February 2008
Know the warning signs of heart failure
Heart failure—one of the most underdiagnosed and undertreated of all the major killers—is starting to emerge from the shadows
of hopelessness as scientists zero in on ways to detect and treat it before serious damage occurs.
Until recently, patients and doctors alike often overlooked or downplayed the crucial early symptoms of heart failure, in part because less-serious conditions—or even simple aging—can cause at least some of the same symptoms. If you know the warning signs, though, you can work with your doctor to determine whether you’re at risk.
Understand the disease
A heart muscle damaged by a heart attack, prolonged hypertension, or severe valvular disease can’t pump properly and thus can’t circulate enough blood. As a result:
The condition tends to worsen over time, until the failing heart cannot supply enough blood to sustain life.
Systolic heart failure, the most common type, develops when the heart cannot contract forcefully enough to eject most of the blood in its main pumping chamber.
But in roughly 40 percent of heart-failure patients, the inadequate circulation stems from diastolic heart failure, from which stiffening of the heart muscle prevents the chamber from filling with enough blood before it contracts.
Know the warning signs
Echocardiography, or ultrasound of the heart, can reveal the early stages of heart failure. But its cost, typically about $1,000, prohibits routine use. So experts generally recommend the test only for people who are at increased risk of the disease—notably those who:
—or for people who have any of these symptoms or signs (that can’t be explained by other causes):
For more information about echocardiography, click Common tests for heart pain.
If you’re diagnosed with systolic failure…
The right drugs, used properly, not only improve but also prolong the lives of people with systolic failure.
Experts have developed treatment guidelines that tailor therapy to the stage of the disease—from ACE inhibitors for early systolic failure, to heart transplants for severe symptoms. Talk to your doctor about the therapies that make the most sense for you.
If you’re diagnosed with diastolic failure…
The optimal treatment of diastolic heart failure is less clear. But in general, treatment focuses on controlling high blood pressure, which almost all of these patients have, by using most of the same drugs recommended for systolic failure.
Several of those drugs have other important benefits as well: Diuretics relieve the symptoms, and beta-blockers and ACE inhibitors or ARBs may act in ways that are not well understood.
Because doctors know less about the diastolic condition, they often treat it empirically, by trying different dosages and drug combinations. That makes it especially important that diastolic failure be treated by a physician who has had considerable experience with the condition or preferably by a board-certified cardiologist.
With either type of the disease, take these other crucial steps
Treating either type of heart failure requires more than taking medication. In addition to the main preventive measures—not smoking, losing weight, and avoiding excessive alcohol intake—patients should take three essential steps:
Before starting to exercise, heart-failure patients should consult with a physiatrist or physical therapist, because the proper
exercise program should be individualized.
Until recently, patients and doctors alike often overlooked or downplayed the crucial early symptoms of heart failure, in part because less-serious conditions—or even simple aging—can cause at least some of the same symptoms. If you know the warning signs, though, you can work with your doctor to determine whether you’re at risk.
Understand the disease
A heart muscle damaged by a heart attack, prolonged hypertension, or severe valvular disease can’t pump properly and thus can’t circulate enough blood. As a result:
- The body’s cells get too little oxygen, causing fatigue.
- Fluid backs up into the lungs, causing cough, shortness of breath, and congestion (which is why the disease is sometimes called
congestive heart failure).
- Fluid also backs up into the veins, causing swollen ankles.
Systolic heart failure, the most common type, develops when the heart cannot contract forcefully enough to eject most of the blood in its main pumping chamber.
But in roughly 40 percent of heart-failure patients, the inadequate circulation stems from diastolic heart failure, from which stiffening of the heart muscle prevents the chamber from filling with enough blood before it contracts.
Know the warning signs
Echocardiography, or ultrasound of the heart, can reveal the early stages of heart failure. But its cost, typically about $1,000, prohibits routine use. So experts generally recommend the test only for people who are at increased risk of the disease—notably those who:
- Have had a heart attack.
- Have a heart murmur (which could indicate a leaky valve).
- Have had elevated blood pressure for a long time.
- Are taking cancer drugs that can harm the heart muscle.
- Fatigue.
- Shortness of breath on exertion.
- Wheezing.
- Frequent coughing (especially at night).
- Swollen ankles.
- Unexplained weight gain.
- Bulging neck veins.
If you’re diagnosed with systolic failure…
The right drugs, used properly, not only improve but also prolong the lives of people with systolic failure.
Experts have developed treatment guidelines that tailor therapy to the stage of the disease—from ACE inhibitors for early systolic failure, to heart transplants for severe symptoms. Talk to your doctor about the therapies that make the most sense for you.
If you’re diagnosed with diastolic failure…
The optimal treatment of diastolic heart failure is less clear. But in general, treatment focuses on controlling high blood pressure, which almost all of these patients have, by using most of the same drugs recommended for systolic failure.
Several of those drugs have other important benefits as well: Diuretics relieve the symptoms, and beta-blockers and ACE inhibitors or ARBs may act in ways that are not well understood.
Because doctors know less about the diastolic condition, they often treat it empirically, by trying different dosages and drug combinations. That makes it especially important that diastolic failure be treated by a physician who has had considerable experience with the condition or preferably by a board-certified cardiologist.
With either type of the disease, take these other crucial steps
Treating either type of heart failure requires more than taking medication. In addition to the main preventive measures—not smoking, losing weight, and avoiding excessive alcohol intake—patients should take three essential steps:
- Avoid drugs that can worsen heart failure. Those include nonsteroidal anti-inflammatory painkillers (NSAIDS), such as ibuprofen (Advil and generic), as well as the diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos).
- Cut back on salt. A diet high in salt, or sodium, can cause the body to retain fluid, forcing the heart to pump harder. Heart-failure patients
should limit their sodium intake to 2,000 milligrams a day.
- Exercise regularly. Until recently, doctors told heart-failure patients to avoid physical activity because they worried that exercise would worsen
the fatigue and shortness of breath. But recent research has shown that exercise can be safe and effective for combating the
disease and may even improve mortality rates.
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