Living with Heart Failure

• Understanding heart failure
  • How the healthy heart works
  • What happens in heart failure
  • What causes heart failure?
  • Types of heart failure
  • Stages of heart failure
• Diagnosing heart failure
  • Your medical history
  • Physical examination
  • Diagnostic tests
• Taking care of yourself with heart failure
  • What is a treatment plan?
  • Reducing your risk factors
  • Monitoring your symptoms
  • Monitoring your weight
  • Balancing salt and fluids
  • Exercising wisely
• Medications for heart failure
  • Diuretics
  • Angiotensin-converting–enzyme (ACE) inhibitors
  • Angiotensin-receptor blockers
  • Aldosterone antagonists
  • Beta blockers
  • Digoxin
  • Other cardiovascular medicines
  • Drugs not recommended for people with heart failure
• SPECIAL BONUS SECTION: High-tech hearts
• Living with heart failure
  • Barriers to treatment
  • Disease management programs
  • Managing medications
  • Heart failure and your emotions
  • The value of hope
• Appendix: Heart failure medication guide
• Resources
• Glossary

What happens in heart failure

Heart failure may start with injury from a heart attack, develop as a result of damaged valves, or be brought on by infection or disease. Many times, it is the product of years of toil against high blood pressure and clogged arteries. Regardless of exactly what sets the process in motion, heart failure culminates in a progressive weakening of your heart’s power to pump. Consequently, blood circulates through your heart and body more slowly; your cells thirst for fresh oxygen and nutrients.

Outward signs of the cardiac muscle’s sub-par performance may remain hidden for months or even years while heart failure advances. To compensate for its weakened state, the heart undergoes a series of structural transformations known as cardiac remodeling. In an effort to expel blood more forcefully, the walls of the left ventricle thicken. The chamber also dilates and takes on a rounder shape, which allows it to hold a larger quantity of blood.

Other physical processes also come to the heart’s aid as it struggles to maintain sufficient output. Levels of stress hormones, which signal the heart to beat faster and harder in times of stress, rise. Blood vessels constrict in an effort to keep blood pressure stable despite the fact that a lower quantity of blood is being pumped out. Circulation is also diverted away from the skin and less important tissues so that the heart and brain receive a steady supply of oxygen and nutrients. In turn, the diminished blood flow to the kidneys activates a set of hormones that prompt the body to retain sodium and fluid in an attempt to supplement the total volume of circulating blood.

In the short run, these fixes enable the heart to deliver a near-normal level of blood to the tissues. But the solution is only temporary. Ultimately, these alterations hasten the heart’s decline. The heart’s modified shape increases the stress on the muscle as it attempts to consume more oxygen. Eventually, the benefits obtained from this accelerated pumping diminish. The faster heartbeat and narrowed blood vessels amplify the heart’s workload, and the costs of the additional yield outweigh the advantages of increased output.