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Diagnosis: Heart Failure

By age 60, your heart has beaten over two billion times.  Day after day.  Minute after minute. Is it any wonder that, for millions of adults, the heart’s pumping power gradually begins to decline? 

This decline is what doctors call “heart failure.”  It doesn't mean the heart is suddenly shutting down. Quite the opposite, it is working harder. Heart failure means that the heart's ability to deliver enough oxygenated blood to all the body's organs and tissues is compromised. Undiagnosed and unchecked, this can lead to debilitating or even fatal damage.

The good news is that heart failure is manageable. You can ease your heart’s workload—and your worry.  In Diagnosis: Heart Failure you’ll learn the mechanics of the heart, the symptoms and warning signs of heart failure, and, most of all, the keys to an effective treatment plan. 

The report will brief you on the expanded array of diagnostic tools that let doctors accurately assess a heart’s condition and pinpoint the contributing causes of heart failure. 

You’ll learn how new classes of medication continue to improve the prognosis for men and women with heart failure.  The report compares the efficacy and side effects of more than 50 frontline drugs including beta blockers, diuretics, ACE inhibitors, and more.

Equally important, the report will help you understand and invest in the steps you need to take to keep heart failure in check. You’ll get guidance for monitoring symptoms, for sticking to your doctor's strategy, and for making heart-smart lifestyle changes.

Prepared by the editors of Harvard Health Publications in consultation with Deepak L. Bhatt, MD, Professor of Medicine, Harvard Medical School; Chief of Cardiology, VA Boston Healthcare System; Director, Integrated Interventional Cardiovascular Program, Brigham and Women’s Hospital; and VA Boston Healthcare System Senior Investigator, TIMI Study Group. 49 pages. 2013.

  • 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
    • Medications 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 subpar 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 eff ort to expel blood more forcefully, the walls of the left ventricle thicken, or the chamber may dilate and take 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 suffi cient output. Levels of stress hormones, which signal the heart to beat
faster and harder in times of need, 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 fi xes 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. Th e 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.

The following reviews have been left for this report. Log in and leave a review of your own.

This is a thorough explanation in a general sense and very helpful to understanding my Dad's heart failure diagnosis.
This is a great Health Report from Professor Bhatt. The illustrators have also done a marvellous job. Obviously heart surgery has come a long way since the happenings in South Africa in the late nineteen sixties! Thank you, Dr Bhatt!

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