American Medical Association Family Medical Guide - American Medical Association [329]
In systolic heart failure, blood backs up in the veins that carry blood from the lungs to the heart, increasing blood pressure in the lungs. The lungs become swollen and congested with fluid. This condition is called pulmonary edema. In diastolic heart failure, blood accumulates in the veins that lead to the heart from other parts of the body. These parts of the body, especially the legs, ankles, and feet, may become swollen. Some people who have diastolic heart failure also have lung congestion.
Despite its name, heart failure is not always life-threatening. The outcome depends on the severity of the underlying disorder that is causing heart failure and on how soon treatment begins. Although there is no cure for heart failure, it can be controlled with medication and a healthy lifestyle.
Symptoms
Heart failure usually develops slowly. The main symptom of heart failure is shortness of breath as a result of lung congestion. You may become short of breath while active or while resting. You may have difficulty breathing when you lie down, and your breathing problems may become severe enough to disturb your sleep. At times you may wake up gasping for air. Although episodes of severe shortness of breath usually last less than an hour, the experience can be frightening.
Your lungs may become so swollen and congested that your breathing may be raspy or you may wheeze. You may also have chest pain and a persistent cough that produces frothy, blood-flecked phlegm. The fluid in your lungs decreases your resistance to infection; pneumonia (see page 660), for example, is a frequent complication of heart failure.
Fatigue is another common symptom of heart failure. Because your body tissues are not receiving enough oxygen and nutrients, you may feel weak or tire easily. Fluid accumulation may cause the lowest part of your body to swell. For example, if you are confined to bed, the lower part of your back may become swollen. If you are standing, your legs, ankles, or feet may become swollen. Your liver may also become swollen, causing abdominal pain.
Other possible symptoms of congestive heart failure include low blood pressure, dizziness, and confusion. You also may lose your appetite but experience rapid weight gain from the accumulation of fluid.
For some people, symptoms may not develop until the condition is at an advanced stage. The heart muscle attempts to compensate for its decreased pumping ability by growing larger and thicker and contracting more often. However, the effects of this adjustment are only temporary, and symptoms develop eventually.
Diagnosis
Diagnosis of heart failure is based on your symptoms and risk factors and a physical examination. The doctor will listen for lung congestion and abnormal heart sounds with a stethoscope. He or she may order a chest X-ray to look for lung congestion and check the size and shape of your heart. The doctor may order an echocardiogram (see page 561) to examine the heart valves and determine how much blood the heart pumps out when it contracts, and an electrocardiogram (ECG; see page 559) to determine how well the heart is functioning. He or she may also recommend a coronary angiogram (see page 561) to evaluate the condition of the coronary arteries. The doctor may order additional tests to rule out possible causes of your symptoms other than heart disease, such as anemia (see page 610) or an overactive thyroid gland (hyperthyroidism; see page 901).
Treatment
Treatment of congestive heart failure focuses on the underlying disease or condition that is causing it. Your doctor will recommend lifestyle changes you will need to make to improve the quality of your life and control your risk factors for heart disease. For example, if you smoke, your doctor will recommend that you quit smoking. He or she also will recommend that you lose weight if necessary and reduce the amount of fat in your diet. Your doctor also may recommend reducing your intake of caffeine and sodium and eating smaller,