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Dani Aylsworth was 19 when she joined the Army in 2008. She served in Afghanistan as part of an elite female Special Forces team. But when she returned home as a combat veteran, posttraumatic stress disorder (PTSD) hit hard. For 6 years, heavy drinking helped buffer the painful memories.
In 2017, Aylsworth went to the doctor feeling unwell. "They told me I was young and healthy, so it was probably just an upper respiratory infection," she says. Unbeknownst to Aylsworth and her doctor, she had pneumonia. After 2 weeks without treatment, it turned into sepsis.
This was when Aylsworth's heart failure crisis began. The sepsis attacked her heart, and she spent 12 days in a coma. When she woke up on Christmas Eve, 2017, just 8% of her heart was working.
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What Is Heart Failure?
Normally your heart pumps oxygen-rich blood from your lungs out to the rest of your body. Heart failure can mean that your heart is too weak, or it can't fill up with enough blood to meet your body's oxygen needs. When this happens, the blood backs up. This causes fluid to build up in your body.
No Chance to Heal
Aylsworth's doctors sent her home with an external defibrillator vest. If her heart went into a life-threatening rhythm while healing, the vest would shock it back into its normal rhythm.
Her heart didn't heal.
"I kept drinking," she says. "My heart output wasn't increasing." Her ejection fraction, the amount of blood her left ventricle pumped out with each contraction, was just 17%. A normal ejection fraction is 55% to 75%.
During that time, she was too sick to work or care for her then 8-year-old daughter. "My fingers were huge. My face was swollen. I had about 40 pounds of fluid on me, which made it harder for my heart to beat," she says.
In 2018, Aylsworth moved from Florida to Houston to start the process for a heart transplant. She enrolled in a heart failure clinic. Two to three times a week, the staff there would take her blood and monitor her progress.
But after 5 months in the program, Aylsworth was denied the heart transplant she desperately needed because she couldn't stop drinking. "My prognosis wasn't good. I accepted that I wasn't going to make it," she says.
In November 2018, Aylsworth went into cardiac arrest. Her heart stopped beating. It happened twice within 20 minutes.
"Thank God I had an internal defibrillator. That saved my life," she says.
Causes of Heart Failure
Heart failure often results when conditions like these damage your heart:
- Coronary artery disease. Fatty deposits called plaques narrow the vessels that carry blood to your heart, allowing less blood to flow through them.
- Heart attack. A coronary artery suddenly becomes blocked. This starves the heart of oxygen and nutrients. Part of the heart muscle dies and can't pump blood as well.
- High blood pressure. Extra pressure in your arteries forces your heart to pump harder to push enough blood out to your body. Over time, high blood pressure can weaken your heart.
- Heart valve problems. Your heart's four valves keep blood flowing in the right direction. An infection, disease, or defect can prevent these valves from closing all the way. This makes your heart pump harder to keep your blood moving forward.
- Heart muscle damage. Inflammation called myocarditis, drug or alcohol use, or an infection can damage the heart muscle.
- Heart defects. Some people are born with problems that affect their heart's ability to pump.
Heart Failure Types
Doctors classify heart failure based on the part of your heart that's affected and how well your heart pumps.
Your heart has four pumping chambers. The two atria at the top receive blood into your heart. The two ventricles at the bottom pump blood out of your heart.
Ejection fraction refers to how well your left or right ventricle pumps blood with each beat.
Left-sided heart failure is when the left ventricle can't pump enough blood to your body.
Right-sided heart failure is when your right ventricle can't pump enough blood to your lungs.
Heart failure with reduced ejection fraction means your heart is too weak to pump enough blood out to your body.
Heart failure with preserved ejection fraction means your heart isn't that weak, but it can't fill up enough to pump the amount of blood your body needs.
Congestive heart failure (CHF) is another name for heart failure. It happens when the flow of blood from your heart slows down, causing a backup of blood to your heart. Your tissues swell with fluid.
Treatments for Heart Failure
Though heart failure isn't curable, treatments can slow damage to your heart and improve your symptoms. You'll probably need to stay on treatment long-term.
Managing heart failure often involves a combination of medication, surgery, and devices.
Medications. A few different medicines treat the causes and symptoms of heart failure:
- ACE inhibitors, angiotensin II receptor blockers (ARBs), angiotensin receptor-neprilysin blocker (ARNI), and beta-blockers lower high blood pressure.
- Diuretics (water pills) remove excess fluid from your body.
- Spironolactone lowers your blood pressure, raises your blood potassium level and stops stress hormones from attacking your heart.
- Digoxin (Lanoxin) strengthens your heartbeat.
- Hydralazine and isosorbide dinitrate (BiDil) relax blood vessels.
- Blood thinners prevent clots if you have atrial fibrillation.
- Statins lower unhealthy LDL cholesterol that clogs arteries.
- SGLT-2 inhibitors help to lower blood pressure, ease inflammation, and help your body make more red blood cells to carry oxygen to the heart.
- Vericiguat (Verquvo), an oral soluble guanylate cyclase (sGC) stimulator helps to relax the heart's blood vessels and make them wider so the heart can pump more oxygen-rich blood to the body.
Surgery. Doctors can use a few procedures to treat the cause of heart failure or implant a device to keep your heart in a healthy rhythm.
- Coronary artery bypass. This surgery uses a healthy blood vessel from another part of your body to route blood around a blocked artery.
- Heart valve repair or replacement. This surgery fixes a damaged heart valve or replaces it with one made from metal, plastic, or human or animal tissue.
- Percutaneous coronary intervention (PCI). This procedure, also called angioplasty, opens blocked blood vessels.
- Implantable cardioverter defibrillator (ICD). This device is similar to a pacemaker. Once implanted under your skin, it monitors your heart rhythm and delivers a shock to bring it back into a normal rhythm.
