Heart failure – 5 warning signs

It’s an unfortunate truth that your body slows down in your sixth and seventh decades. Climbing a flight of stairs that you once took two at a time can now feel as daunting as scaling Mount Everest. While some degree of vitality loss can be attributed to natural aging, fatigue and breathlessness may also be signals that your heart is not functioning as well as it should. “There is a general tendency for people to ignore heart failure symptoms and attribute them to just getting older. Therefore, it was very important for us to create an easy way to identify those symptoms,” says Dr. Mandeep R. Mehra, medical director of the Heart and Vascular Center at Harvard-affiliated Brigham and Women’s Hospital.

Overview

Heart failure – sometimes known as congestive heart failure – occurs when the heart muscle doesn’t pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath.

Certain heart conditions, such as narrowed arteries in the heart (coronary artery disease), longstanding high blood pressure, or heart attack, gradually leave the heart too weak or stiff to fill and pump blood properly. But faulty heart valves or genetic disease may also be to blame. No matter what the cause, the failing heart can no longer pump well enough to keep up with the body’s demand for oxygen-rich blood.

Heart failure can be ongoing (chronic), or it may start suddenly (acute).

Proper treatment can improve the signs and symptoms of heart failure and may help some people live longer. Lifestyle changes – such as losing weight, exercising, reducing salt (sodium) in your diet, and managing stress – can improve your quality of life. However, heart failure can be life-threatening. People with heart failure may have severe symptoms, and some may need a heart transplant or a ventricular assist device (VAD).

One way to prevent heart failure is to prevent and control conditions that can cause it, such as coronary artery disease, high blood pressure, diabetes, and obesity.

Symptoms

To help both doctors and patients quickly spot a possible combination of heart failure symptoms, the Heart Failure Society of America developed a handy tool that goes by the acronym FACES.

• F = Fatigue. When the heart can’t pump enough oxygen-rich blood to meet the body’s energy needs, a general feeling of tiredness or fatigue sets in.
• A = Activity limitation. People with heart failure are often unable to do their normal activities because they become easily tired and short of breath.
• C = Congestion. Fluid buildup in the lungs can result in coughing, wheezing, and breathing difficulty.
• E = Edema or ankle swelling. When the heart doesn’t have enough pumping power to force used blood back up from the lower extremities, fluid can collect in the ankles, legs, thighs, and abdomen. Excess fluid can also cause rapid weight gain.
• S = Shortness of breath. Fluid in the lungs makes it more difficult for carbon dioxide in used blood to be exchanged for fresh oxygen. It may also be harder to breathe when lying down because gravity allows fluid from below the lungs to travel up the torso.

By themselves, these five warning signs do not confirm a diagnosis of heart failure, but they do convey a sense of urgency to seek medical advice, says Dr. Mehra.

Other signs and symptoms may include:

• Rapid or irregular heartbeat
• Nausea and lack of appetite
• Difficulty concentrating or decreased alertness
• Chest pain if heart failure is caused by a heart attack.

Further testing

In addition to the physical exam, doctors have two other important tools to spot the presence of heart failure. The first is an echocardiogram (often called an echo), which is a simple, non-invasive test that uses ultrasound to create images of your heart while it beats. If the echo shows a lower-than-normal percentage of blood leaving the heart when the left ventricle contracts, there is a strong possibility of heart muscle damage. Other findings that point to heart failure include abnormal thickening and ballooning of the heart wall and malfunctioning heart valves.

The next step in identifying early-onset heart failure is to look for biomarkers in the blood, such as B-type natriuretic peptide, which is released when the heart is under stress. “I call these compounds ‘tears from the heart’ because they show that the heart is crying for help,” says Dr. Mehra. Once the initial diagnosis is confirmed, further testing may be needed to figure out what’s causing the heart’s dysfunction and determine the best treatment approach.

When to see a doctor

See your doctor if you think you might be experiencing signs or symptoms of heart failure. Call emergency medical help if you have any of the following:

• Chest pain
• Fainting or severe weakness
• Rapid or irregular heartbeat associated with shortness of breath, chest pain, or fainting
• Sudden, severe shortness of breath and coughing up white or pink, foamy mucus.

Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. Don’t try to diagnose yourself.

Emergency room doctors will try to stabilize your condition and determine if your symptoms are due to heart failure or something else.

If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. This may also be the case if you gain 5 pounds (2.3 kilograms) or more within a few days. Contact your doctor promptly.

Drugs to avoid when you have heart failure

People with heart failure often take multiple medications. However, several commonly used prescription drugs, over-the-counter medicines, and supplements can interact dangerously to intensify heart failure symptoms. To be on the safe side, make sure all of your medical providers have a complete list of all the medicines you take. Particular compounds to watch out for include these:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). This class of widely used painkillers, which includes ibuprofen (Advil, Motrin), can worsen heart failure symptoms by causing the body to retain sodium and fluid.
• Heartburn medicines and cold remedies. These over-the-counter aids often contain high amounts of sodium, which can trigger fluid overload.
• Herbal remedies. Many so-called natural supplements contain substances such as ephedra, St. John’s wort, ginseng, hawthorn, black cohosh, and green tea. All can react badly with several common heart medications.

Source: Harvard Health Publishing (Harvard Medical School), Mayo Clinic

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