Heart Failure: Causes, Risk Factors, Symptoms, and Treatments (video/podcast)

The words “heart failure” may sound alarming, but they don’t mean that the heart has completely stopped beating. Rather, heart failure means that the heart is not pumping enough blood to meet the body's needs — and while it certainly is a serious condition, it is not an instant death sentence.

Heart failure affects millions of people in the United States. In this video, San Diego Health host Susan Taylor discusses with Rola Khedraki, MD, a heart failure and transplant cardiologist at Scripps Clinic Anderson Medical Pavilion in La Jolla, what causes heart failure and how it is treated.

Heart failure is caused by conditions that damage the heart muscle and affect its ability to pump blood. Heart failure is not the same as a heart attack, which happens when the flow of blood to the heart is suddenly blocked.

However, a heart attack can damage the heart tissue, which can then lead to heart failure. Other medical conditions that impact the heart, such as high blood pressure, coronary artery disease, valve disease and diabetes can also raise the risk of heart failure.

“Age is another risk factor; as we get older, we may be more likely to have these conditions. Lifestyle factors, such as smoking, excessive alcohol use, diets high in processed foods, sedentary lifestyles and chronic stress, can increase heart disease risk,” says Dr. Khedraki. “Genetics also play a role, so if heart disease runs in your family, you might be at higher risk.”

As the heart struggles to get enough blood to the rest of the body, symptoms of heart failure typically include shortness of breath, fatigue and swelling in the legs, ankles or abdomen caused by a buildup of fluid. Fluid in the abdomen can sometimes lead to poor appetite and nausea.

“Congestive heart failure” is a term used to describe heart failure in which fluid buildup is a main symptom, but there is no significant difference between these terms.

Diagnosing heart failure starts with taking a medical history and evaluating the patient’s symptoms. Common diagnostic tests include an electrocardiogram, which looks at the heart rate and rhythm, and an echocardiogram, which is an ultrasound of the heart that shows the heart muscle and measures the pressures inside of the heart.

Unless heart failure is caused by a condition that is reversible, such as a blocked artery, it is considered a chronic condition. How long a person can live with heart failure depends on the individual and the severity of the condition; some patients have very mild heart failure, while others have very advanced. One of the strongest predictors of life expectancy is how often people have to be admitted into the hospital for heart failure.

“Heart failure treatments are really aimed at keeping patients out of the hospital, extending their life and improving their quality of life,” says Dr. Khedraki. “It is an exciting area, because we've seen so many advancements.”

The first step in treatment is usually a combination of drugs that attack the heart failure pathway from different angles. These work to decrease the workload on the heart, relax the blood vessels and decrease stress hormones that cause heart failure.

If medications alone are not effective, a cardiologist may recommend surgical therapies. Tiny electronic devices, implanted into the upper chest wall, can synchronize the electrical activity of the heart. This is appropriate when both sides of a patient’s heart are not contracting simultaneously. Defibrillators are devices that deliver a shock to the hearts of patients who are at risk for life-threatening arrhythmias, which are irregular heartbeats.

“In some cases, we offer surgeries to fix heart valves and heart arteries,” says Dr. Khedraki. “Fortunately, nowadays, we have many minimally invasive techniques to deliver heart valves or stents to open blocked arteries.”

In severe cases where patients have advanced heart failure, a type of pump called a left ventricular assist device (LVAD) may be implanted into the left ventricle to help pump blood through the body.

To some extent, says Dr. Khedraki, heart failure can be prevented.

“Prevention involves managing risk factors, adopting a healthy lifestyle that limits processed foods, exercising regularly, avoiding excess alcohol, managing stress and having good quality sleep. That also means treating sleep disorders like sleep apnea,” she says.

“Have regular checkups with your doctor, so that when problems arise, they can be caught early. And, listen to your body. Pay attention when you have symptoms like shortness of breath, chest discomfort and seek medical attention immediately.”

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