Heart failure is a condition where the heart is too weak ("heart failure with reduced ejection fraction", previously called "systolic" heart failure) or too stiff ("heart failure with preserved ejection fraction", previoulsy called diastolic heart failure) to pump blood properly to the body.  The body usually tries to compensate by telling the kidneys to retaining salt and water, which leads to fluid retention. This increases the blood volume, but the excess fluid also causes tissue swelling in the legs, abdomen, liver and lungs. Patients usually report leg swelling and/or abdominal bloating and usually experience shortness of breath with exertion. Trouble breathing at night is also common and this is due to the effects of gravity pulling the fluid towards the lungs when lying flat on one's back. 


Until the recent discovery of medications which improve the outlook for patients with systolic heart failure (weak heart muscle), patients with this condition had a severely reduced life expectancy (comparable to those with lung cancer). Most medical textbooks still report a 50% 5-year survival for this condition, but the current outlook for patients treated with modern, advanced treatments is much better than this. Several new life-prolonging medication-based treatments have become available in the last several years and an increasing number of patients are being treated with invasive treatments such as specialized pacemakers, ICDs, LVADs (left-ventricular assist devices, ie: artificial heart). Heart transplantation remains a treatment of last resort for select patients with advanced heart failure, although donor availability has been on the decline over the past decade.


About half of patients with symptoms of heart failure do not have a weak heart, but are unable to fill their heart cavity with blood between heart beats due to a stiff heart (diastolic heart failure). The heart filling tends to occur at higher than normal filling pressures. These patients also have a tendency to retain salt and water and will experience fluid retention just like those with a weak heart muscle (systolic heart failure). Avoiding dietary salt and the use of water pills (diuretics, which eliminate salt via the kidneys) can control the fluid retention, but there are no known treatments which can 'un-stiffen' the heart or alter the long-term outlook for patients with this form of heart failure. Maintaining regular physical exercise to avoid deconditioning and frailty is also an important part of managing heart failure, as long as no contraindications to exercise are present. Patients with diastolic heart failure are often (but not always) elderly and often have many other medical problems which also need to be addressed (like anemia, kidney failure, etc). 


Heart failure can have many causes, but traditionally coronary artery disease and hypertension are the leading causes. A component of genetic predisposition plus other factors (hypertension, diabetes, obesity, atrial fibrillation) often contributes to heart failure. Although there are rare viral causes of rapidly worsening heart failure (giant cell myocarditis), viral causes of heart failure are now thought to be uncommon. Several decades ago, viral myocarditis was thought to be a more significant contributor to heart failure. Atrial fibrillation can often severely worsen heart failure symptoms due to the loss effective atrial pumping to help fill the ventricular pumping chambers. 






Disclaimer: The brief patient information supplied here and the outside links provided are not intended to replace the advice of your physician and are only meant to help guide patients to formulate questions during their physician appointments. Each patient's situation is unique and a large number of factors are considered when arriving at a management plan for your specific condition. 




​Heart Failure