- Cardiac resynchronization therapy (CRT). This device helps your ventricles contract together if they're out of sync, to push blood out of your heart.
- Left ventricular assist device (LVAD). This helps pump blood from the ventricles to the rest of your body.
- Heart transplant. If heart failure is so severe that medications and surgery don't help, you can have this procedure to replace your damaged heart with a healthy one from a donor.
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Wearable Devices and Heart Failure
We already use wearable sensors with our smartphones and watches to track our daily steps and sleep. Now, researchers are studying whether these devices might also improve heart failure care and outcomes.
Wearable sensors that track measurements like your heart rate and blood pressure could help your doctor see whether your treatment is working, and if you need to make some changes.
Some heart monitoring features have already been incorporated into smartwatches. One technology uses a light sensor to measure changes in blood flow and heart rate through the skin.
The studies on wearable devices have so far been small but promising. In one study, a wearable vest that monitors fluid in your lungs helped reduce hospital readmissions by 87%.
A few challenges stand in the way of making wearable devices available for everyday use. One worry is that the connectivity these tools require might expose people's sensitive health data to hackers.
Heart Failure and Race
New treatments have improved heart failure survival overall, but not everyone has benefited equally. Black and Hispanic people are at higher risk for heart failure than white people. They're also less likely to get lifesaving treatments like an ICD, CRT, or heart transplant, and they're more likely to be hospitalized or to die from heart failure.
Where you live might also affect your prognosis. People who live in poorer neighborhoods are at higher risk for heart failure and worse outcomes from it. One reason could be a lack of access to healthy food, safe places to exercise, and good medical care.
Progression
A couple of weeks after Aylsworth awoke from her coma, her heart failure started to progress. "The first thing I noticed was my memory," she says. "The lack of oxygen to my brain due to low cardiac output made me forgetful. I forgot who my daughter was one time."
Her body began to hold onto fluid. It would seep out from between her fingers. She couldn't catch her breath, and everything she did made her tired. As the heart failure got worse, her organs started to fail. "My gallbladder kept backing up from my liver and poisoning me," she says. Then came the two cardiac arrests that nearly ended her life in 2018.
Heart failure is a chronic and progressive condition. It's with you for life and it gets worse over time. The course of heart failure can be unpredictable. It's also different for each person. But by following your treatment plan, you can manage your disease and keep it stable.
While you're in treatment for heart failure, it's important to maintain a good quality of life. This term describes how much of an effect heart failure symptoms have on your daily activities. A common way to measure quality of life is with the Kansas City Questionnaire. It includes 23 questions about your symptoms and how they've affected you in the last 2 weeks. Your doctor can use the results to adjust your treatment.
Outlook
Aylsworth's heart failure has improved, but her future is still uncertain. Her ejection fraction hovers only 4% above the range for heart failure.
"I don't know if I'll need a heart transplant later on," she says. "There's so much unknown. All I know is that I have the control to, at least right now, manage this. I know that if I do what I'm supposed to do -- take my meds, eat how I'm supposed to, get up and get out -- I'm going to feel good."
Given her uncertain future, she's making multiple plans for her medical care. She has a primary care doctor and cardiologist in Destin, FL, where she lives. And she's setting up connections with a major medical institution that has an advanced heart failure clinic, "in case things get bad again."
How Long Can You Live With Heart Failure?
It's normal to wonder how long you might live with a chronic condition. People with heart failure often have a shorter life expectancy than those without it. Survival rates decline the longer people live with heart failure. At one year after diagnosis, 80% to 90% of people are still alive. By 10 years, 30% are still alive.
Keep in mind that these are general numbers that include large groups of people. Everyone is different. Your life expectancy depends on how well you manage your heart failure and what other conditions you have. Your doctor can give you better insights on what your future might hold.
Planning for the Future
Even if you feel fine now, at some point you may be too sick to make health care decisions for yourself. Though it can be hard to talk about the end of life, making choices now will ensure you get the kind of care you want when that time arrives.
Advanced care planning involves thinking about your wishes for future care and then letting your family and doctor know them. For example, if you were to go into cardiac arrest, would you want CPR? Do you want to be put on a ventilator if you can't breathe on your own, or on a feeding tube if you can't eat?
Once you know what you want, write your plan into a document called an advance directive. It might include these documents:
Coming Back
Aylsworth enrolled in a cardiac rehabilitation program, coupled with outpatient treatment to address her alcohol use and PTSD. Cardiac rehab taught her interventions like diet and exercise to strengthen her heart.
Today, she takes 12 medications. Some manage her blood pressure. Others remove extra fluid from her body. She also takes supplements to replace the magnesium and potassium that her medicines deplete. Aylsworth credits medication and lifestyle changes like exercise, diet, and quitting alcohol with helping her recover.
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Aylsworth's doctors had told her that if she didn't see an improvement in her heart's pumping ability within the first 2 years, she most likely wouldn't see any at all. It took 2 1/2 years, but that improvement finally came.
"Everything that they told me to expect hasn't happened, and I'm doing the opposite. I'm getting better," she says.
"I'm able to walk without getting winded. I'm able to finish a sentence without gasping for air. I'm able to wake up in the morning without my face being full of fluid and puffy. I'm able to exercise with my daughter."
About 9 months ago, Aylsworth started working part-time at a performance and recovery center that specializes in cold therapy. She's close to earning her bachelor's degree in social work. And she recently celebrated her second anniversary of sobriety.
"Life now is so much different than it was before," she says. "I'm just so thankful to be here and to have survived, to be sober, to be healthy...It's hard not to be positive."
Lifestyle Changes For Heart Failure
What Is Ejection Fraction?
Staying Active with Advanced Heart Failure