heart failure.
• Carnitine (500 mg two times per day) — Some early studies suggest that L-carnitine supplements may reduce your chances of developing heart failure after a heart attack and improve exercise capacity if you already have heart failure. Carnitine is a nutrient that helps the body convert fatty acids into energy. This energy is used primarily for muscular activities throughout the body. Most studies used a special form of carnitine called propionyl-L-carnitine.
• Coenzyme Q-10 (CoQ10, 100 to 200 mg per day) — Levels of CoQ10 are low in people with heart failure. Several research studies suggest that CoQ10 supplements can help reduce swelling in the legs, enhance breathing by reducing fluid in the lungs, and increase exercise capacity in people with heart failure. Not all studies agree, however. More research is needed to see if CoQ10 has any real benefit. In the meantime, talk to your doctor about whether this supplement would be good as well as safe for you.
• Creatine — Creatine is a naturally occurring amino acid (protein building block) found mainly in muscles. In a few studies of people with congestive heart failure, injections of creatine (in addition to standard medical care) provided improvement in heart function and ability to exercise compared to those who received placebo. Taking creatine orally improved muscle function and endurance. More studies are needed to determine whether oral creatine has any benefit for people with heart failure.
• Vitamin B1 (Thiamine) — Thiamine may be related to heart failure in several ways. First, low levels of thiamine can contribute to the development of congestive heart failure. On the flip side, people with severe heart failure can lose a significant amount of weight including muscle mass (called cachexia) and become deficient in many nutrients including thiamine. In addition, diuretics (water pills) can cause your body to lose too much thiamine. Talk to your doctor about measuring your level of vitamin B1 and whether you should take thiamine.
• Amino acids — A few small studies suggest these amino acids might be helpful for heart failure, but more research is needed:
  • Arginine (needed for the body to make nitric oxide, which helps blood flow)
  • Taurine (helps heart muscle contract)

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.

• Hawthorn — Hawthorn (Crataegus spp.), a member of the rose family, was used by physicians in the early 1800s to treat circulation and respiration (breathing) problems. The flowers and berries have been used traditionally to treat irregular heartbeat, high blood pressure, chest pain, atherosclerosis (hardening of the arteries), and heart failure. Several scientific studies suggest that hawthorn improves the heart’s ability to pump blood in people with heart failure. It also significantly improved symptoms (like reduced shortness of breath and fatigue) and helped people exercise longer. No studies have examined whether hawthorn can work safely with other medications, or how it compares to drugs such as ACE inhibitors. Talk to your doctor to see if hawthorn is right for you.
• Berberine (300 to 500 mg four times per day) – Berberine, an active ingredient of goldenseal (Hydrastis canadensis) and other herbs, can dilate blood vessels. In one study, people who took berberine for eight weeks had better heart function and were more able to exercise than those who took placebo. A few other studies suggest that when berberine is combined with standard medicines for heart failure, it can improve heart function and quality of life. Talk to your doctor about whether it is safe and appropriate for you to take berberine in addition to your usual care.

Prognosis and Complications

Heart failure is a serious disorder that leads to a lower life expectancy. It is generally a chronic illness, but many forms of heart failure can be controlled by treating the underlying causes, making lifestyle changes, and taking medication.

Potential complications include:

• Pulmonary edema (fluid buildup in the lungs)
• Total failure of the heart to function (circulatory collapse or shock)
• Arrhythmias (irregular heart rhythm) including fatal arrhythmias

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