Our bodies depend on a constant supply of blood from the heart to provide oxygen and nutrients to our organs and tissues. Heart failure occurs when the heart loses its ability to effectively pump blood to the body. Unlike a heart attack, which happens suddenly when there’s a blockage in an artery that supplies blood to the heart, heart failure happens gradually as the heart muscle weakens.
The heart has two upper chambers (atria) and two lower chambers (ventricles). The right upper chamber takes in blood from the body and sends it through the right ventricle, where it receives oxygen from the lungs. Blood then travels through the left atrium to the left ventricle and is pumped out to the body.
“Typically, when we say someone has heart failure, either they’re not getting enough blood flow or fluid is backing up into their lungs and the rest of the body,” says Dr. Srivastava. “Heart failure can range from very mild to extremely serious. There’s quite a spectrum.”
Systolic heart failure happens when the heart is not squeezing enough to pump adequate blood flow to the body. Diastolic heart failure develops when the ventricle is stiff and doesn’t relax enough after pumping. This can lead to fluid building up in the lungs, a condition called congestive heart failure.
Heart failure often occurs after a serious heart attack that affected blood flow to the heart, but other causes of heart failure include high blood pressure and diabetes. Lifestyle factors, such as smoking or obesity also may contribute. Some hereditary conditions or gene mutations that run in families can raise the risk, but having a mutation does not necessarily mean you will develop heart failure. Genetic testing can help identify mutations that may increase heart failure risk.
The most common symptoms of heart failure include:
- Difficulty breathing
- Rapid weight gain
- Ankle swelling
People may have mild heart failure symptoms, such as feeling a bit short of breath or putting on a few pounds, for months or years before they consult a doctor. That’s why it is important to get annual health check-ups with your physician or cardiologist. If you have mild symptoms that have developed over time, make an appointment to get them checked out. However, if your symptoms occur suddenly, such as sudden shortness of breath or swollen ankles, go to urgent care or the emergency room.
After evaluating your symptoms, your physician will likely order an electrocardiogram (EKG) to look at your heart rate and heart rhythm. You also may have an echocardiogram, an ultrasound of your heart muscle, to see how it’s squeezing and relaxing as well as how the valves are functioning.
Depending on where a patient falls on the heart failure spectrum, treatments may range from lifestyle changes and medication to surgery.
Dr. Srivastava advises all of his patients to start with a healthy lifestyle, including a heart-smart diet low in sodium, no smoking or sugary drinks, quality sleep and at least 20 minutes of physical activity most days of the week. Often, lifestyle changes combined with medication are enough to manage mild heart failure.
“If a patient does that and still comes back to me with symptoms, we are fortunate at Scripps to have devices and therapies like the CardioMEMS device,” says Dr. Srivastava. “It’s a chip that we place between the patient’s heart and lungs, and I can monitor their fluid levels in real time while they are at home.”
Patients who have leaky heart valves may benefit from surgery to repair or replace the valve; often, this is a minimally invasive procedure with a single small incision and a short recovery time. If the heart muscle itself is weak, surgery to implant a heart pump may be an option.
“These are just a few examples of treatment options for our patients with heart failure,” says Dr. Srivastava. “We have an excellent heart team and can offer therapies that can help you live a good life.”