BY JODI STAMPER, RN
Ministry Medical Group

Despite the name, heart failure does not mean the heart is quitting. It does mean, though, that the heart muscle is not pumping blood efficiently enough to meet the oxygen and nutritional demands of an individual’s body. This is a serious condition that can severely affect quality of life.

In its early stages, heart failure usually affects one side of the heart, but over time, both sides may be affected. The left ventricle is the bottom chamber of the heart that receives blood from the lungs and pumps oxygen-rich blood out to the body. The long-term result of uncontrolled high blood pressure or damage to the heart from a previous heart attack can cause left-sided heart weakness which leads to failure over time. The poor pumping ability of the left ventricle causes blood to back up into the lungs, causing shortness of breath, fatigue, coughing and congestion in the lungs.

The right side of the heart receives oxygen-poor blood from the body and pumps this blood to the lungs to be refreshed with oxygen. Right-sided heart failure usually occurs as a result of left-sided failure. As blood backs up over time, the right ventricle becomes weak and has a harder time pumping blood to the lungs. The result of this is even greater fluid buildup throughout the body. Eventually, the right ventricle becomes overworked and damaged, leading to right-sided failure. In some cases, often because of lung disorders, the right side of the heart can fail even when the left side of the heart is healthy.

The most common symptoms of heart failure include shortness of breath, fatigue and weakness, persistent cough or wheezing, swelling in feet, ankles or legs, decreased ability to exercise and a rapid heartbeat. It is normal for a person to have shortness of breath or fast heartbeat during or after a strenuous activity such as running, but a person with heart failure may feel these same symptoms when walking a bit faster than usual or, in later stages of heart failure, simply rising from a chair.

Swelling in the legs, feet, ankles and sometimes in the abdomen, is caused by fluid retention which is a result of the reduced pumping ability of the heart. This build up of fluids in the cells of the body is called edema. Ongoing edema places extra stress on the heart – making worse any damage that already exists in that muscle. Congestive heart failure, commonly known as CHF, occurs when blood backs up into the liver, abdomen or lungs due to the weakening of the heart muscle.

Heart failure is not the only reason one may experience edema. It can also be a result of eating too much salty food, vitamin deficiencies, kidney problems or from hormonal changes women experience as part of their monthly cycle. In many cases, physical activity and a low sodium diet can control fluid retention.

Risk factors for heart failure include a history of coronary artery disease (CAD), heart attack, high blood pressure, heart valve disease, idiopathic cardiomyopathy, lung disease, diabetes, obesity, alcohol and drug use and family history of heart failure.

If a diagnosis of heart failure is suspected, several tests need to be ordered by your clinician before the diagnosis can be confirmed. A chest x-ray will look for fluid in the lungs and the size and shape of the heart. An echocardiogram is an ultrasound that measures how well the heart is pumping blood and checks the thickness of the heart muscle as well as identifies any issues with the valves. An electrocardiogram (EKG/ECG) checks the electrical impulses of the heart and provides information on heart rhythm and how fast the heart is beating. It is very important that patients with heart failure monitor their weight closely as an increase weight of more than 3 pounds overnight or a 5-pound weight gain in one week may indicate worsening of their heart failure.

Successful management of heart failure occurs in closely working with your clinician and health care team. Education should include medications, diet and nutrition, exercise and activity, testing and treatments, as well as managing symptoms at home.

Jodi Stamper, RN, is a case manager with Ministry Medical Group, part of Ascension