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More than 5 million Americans have heart failure, and 500,000 more cases are diagnosed each year. The condition develops gradually, due to injury to or weakness of the heart—underlying causes include these, among others:
- Heart attack
- High blood pressure
- Coronary artery disease
- Heart valve disease
- Abnormal heart rhythms
- Diseases of the heart muscle (cardiomyopathies)
There are two types of heart failure: systolic and diastolic. In systolic heart failure (which is more common in men), the left ventricle becomes enlarged and contracts so weakly that it can’t pump blood from the heart to the body. In diastolic heart failure (more common in women), the heart’s pumping strength is preserved—however, the ventricles don’t relax sufficiently between beats, meaning they can’t fill properly with blood.
Heart Failure Basics
If you have heart failure, you will be monitored by your doctor in order to ensure that your condition doesn’t worsen. If your heart failure is considered stable, you may only see your doctor two to four times per year—and with this in mind, Mount Sinai cardiologist Bruce Darrow, MD, PhD, emphasizes the importance of self-monitoring between doctor visits. “The cornerstone of managing patients with heart failure is symptom reporting,” he says. “Recognizing the warning signs of worsening heart failure and alerting your doctor can sometimes help you avoid hospital admission. A simple change in your medication, for example, may be all that is needed to prevent your heart function from deteriorating further.”
Dr. Darrow points to these areas as key when it comes to being vigilant about your health if you have heart failure:
- Exercise capacity: One of the two systems your doctor may use to classify the severity of your heart failure is based on your ability to engage in physical activity (see “How Heart Failure Severity is Classified,” below).
Exercise is just as good for people with heart failure as it is healthy individuals: research shows it can improve quality of life for heart failure patients, as well as reduce symptoms, hospital re-admissions, and mortality. Check with your doctor about what types of exercise are suitable for you, and what level of intensity you should aim for (also ask about local cardiac rehabilitation programs, since these are individualized and supervised).
As a rule, combine aerobic activities like walking, swimming or cycling with flexibility exercises (yoga, tai chi) and strength training (check weight limits with your doctor). “Exercise at whatever time of day you tend to have the most energy,” Dr. Darrow advises. “You may be advised to avoid certain exercises, and modify exercise intensity in certain conditions—for example, hot weather.”
When you’re exercising, you can expect to feel short of breath (see below). Your heart rate will also increase, and you’ll sweat. However, if you feel very short of breath and experience dizziness, pause for a rest. “Call your doctor if the symptoms return once you begin exercising again, and also if your heart rate increases above 130-140 beats per minute,” Dr. Darrow cautions. “If you experience pain and/or a sensation of pressure or tightness in your chest, shoulder, arm and/or jaw, immediately stop exercising and call 911.”
- Shortness of breath: This is a common symptom for people with heart failure, and occurs because a failing heart can’t effectively pump blood out to the body. One of the results of this is that fluid accumulates in the lungs, causing shortness of breath (known as dyspnea).
- Fatigue: Heart failure causes fatigue because your heart’s decreased pumping ability reduces the amount of oxygen reaching your muscles. Staying physcially active can help you build up your exercise capacity, but if you feel more fatigued than usual while exercising, mention it to your doctor. “It’s a good idea to keep a daily journal noting your energy levels at different times and after any exercise sessions,” Dr. Darrow advises. “It can help identify a pattern of increased fatigue.”
- New York Heart Association. This divides patients into groups according to how impaired they are when it comes to physical activity. Class I patients are able to engage in physical activity without undue fatigue, heart palpitations, dyspnea (shortness of breath), and chest pain (angina). The classification progresses through Classes II (mild-to-moderate), III (moderate) and IV (severe), with each category marking an increase in symptoms.
- American College of Cardiology/American Heart Association. This classifies heart failure based on its progression rather than on a patient’s functional capacity. Stage A includes people who are high risk for heart failure but have no structural disorder of the heart, Stage B is for those who have a structural disorder but exhibit no heart failure symptoms, Stage C is for people with heart failure symptoms caused by underlying structural disease, and Stage D includes patients with end-stage heart failure.
- Blood pressure: You will likely be advised to monitor your blood pressure at home, since it is an important measure of your heart health and how well your medications are working. Ask your doctor what range of measurements is right for you, and call him or her if your blood pressure is higher than normal. Dr. Darrow recommends that you purchase a digital blood pressure monitor with a cuff than inflates automatically. “Research suggests that arm cuffs are more accurate than wrist cuffs,” he adds.
- Increasing weight: Checking your weight is an important part of daily self-monitoring if you have heart failure—however, research suggests that fewer than half of heart failure patients do this, even if they have been recently discharged from hospital after an exacerbation of their condition.
“Excess weight is a major risk factor for worsening heart failure, so be sure to follow a healthful, nutritious Mediterranean-style diet that prioritizes fresh fruits and vegetables, and whole grains,” Dr. Darrow says. “Limit your sodium intake too—sodium causes the body to retain fluid, which increases blood volume and gives your failing heart a heavier workload.”
Weigh yourself daily, after urinating and before eating, and report any weight gain of two to three pounds or more in two days to your doctor, since this can signal fluid retention. Also stay alert for abdominal bloating (your clothes may seem tighter), and swelling in your fingers (rings may feel tighter) and feet (shoes may feel tighter), which also can signal fluid retention.
In mild heart failure, you may feel short of breath only when exercising. But if you start to notice that you’re breathing harder than usual while exercising or when you’re at rest, or if you wake from sleep feeling short of breath, tell your doctor.
“No longer being able to lie flat is a marker for worsening heart failure,” Dr. Darrow notes, “so if your doctor has previously advised you to prop yourself up on pillows while sleeping to avoid shortness of breath, tell him or her if you find that you now need more pillows than before.”
HOW HEART FAILURE SEVERITY IS CLASSIFIED
If you have heart failure, your doctor will classify its severity using one of two systems: