Heart Failure

Causes, symptoms and stages of heart failure

Scripps Clinic cardiologist  Ajay Srivastava, MD, uses a stethoscope during a heart examination with Hall of Famer Rod Carew.

Dr. Ajay Srivastava, Advanced Heart Failure, Scripps Clinic

Causes, symptoms and stages of heart failure

Scripps cardiovascular teams are nationally recognized for breakthrough work in diagnosing and treating heart failure, the life-threatening condition that affects more than 5 million people in the US. Our doctors have decades of highly specialized experience helping people overcome heart problems and managing serious conditions which, if left unchecked, can be fatal.


Scripps has the only San Diego heart program consistently recognized as one of the nation’s best for cardiology and heart surgery by U.S. News & World Report. Locally, Scripps is ranked number one among regional health care providers in cardiology and heart surgery.

About heart failure

Heart failure is the heart’s inability to pump blood properly to deliver enough oxygen to the body. This complex condition is most common among patients age 65 or older, but it can affect people at any age.


Doctors can measure the heart’s pumping capacity, which is known as ejection fraction. A normal ejection fraction is more than 55 percent, according to the National Heart, Lung and Blood Institute. Enlargement of the heart’s left ventricle can reduce its ability to pump the necessary amount of oxygen-rich blood to the body, resulting in a lower ejection fraction. Heart failure is not the same as heart attack, which happens when there is a blockage in one of the arteries that supplies blood to the heart.

Diagnosing heart failure

Scripps cardiology teams use the most advanced heart screening technologies and procedures to detect and diagnose heart failure. These may include:


  • Medical history, including family history and review of medications
  • Physical exam including heart rate, blood pressure, weight, lungs and breathing, and any noticeable signs of swelling in the legs or belly region
  • Blood tests to detect other undiagnosed risk factors, such as diabetes, and to check if the kidneys and liver have been affected
  • An electrocardiogram (EKG or ECG) to record the heart’s electrical functions, such as heart rate, heartbeat rhythm, and strength and timing of electrical signals as they pass through each part of the heart
  • Stress EKG, a physical test typically involving a treadmill, that can detect reduced blood flow to the heart
  • Chest X-ray to provide a picture of the heart, lungs and major blood vessels
  • Echocardiogram (ECHO) using sound waves to create moving pictures of the heart — particularly its chambers and valves — and detect possible blood clots, fluid buildup or other problems
  • Cardiac blood pool scan (also called nuclear ventriculography) that shows how well the heart pumps blood to the rest of the body
  • Cardiac catheterization using the insertion of a long, thin flexible tube to check blood vessels that supply blood to the heart

Heart failure treatment at Scripps

Thanks to advancements in cardiovascular medicine, heart failure can be managed and potentially reversed in some cases. This is possible when heart failure is diagnosed early, treated successfully and patients make necessary lifestyle changes. These changes can include modifying diet, increasing exercise, reducing alcohol consumption or quitting smoking.

Medications and procedures for heart failure

Scripps heart specialists treat heart failure with the latest therapies and surgical procedures performed in state-of-the-art hospitals and facilities. Treating heart failure may involve one or more of the following:

Cardiac rehabilitation for heart failure

Our cardiac rehabilitation programs can help you recover faster and make necessary lifestyle changes to guard against repeat heart problems. Scripps can help you adopt a healthier lifestyle, including an exercise program and healthy diet designed to improve your health and help you move forward in a positive way after surgery, or interventional cardiology procedures to treat a heart condition.


Scripps Center for Integrative Medicine offers complementary therapies for heart failure. The customized Lifestyle Change Program combines complementary therapies with medical therapies in a holistic mind-body approach.


As part of our commitment to the community, Scripps also offers wellness and heart health classes free of charge to the public.

Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal membrane oxygenation (ECMO) is a treatment in which blood is oxygenated and waste is removed before being pumped back into the bloodstream. Scripps cardiac experts have successfully used ECMO as a short-term option for patients with massive heart attacks, or those who experience a sudden significant decrease in heart function and may suffer end-organ damage if not treated immediately.


ECMO is used only after medications and a breathing machine (ventilator) have failed, and works for the heart, lungs or both. This life-saving measure is usually performed in the operating room, but it can also be used in the emergency room, a hospital room or outside the hospital.

Home care for heart failure

The first step to managing your heart failure symptoms is knowing what’s normal for you. This is considered your baseline. Knowing your baseline and tracking your heart failure symptoms every day can help you quickly identify signs of your condition worsening.

What to expect at your first appointment

During your first appointment with our heart failure specialists, you’ll meet our heart failure team, including a heart failure physician and a nurse practitioner/physician assistant. We will review your medical history and any medical test results.


During the visit, you can expect to:


  • Learn more about your condition
  • Receive diet and lifestyle recommendations 
  • Have your medications adjusted 
  • Obtain orders for follow-up tests


We usually perform the following tests:


  • Echocardiogram (ultrasound imaging of the heart) to measure your heart and valve function
  • Electrocardiogram (EKG) to assess the rhythm of your heart
  • Blood tests to check your kidney and liver function
  • Device check of your cardiac defibrillator or pacemaker to make sure it is working appropriately


Depending on the severity of your condition, several diagnostic tests may be performed after your appointment, including exercise stress testing (VO2 max testing) and cardiac catheterization.


  • Please bring your medication list and the actual pill bottles for those medications.
  • Bring any test results, including laboratory tests. It is best to obtain the images on CD for echocardiograms, angiograms and stress tests.
  • We usually obtain notes from your physician before your appointment, but encourage you to bring any medical documentation available to you.
  • If you need any diagnostic tests, our clinic will help you set up appointments.
  • Plan to be at the clinic for at least one hour.

Research and clinical trials

Scripps is consistently on the leading edge of cardiovascular research and clinical trials, working to bring the most innovative treatments and care options to patients. Locally and regionally, we’ve led the way with many firsts for cardiovascular breakthroughs.


Our physicians and scientists are actively involved in research and studies to provide greater understanding of heart disease and enable a faster availability of new treatments to patients. If you are interested in participating in clinical trials, please discuss with your physician about potentially appropriate matches.