Jeremy Alfred 
Heart failure is a disease in which the heart does not pump enough oxygen-rich blood into the body. The heart does not stop working, but its efficiency is reduced in one or more of the following ways:
- The heart cannot pump out enough oxygen-rich blood into the body efficiently. This is left-sided heart failure.
- The heart cannot pump enough blood into the lungs to pick up oxygen. This is right-sided heart failure.
- The heart muscles become too stiff to refill the heart with sufficient blood.
Heart failure is also called congestive heart failure because as the disease progresses, it causes a buildup of fluid (congestion) in organs such as arms, feet, and lungs.
Heart failure can happen suddenly, or the heart can weaken over time until the symptoms become noticeable.
Heart failure is a serious condition requiring medical care. There is currently no cure for heart failure, but medications can slow down heart damage and relieve the symptoms.
Prevalence
Heart failure is common in the US. CDC estimates that it affects 6.7 million adults. In 2022, heart failure represented 13.9% of all causes of death in death certificates, indicating that it is a leading cause of death.
Symptoms of heart failure
Heart failure is typically progressive, and symptoms tend to get worse over time. Symptoms can depend on the cause and severity of heart failure. They usually arise due to fluid retention (congestion) in organs such as the lungs.
Common symptoms of heart failure include:
- Unusual shortness of breath while performing everyday activities
- Difficulty breathing when lying down
- Sudden unexplainable weight gain such as gaining more than 2 lbs. a day or 5 lbs. a week
- Swelling in feet legs, ankles, or the belly
- Feeling weak or exhausted
Risk factors
Diseases
Coronary artery disease. Coronary artery disease is caused by a buildup of plaque in the arteries. It weakens the heart muscle and increases the risk of heart failure.
Diabetes. In diabetes, sugar from the food is not internalized into the cells for energy. It occurs due to a lack of insulin in type 1 diabetes, or cells becoming insensitive to insulin in type 2 diabetes. The sugar from ingested food stays in the blood. It can damage blood vessels and nerves in the heart and over time cause heart disease and heart failure. The incidence rate of heart failure in those with diabetes is 3 times higher than in those without diabetes. Diabetes also speeds up the damage from heart failure, making the disease progress faster than normal.
High blood pressure. High blood pressure can make the blood vessels narrower and the heart’s walls stiffer. This forces the heart to work harder to pump blood thickening the lower left chamber over time and making pumping even more inefficient. This weakens the heart which can cause heart failure. High blood pressure also exacerbates coronary artery disease- another risk factor for heart failure.
Chronic kidney disease. The functions of the kidney and the heart are tightly linked. Kidney disease can start or worsen heart failure through altered blood flow, salt and water retention, and congestion of the veins.
Anemia or iron overload. Anemia is a condition in which the body does not make enough healthy red blood cells or hemoglobin. It is often caused by iron deficiency. Anemia affects the heart both directly and through the kidneys. It can stress the heart by increasing the stroke volume and heart rate. It can also stress the heart by reducing blood flow through the kidneys and increasing fluid retention. A third of all people who suffer from heart failure have anemia. Iron overload on the other hand causes toxicity that damages the heart muscle cells, weakening the heart and causing heart failure.
Atrial fibrillation. Atrial fibrillation is an arrhythmia of the heart strongly associated with heart failure. It can make the heart beat so fast that it does not adequately fill up with blood, which leads to heart failure. In turn, heart failure remodels the arteries structurally and electrically exacerbating atrial fibrillation. Both conditions feed each other forming a vicious circle of disease.
Thyroid disease. Thyroid disease is associated with worsening heart failure. Abnormal levels of thyroid hormone are associated with heart failure. Low levels of thyroid hormone can cause hypertension, cause or exacerbate heart failure, and lead to a higher risk of death. On the other hand, excess thyroid hormone can cause atrial arrhythmia and hypertension also resulting in heart failure.
Other heart-related diseases. Many diseases that affect the structure or function of the heart can cause heart failure.
Genetics
Heart failure results from a combination of genetic and environmental factors. Genetics can influence a person’s susceptibility towards high blood pressure which can portend heart failure. It can also affect how fast the disease progresses, and which medications work well.
Aging
Aging changes the heart structure and deteriorates the suppleness of the heart muscles. In the presence of other risk factors, aging can increase the risk of heart failure.
Infections
Infection with respiratory viruses such as COVID-19 can cause inflammation in the heart leading to heart failure.
Infection with HIV can also increase inflammation because of changed levels of various immune cells, leading to heart failure.
Lifestyle and related factors
Smoking tobacco. Smoking tobacco exposes the heart to harmful chemicals that can increase plaque deposition in the arteries causing coronary artery disease and increasing the risk of heart failure.
Unhealthy diet and alcohol use. Diet is tightly associated with the development of heart disease. A diet containing too many saturated and trans fats can result in cholesterol buildup inside the arteries, and forming plaque.
Heavy alcohol consumption changes the structure and function of the heart and increases stress and blood pressure which over time can result in heart failure.
Lack of exercise. Not exercising can lead to increased plaque deposition in the arteries increasing the risk of heart failure. A large study from Johns Hopkins Medicine with 11,000 adults showed that after just six years of exercise, middle-aged people start reducing their risk of heart failure compared to others of the same age who did not exercise.
Tips for a healthy heart
The National Heart, Lung, and Blood Institute (NHLBI) recommends 6 strategies to reduce the risk of heart disease.
- Eating healthy
- Moving more
- Maintaining a healthy weight
- Quitting smoking
- Reducing stress by getting enough sleep and practicing calming techniques such as meditation
- Tracking your numbers regularly to gain control over your health
NHLBI suggests making fitness a group activity with at least one other partner to make it more enjoyable and prevent the temptation to skip sessions.
The information provided in our blog posts is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
