Heart failure: Questions and answers

What is heart failure?

Heart failure occurs when your heart isn't pumping blood as well as it should. Because your heart isn't able to pump the normal amount of blood out of ventricles, the blood vessels leading into your heart can become congested or "backed up" with blood.

Your heart may be damaged and pump with less force. To try to keep the same amount of blood moving through your body, the chambers stretch and become larger to hold more blood. Your heart muscle becomes weaker as it tries to pump this increased blood.

Eventually, parts of your body hold excess fluid that isn't being circulated well by your heart. Your body becomes congested with fluid. This is why heart failure is sometimes called "congestive heart failure."

What causes heart failure?

The most common causes are coronary artery disease, heart attack, high blood pressure, valve disease, and unknown (known as idiopathic cardiomyopathy).

What are common signs of heart failure?

Breathing problems
Waking up breathless at night
Swelling in the feet, ankles, legs, hands and/or lower back
Swelling in the abdomen
Weight gain, even with loss of appetite
Extreme fatigue
Dizziness, lightheadedness, inability to concentrate
Heart palpitations

It's important to know that heart failure symptoms can be managed. The earlier you recognize your symptoms and report them to your health care provider, the less time you may need to spend in the hospital.

When do I need to call my health care provider?

Call your health care provider if you:

gain more than three pounds in one day, or five or more pounds in one week
have swelling in your ankles, legs or abdomen
have increased fatigue
have increased shortness of breath on exertion, shortness of breath at night or when lying flat
have an unexplained cough, or a "hacking" night cough
cough up pink or blood-tinged phlegm (mucus)
have decreased urination during the day, but more frequent need to urinate at night
need to sleep with more pillows at night
feel lightheaded or dizzy
have nausea or being unable to eat and/or take medications
have chest pain or discomfort with activity that gets better with rest.

When do I need to call 911?

Call 911 if you:

pass out or faint
become extremely short of breath or are unable to talk due to being breathless
have severe chest pain that is not helped by prescribed medicine
have a continuously rapid, racing heartbeat

What activities can I do? And when?

Regular exercise is important for people who have heart failure. Check with your health care provider for what's right for you. Some general guidelines:

Balance exercise with rest.
Increase exercise slowly.
Do not exercise right before or after meals.
Drink 6 to 8 ounces of water before you exercise, unless you are on a fluid restriction.

How do I know if I'm doing too much?

If you have any of these symptoms, stop and rest:

dizziness or lightheadedness
nausea and vomiting
cold sweat
shortness of breath that makes talking difficult
unusual fatigue or extreme exhaustion
a feeling that your heart is suddenly racing, pounding. skipping beats or has become irregular
fainting or black-out spells
chest pain or pressure or pressure in your neck, jaw, teeth and arm, or between your shoulder blades
any new orthopedic problem, such as joint or muscle pain. See your health care provider for advice.

What if my weight increases? How much is too much?

A buildup of water in your body causes weight gain. When your body retains fluid, your weight goes up.

Tell your health care provider if you gain three pounds or more in one day, five pounds or more in a week, or if your weight stays the same but you're not eating well. This is why it is important that you weigh yourself at the same time every day.

Is my scale OK to use?

Yes.

Write down your weight when you get home from the hospital so you have a baseline weight.
Weigh yourself at the same time on the same scale every day.
Wear the same amount of clothing each time you weigh yourself.
Write down your weights so you can share this information with your health care provider. Our daily weight log (requires Adobe Reader) can help.

Are there diet restrictions I need to follow?

Limit your sodium you eat to keep from retaining extra fluids.
Maintain a good weight for you. Being overweight makes your heart work harder.
Eat healthful, well-balanced meals.
Talk with your health care provider about the use of caffeine and alcohol.

What medicines are used for heart failure and what do they do?

A combination of different types of medicines are helpful for people with heart failure. For example:

ACE (angiotensin converting enzyme) inhibitors relax your blood vessels and make it easier for your heart to pump blood. Sometimes it takes several weeks before you notice any changes.
Beta blockers reduce the workload on your heart and help your heart work with less oxygen.
Diuretics help rid your body of excess fluid by increasing the amount of urine you make. The workload of your heart is reduced when the amount of fluid in your body is reduced.
Digoxin strengthens your heart so it can pump more blood, and controls irregular heart rhythms.
ARB (angiotensin receptor blocker) relaxes your blood vessels and allows your heart to pump easier. You would be prescribed an ARB if you cannot tolerate an ACE inhibitor.
Aldosterone antagonists block the effects of a hormone that makes your kidneys retain more sodium and water.
Hydralazine and nitrates relax your blood vessels and decrease how hard your heart has to work to pump blood through your body. You may be prescribed hydralazine and nitrates if you cannot tolerate ACE inhibitors or ARBs.
Warfarin (Coumadin®) decreases the clotting ability of the blood and helps to prevent blood clots.

Taking your medicine as prescribed is vital to treating your heart failure. It may take many days or weeks to find the right doses and/or combinations of medicines. This will take patience as you and your health care team work together to find the:

right medicine for you
right amount of each medicine
best time of the day to take each medicine