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Am Fam Physician. 2001;63(4):773-774

What is heart failure?

Despite the way it sounds, the term “heart failure” doesn't mean your heart has stopped working completely. It simply means that your heart isn't pumping blood through the body as well as it should. Heart failure is also called congestive heart failure. “Congestive” means fluid is building up in the body because the heart isn't pumping the way it should

What causes heart failure?

Heart failure has many different causes. Some of the common causes are listed below:

  • Coronary artery disease (narrowing of the blood vessels to the heart)

  • Past heart attack

  • Problems with the heart muscle (also known as cardiomyopathy)

  • High blood pressure

  • Heart valve problems resulting from disease, infection or a congenital (present from birth) defect

  • Abnormal heart rhythms (also known as arrhythmias)

  • Damage to the heart caused by substances, such as alcohol or drugs

  • Congenital heart disease

What are the symptoms of heart failure?

Some people with heart failure have few problems or symptoms. Possible symptoms include:

  • Shortness of breath (perhaps when walking or climbing stairs)

  • Shortness of breath when lying down

  • Breathlessness that wakes you up suddenly in the night

  • General tiredness or weakness

  • Swelling of the legs (usually just the feet or ankles)

  • Rapid weight gain (1 to 2 pounds a day for three days in a row). To keep track of your weight, weigh yourself each morning after urinating but before eating anything.

  • Chronic cough

Call your doctor if you have any of these symptoms, especially if you had heart problems before.

What tests are needed to diagnose heart failure?

Your doctor may initially diagnose heart failure based on your medical history, your symptoms and a physical exam. He or she might also order one or more of the following tests:

  • Blood tests

  • Urine tests

  • Chest x-ray

  • Electrocardiogram (also called EKG or ECG)

  • Echocardiography or radionuclide ventriculography

The last two tests are often used to make sure of the diagnosis of heart failure. In a test called echocardiography, a probe that sends out sound waves is moved across the surface of your chest. This allows your doctor to get pictures of your heart that show how well it is pumping.

Radionuclide ventriculography is a test that involves injecting very low doses of a radioactive substance into your blood. This substance travels to your heart and helps your doctor get pictures showing how well it is pumping. The radioactive substance is safe and leaves your body completely after the test is finished.

What treatment will I need if I have heart failure?

Heart failure can't be completely cured, but many steps can be taken to improve your heart's pumping and to treat your symptoms. An important part of treatment is taking care of any underlying problems, such as high blood pressure. Treatment may also include lifestyle changes and medicine. Here are some important things you should talk about with your doctor:

Diet. You may need to reduce the amount of salt and fat you eat. Other changes in diet may be advised, depending on what other health problems you have.

Alcohol. You will be advised to avoid alcohol or strictly limit your use of it.

Exercise. Most people with heart failure can still exercise, but your doctor will help you decide how much and what kind of exercise is right for you.

Medicine. Many different medicines are used to treat heart failure. You may need to take one or more medicines, depending on your symptoms. Your doctor will talk about these medicines with you. It may take a while to find the right medicine for you and the right amount of it, but you should always take your medicine exactly as your doctor tells you to.

Family support. Your family can be a big help to you as you deal with heart failure, so involve them when possible.

Other sources of support. Your doctor can give you information about support groups for people with heart failure. It sometimes helps to talk with other people who have similar problems.

For more information

American Heart Association

National Heart, Lung, and Blood Institute

Agency for Healthcare Research and Quality (AHRQ)

  • Publications Clearinghouse

  • Telephone: 1-800-358-9295

  • Web address: (Ask for AHCPR Publication No. 94-0614)

The Mended Hearts, Inc. (support group for heart patients and their families)

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