Heart failure, or weakening of the heart muscle resulting in a limited ability to pump blood, is a common problem affecting approximately 5 million Americans. It is the only major cardiovascular disorder that is on the rise. The number of deaths in the United States from heart failure has more than doubled since the late 1970s. Roughly 400,000 to 700,000 new cases are diagnosed and approximately 250,000 Americans die annually from this condition.

Many people with heart failure do not know that they have it as they attribute many of its symptoms to getting older. Although heart failure can develop suddenly, most often its development is a gradual process where symptoms tend to get worse with time.

Common symptoms of heart failure include:

• Shortness of breath, which can happen even during mild activity
• Difficulty breathing when lying down
• Weight gain with swelling in the legs, ankles, or fullness in the abdomen from fluid retention
• General fatigue and weakness 

Heart failure can be caused by a number of problems within the heart. Heart attacks, high blood pressure, problems with heart valves, or long-standing problems with heart arrhythmias, where the heart can beat very fast, can all weaken the heart over time. Sometimes heart failure can run in families and it can also happen during pregnancy.

If you have the symptoms listed above, you should talk to your primary care provider about how you are feeling. Your primary care doctor will assess your symptoms and may request that you receive an ultrasound of the heart, an echocardiogram, to check your heart’s structure and function. The echocardiogram will determine if the pumping capability of your heart is normal, or if it is not moving as much blood forward each beat as it should. In addition moving blood forward in a squeezing motion, hearts also need to be able to relax after they squeeze to allow new blood to enter the heart. If the heart muscle can’t relax, fluid can back up into the lungs, abdomen or legs and cause symptoms of heart failure. 

Treatments for Heart Failure

If you, a friend, or a family member is diagnosed with heart failure, there are many treatment options available. If your heart does not pump blood forward as well as it should, you may need to undergo an evaluation of the arteries of your heart to determine if the arteries are causing one or more of the walls of the heart to move abnormally. Various laboratory tests can aid in looking for a cause of heart failure.

Regardless of the underlying cause, if your heart does not pump blood forward as it should, there are two main classes of medication – beta-blockers and ACE-inhibitors – that have been shown in research trials to help strengthen the heart over time. Common beta-blockers are metoprolol succinate (Toprol XL) and carvedilol (Coreg) and common ACE-inhibitors are lisinopril and enalapril. These medications work by blocking certain stress hormones in the body responsible for the progression of heart failure. Trials have shown beta-blockers to decrease the incidence of death by up to one-third in heart failure patients. These medicines often need to be initiated at low doses, and then the dose of the medication is increased at subsequent visits as blood pressure and heart rate allows. 

If you are troubled by water retention and swelling, your doctor may give you a prescription for a fluid medication to help your kidneys remove the excess fluid. Eating a low salt diet and keeping track of your blood pressure and daily weight will help your doctor manage your medications appropriately. With time, you can also learn how to assess your symptoms and adjust your fluid medication on your own to avoid episodes of swelling and increased shortness of breath.

Heart Failure Pathway

If you are diagnosed with heart failure, the cardiology team at the Intermountain Heart Institute has a new program available called the Heart Failure Pathway to get you started on the right track. The doctors in the Heart Failure Pathway will assess your symptoms and get you started on medications that will get you back to the activities in life that matter to you. The doctors in the Pathway will see you every two weeks to adjust your medications to the doses that have been shown to improve the strength and function of the heart in clinical research trials. If you have been diagnosed with heart failure and you and your doctor wish for you to receive your care through the Heart Failure Pathway, you can call 801-507-3500 to set up an appointment, which will be provided within seven days.

If you are diagnosed with very advanced heart failure, you may be referred to the Advanced Heart Failure/Transplant clinic. If despite appropriate medications and potential procedures, including repair of heart arteries or valve issues, your heart is still very weak, you may be a candidate for advanced therapies. Advanced therapies include intravenous medications to help the heart pump (inotropes), an artificial heart (left ventricular assist device), or heart transplant.

Heart failure is a common problem with a wide spectrum of severity. If you or a family member has symptoms suggestive of heart failure, please seek medical attention. There are many therapies that have the potential to strengthen the heart with time and get you back to things that you enjoy most.

For more information about heart failure, we invite you to speak with a cardiologist. To find a provider near you, visit www.IntermountainHeartInstitute.org.