If the heart muscle is weak, it can’t pump well — that’s Heart Failure (HF) (“CHF” for “Congestive Heart Failure” is the old term). It usually happens to the left side of the heart, which pumps blood throughout the body, but sometimes only affects the right side that pumps blood to the lungs (see Diagram — Anatomy of the Heart). There are a variety of causes:
- long-standing or severe Hypertension (high blood pressure)
- Heart Attacks (current, or previous)
- other heart diseases (damaged valves, Atrial Fibrillation, etc.)
- viral infections (Myocarditis)
- toxins (especially alcohol)
- various uncommon diseases
The main symptom of HF is new shortness of breath while walking or exercising. At night there’s often a cough that makes people sleep sitting up, or sudden shortness of breath that awakens them. The feet may swell.
We suspect HF if we hear crackles (“rales”) at the bottoms of the lungs, with a stethoscope. We might find swollen feet (subtle or obvious), prominent neck veins (hard to see), or hear certain sounds in the heart (“gallops” or “murmurs”).
Diagnosis is easily made by echocardiogram, which also helps distinguish among the sub-types of HF, which can help us pinpoint the cause. A blood test for the B-type Natriuretic Peptide (“BNP”) is a quick way to rule out HF if the test is normal.
Prognosis, i.e. what will happen to the patient, all depends on the cause and severity. Many patients with HF can have their disease controlled with a variety of medications, and avoiding salt. Those with very severe HF may have a defibrillator implanted in the heart, to prevent sudden death. Some need a heart transplant (some can’t qualify).