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Published on May 28, 2019

What You Need to Know About Heart Failure

Heart failure graphic.

Source: UNC Health Talk.

Heart failure, also known as congestive heart failure, is a chronic condition that affects more than 6 million Americans, according to the American Heart Association.

Despite its name, heart failure does not mean your heart has stopped working. Rather, it means that your heart has weakened or been damaged so it isn’t able to pump enough blood to the rest of your body. In other words, your heart simply cannot keep up with the demands of your body at rest or during activities, such as work or exercise. Common symptoms include swelling in the abdomen and legs, shortness of breath with walking or lying down, and fatigue.

“Heart failure is a generic term that actually encompasses a lot of different syndromes,” says UNC REX cardiologist Elizabeth Volz, MD. “It can be caused by any number of things.”

Common and Not-So-Common Causes of Heart Failure

In the United States, one of the most common causes of heart failure is coronary artery disease, Dr. Volz says. Coronary artery disease results from the buildup of plaque or fatty deposits in your arteries. This slows blood flow, which can lead to a heart attack.

“If someone had a heart attack or damaged their heart muscle directly, it puts a significant strain on the heart,” she says.

In addition to coronary artery disease, uncontrolled high blood pressure may lead to heart failure.

“Chronically elevated blood pressure means your heart has to work harder than it should to circulate blood throughout your body,” Dr. Volz says. Over time, this extra workload can make your heart muscle too stiff or too weak to pump blood effectively. Damage to the heart muscle caused by drug or alcohol use or some viruses also increases the risk of heart failure. Diabetes is another strong risk factor for coronary artery disease and subsequent heart failure.

Dr. Volz says less common causes of heart failure include genetic predisposition, obesity and some medications, such as certain chemotherapy.

Warning Signs

Two of the most common symptoms of heart failure, Dr. Volz says, are shortness of breath and fatigue.

“These tend to be worse when people are trying to do activities, something as benign as walking from room to room, up a flight of stairs, carrying groceries or trying to work,” she says.

Another common symptom is retaining fluid. This is partly because the kidneys aren’t receiving enough blood to work properly; the fluid may build up in the arms, legs, lungs or other organs, and the body becomes congested—hence the term congestive heart failure. Also watch out for symptoms such as chest pain, dizziness or fainting, and fluctuations in blood pressure.

How to Treat Heart Failure

Heart failure is a serious condition that requires medical attention. However, with proper treatment and lifestyle changes, you can live a long, active life.

“There are prescription medications that address whatever it is that was causing the heart to fail. So if it’s high blood pressure, then the medications would address the high blood pressure. If it’s fluid retention, diuretics increase urination to help remove excess fluid from the body,” Dr. Volz says. “With good medical therapy, patients can have an improvement in symptoms and go on to lead normal lives.”

Patients who have heart blockages or have had a heart attack may need a procedure to place stents or bypass surgery to improve blood flow.

In addition to medication or a heart procedure, Dr. Volz says patients need to follow a low-salt diet and make other lifestyle changes. “We educate all of our patients on low-sodium diets because salt affects fluid retention. If you eat a high-salt diet, it tends to make you retain even more water, and that’s detrimental to someone who has congestive heart failure,” she says. “Smoking and alcohol use are strongly discouraged because of their impact on the heart and blood pressure.” Exercise and being active are also encouraged.

Dr. Volz encourages patients to weigh themselves every morning to monitor water retention. If they see a difference, they should call their doctor. “If a patient gains water weight quickly, we may instruct them to take additional water pills for a couple of days to help reduce fluid retention,” she says.

She also asks patients to monitor their blood pressure and heart rate daily. “This way we can make sure that we get them on the optimal dose of the medications,” she says. “To some degree, we want patients to have low blood pressure, because that helps the heart pump more efficiently.”

Improvement Takes Patience

Dr. Volz cautions that the medications may make people feel worse before they feel better. The medications focus on the chemical changes that happen with heart failure.

“When the heart’s failing, there are a lot of signals from the nervous system, a lot of chemicals and hormones that really snowball and make you feel worse,” Dr. Volz says.

“Patients need to hang in there and take their medication even if they don’t necessarily feel better right away,” Dr. Volz says.

An Ounce of Prevention

It’s important for everyone to see a primary care doctor regularly, Dr. Volz says. A physician’s monitoring can help limit the development of risk factors and eventually heart failure symptoms.

“If you’re overweight, have high blood pressure, diabetes or smoke, see a primary care provider to manage those things before they lead to heart disease,” she says. “Oftentimes we can intervene with regular medical care.”

People with a family history of heart failure or heart disease may benefit from seeing a cardiologist, who can detect any problems early.


If you are concerned about heart failure or have a family history of heart disease, call your doctor. If you don’t have one, find a doctor near you.


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