Heart Failure

Almost 2% of all Americans (nearly six million) suffer from congestive heart failure. The number continues to grow, making heart failure the number-one reason for hospitalization in Americans 65 and older.

Common causes of congestive heart failure come from other medical conditions that weaken the heart muscle or the arteries in and around the heart. The most common include:

• Heart valve disease
• Hypertension (high blood pressure)
• Infection (endocarditis)
• Previous heart attacks
• Coronary heart disease (thickening and narrowing of the coronary arteries)
• Congenital heart disease or defects
• Diabetes
• Heart rhythm disorders (cardiac arrhythmias)
• Cancer therapy-associated heart failure
• Genetic diseases
• Pregnancy-associated heart failure and peripartum cardiomyopathy

Another contributing cause of heart failure is cardiomyopathy, which describes any disorder that affects the heart muscle. Three forms of cardiomyopathy are:

• Hypertrophic cardiomyopathy is an uncommon, often familial, condition that involves abnormal thickening of the left ventricle and stiffening of the heart, due to a genetic mutation in key proteins involved in heart muscle contraction
• Dilated cardiomyopathy, the most common type of cardiomyopathy, refers to a markedly enlarged heart with an impaired ability to pump blood. This also can be caused by genetic mutations or other secondary factors, such as viruses or toxins
• Restrictive cardiomyopathy occurs when the heart muscle becomes stiff due to progressive fibrosis or accumulation of abnormal substances and is unable to properly fill with blood

The likelihood of developing congestive heart failure increases with age, mainly due to risk factors having more time to take hold. Lifestyle choices and medical conditions play a role in heart failure risk factors. Those include:

• High blood pressure
• High cholesterol
• Unhealthy diet
• Diabetes
• Obesity
• Tobacco or recreational drug use
• Stress
• Sedentary lifestyle

Common symptoms of heart failure may slowly progress or suddenly start, indicating signs of congestive heart failure. If left untreated, congestive heart failure symptoms progressively worsen over time. Common symptoms of heart failure include:

• Swelling, often in the legs and ankles
• Shortness of breath, especially during physical activity or when lying down
• Weight gain
• Weakness and fatigue
• Nausea, abdominal pain and loss of appetite
• Ongoing cough
• Weight gain of more than two pounds overnight or five pounds in a week

All of these symptoms are common to many medical conditions and may not indicate heart failure. If you experience any of these symptoms or have concerns, consult your doctor.

Congestive heart failure diagnosis is achieved through a comprehensive assessment of the heart muscle, including a doctor's evaluation of the heart's pumping action and thickness of its walls. This testing helps doctors with the diagnosing of heart failure and can determine the underlying cause. Diagnostic tests for congestive heart failure may include:

• Cardiac ultrasound (echocardiogram)
• Standard exercise tolerance test
• Electrocardiogram (also known as EKG, ECG or stress test)
• Magnetic resonance imaging (MRI) scan
• Chest X-ray
• Cardiac catheterization
• Cardiac biopsy
• Nuclear scan
• Positron Emission Tomography (PET) scan
• Cardiac tomography (CT) scan

Patients can expect four congestive heart failure stages, from those at risk of developing heart failure to advanced levels of congestive heart failure.

1. Based on risk factors, family history and/or medical conditions, a patient is deemed at a high risk of developing congestive heart failure.
2. Symptoms may not have presented in this stage, but a doctor has found systolic left ventricular dysfunction and an echocardiogram reads a diminished ejection fraction, often 40% or less.
3. At this point some symptoms of congestive heart failure have presented and a doctor has made a congestive heart failure diagnosis.
4. The final stage of congestive heart failure shows worsening symptoms that are often unresponsive to treatments.

Congestive heart failure treatment aims to improve and extend quality of life for patients. Congestive heart failure is treated and managed through a combination of lifestyle modifications and a wide range of therapies, including medication and interventions, intended to help the heart work more effectively while alleviating heart failure symptoms. Pacemakers and ventricular assist devices can make it easier for the heart to pump blood and remain in rhythm. For some patients with advanced heart failure, a heart transplant may be an option.

Lifestyle Changes

Congestive heart failure patients can improve their quality of life with healthy lifestyle improvements. A heart-healthy diet that includes:

• Weight loss and physical activity
• Fat and salt reduction
• Blood pressure control
• Smoking and alcohol cessation

Medical Therapies

Doctors rely on a mix of medical therapies designed to improve heart function while reducing symptoms, such as:

• Dilate blood vessels and reduce the workload on the heart
• Decrease pressure inside the blood vessels
• Reduce fluid in the body
• Help the heart beat stronger and more regularly

Read more about medications used in the treatment of heart failure/cardiomyopathy.

Non-Surgical Procedures

• Cardiac ablation
• Cardiac resynchronization therapy (CRT)
• Implantable cardioverter defibrillator (ICD)
• Percutaneous catheter-based interventions
• Stents
• Percutaneous transluminal coronary angioplasty (PTCA)
  • Intra-aortic balloon pump (IABP)
  • Intravenous ultrasound (IVUS)
  • Percutaneous ventricular assist device (PVAD)
  • Tailored therapy (oral and IV medications with hemodynamic monitoring used to optimize blood flow and improve patient's symptoms)

Surgical Interventions

• Aortic valve repair and replacement
• Coronary artery bypass grafting (CABG Surgery)
• Ventricular assist device (VAD)
• Heart transplantation

Clinical Trials

Physicians and surgeons at Brigham and Women’s Hospital are leaders in the science of heart failure management and cardiac transplantation, and provide access to a range of clinical trials of experimental therapies that may benefit heart failure patients.

• Metabolic therapy to reduce heart failure readmissions
• Iron deficiency treatment that contributes to cardiac dysfunction
• Long-acting nitrates to improve activity level in patients with heart failure and preserved heart function
• Implantable devices to monitor heart function

Learn more about our research and clinical trials.

For patients and their family members who have familial cardiac diseases such as hypertrophic cardiomyopathy, the Heart and Vascular Genetics Program offers evaluation by a specialist and blood testing for genetic cardiac disorders.