What Is Heart Failure?
Heart failure means that your heart isn't working as efficiently as it should. If your doctor thinks you might have heart failure, they will talk with you about your medical history and do a physical exam and tests.
Medical history: To get your medical history, your doctor will want to know if:
- You have any other health problems such as diabetes, kidney disease, angina (chest pain), high blood pressure, or other heart problems
- You smoke
- You drink alcohol, and if so, how much
- You are taking medications
Physical exam for heart failure: Your doctor will look for signs of heart failure as well as other illnesses that may have weakened your heart. They will:
- Listen to your heart
- Take your heart rate
- Check your blood pressure
They’ll also look at your appearance while you sit, do mild activity, and lie flat. People with mild or moderate heart failure may appear comfortable at rest, but when active, they often become short of breath. Those with heart failure may be uncomfortable if they lie flat for a few minutes.
Your doctor may check for fluid in your lungs with a stethoscope. People with heart failure may also have neck veins that are larger than normal, swelling of the legs or belly, or an enlarged liver.
Heart Failure Tests
Tests that your doctor might order to diagnose heart failure include:
Blood tests to check for anemia, thyroid problems, and high cholesterol, conditions that can be related to heart failure. There is also a blood test for B-type natriuretic peptide (BNP), which can indicate active heart failure.
Urine tests to look for signs of kidney problems or diabetes, a cause of heart disease
Electrocardiogram (ECG or EKG) to assess the heart rate and rhythm. This test can often detect heart disease, heart attack, an enlarged heart, or abnormal heart rhythms that may cause heart failure.
Chest X-ray. You may get this done to see if your heart is enlarged and if your lungs are congested with fluid.
Echocardiogram. This is an ultrasound test to check on heart muscle function, see how well the heart is pumping, and detect problems with the heart valves that may cause heart failure. It can also measure ejection fraction (EF). EF is a measure of how much blood is pumped out of the heart with each beat. A normal EF is generally greater than 55%, which means that over half of the blood volume in the heart's main pumping chamber is pumped out with each beat.
Radionuclide ventriculography. This shows the pumping function of the left and right ventricles (the heart's large pumping chambers) during heart contractions. This test can also measure EF. Rarely done by itself, you may get it as part of an exercise stress test.
Cardiac MRI. The goal is to distinguish scar from normal tissue and abnormalities in the heart muscle. Cardiac MRI can also measure EF. This test is generally available only in large heart centers and is rarely used as a first step in heart disease diagnosis.
Exercise stress test. This is an EKG done while you either walk on a treadmill, cycle on a stationary bike, or use medications to simulate exercise. This test lets your doctor check for any heart function problems brought on by exercise, which may indicate coronary artery disease.
Your doctor may also do more invasive tests, such as cardiac catheterization, to directly visualize the heart's chambers. This test can determine if coronary artery disease is present and can also measure EF.
CT coronary angiogram. It uses an X-ray and a contrast dye to see if you have coronary artery disease. Your doctor can view images in 3D, which lets them see blockages in your arteries.
Myocardial biopsy. In this test, your doctor puts a small, flexible biopsy catheter into a vein in your neck or groin, and takes a small piece of your heart muscle. This test can diagnose certain types of heart muscle diseases that cause heart failure.
Heart Failure Treatment
Treatment of heart failure focuses on slowing or reversing its progression. The earlier treatment starts, the better.
After making the diagnosis, your doctor will recommend lifestyle changes. They may recommend that you reach and maintain a healthy weight, become more active, cut down on sodium and fluids, and avoid alcohol. If you smoke or chew tobacco, you'll be advised to stop. You'll work with your doctor to find the right balance of rest and activity, as mobility is important for blood circulation. You will also need to weigh yourself daily and record your weight to help flag any fluid retention.
Your doctor will also prescribe several medications to manage your heart failure or the problem that caused the heart failure. Drugs used to treat heart failure, often in combination, include:
Diuretics or water pills can help reduce symptoms of heart failure or keep them from getting worse. For example, they may help make breathing easier by helping pull fluid out of the lungs. A diuretic makes you urinate a lot, especially when you first start taking it. The diuretics you're most likely to be started on for heart failure include bumetanide (Bumex), furosemide (Lasix), and torsemide (Demadex).
Your doctor may also prescribe a thiazide diuretic like chlorothiazide (Diuril) or metolazone (Zaroxolyn). Another option is a mineralocorticoid receptor antagonist like eplerenone (Inspra) and spironolactone (Aldactone) that removes extra salt and fluid and holds onto potassium.
ACE inhibitors have several benefits for people with heart failure. These medications are vasodilators, which means that they expand blood vessels and increase blood flow, thus helping the heart pump more efficiently. ACE inhibitors are important heart failure drugs since they have been shown to help most people with heart failure live longer and with a better quality of life. ACE inhibitors include: captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace) and trandolapril (Mavik).
Angiotensin receptor blockers (ARBs) work in similar ways as ACE inhibitors. They are prescribed when people get side effects from ACE inhibitors, such a cough or high potassium levels. Examples of ARBs include: candesartan (Atacand), losartan (Cozaar), and valsartan (Diovan).
Angiotensin receptor-neprilysin Inhibitors (ARNs) combine a neprilysin inhibitor and an ARB. Entresto (sacubitril/valsartan) is seen as a possible replacement for ACE inhibitors or other ARBs.
Beta-blockers can improve the heart's ability to relax, and curb production of harmful hormones made by the body in response to heart failure. Beta-blockers used to treat heart failure include carvedilol (Coreg) and metoprolol (Lopressor).
Digoxin, sold under the brand name Lanoxin, may improve heart pumping function and control certain heart rhythm problems. Digoxin is an older medication and not used as often as in the past, because many of the newer drugs appear to have more profound effects on symptom control and overall outcome. But it may still be a reasonable add-on for people whose symptoms don't improve with diuretics and ACE inhibitors.
Selective sinus node inhibitors is a class of drug which targets a specific area of the heart, the sinoatrial pacemaker. Ivabradine (Corlanor) lowers the heart rate and helps the lower left ventricle contract more efficiently.
Soluble guanylate cyclase (sGC) stimulators help relax and widen the blood vessels so blood can flow more easily. The drug vericiguat (Verquvo) can be prescribed for people with chronic heart failure who have been hospitalized or need IV diuretics. It helps reduce the risk of dying and further hospitalization.
Some of these drugs may cause unwanted side effects. Tell your doctor about any problems you have. Don't stop or cut down on the dose of any prescribed medication unless your doctor tells you to.
In some cases, when drugs don't improve heart function enough or cannot be tolerated, you may need surgery or another procedure. Doctors recommend surgery for several major reasons: to correct certain problems that cause heart failure (such as coronary artery bypass graft surgery), to repair or replace valves, to implant devices (such as an intra-aortic balloon pump, specialized pacemakers, ICDs, or ventricular-assist devices) to help the heart pump, or to transplant a new heart. Heart transplants are used to treat severe congestive heart failure.
If the cost of any medications is a problem for you, tell your doctor. There may be lower-priced generic medications or other options.