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Living with Heart Failure




Heart failure is a condition in which the heart is not working as well as it should due to difficulty pumping blood, either from being too weak or too stiff. As a result, the heart, organs and tissues cannot receive an adequate supply of blood, making it more difficult to do activities that may have been easy in the past. Getting acquainted with how the heart works may help in understanding how heart failure occurs and what a person can do about it.

Heart Failure: Knowledge for Effective Self-Care

Heart failure is a progressive and chronic condition in which the heart's muscle is weakened and may no longer pump effectively. Heart failure has different causes, including:
  • Blocked arteries in the heart
  • Heart attack
  • High blood pressure
  • Heart valve problems
The heart function and type of heart failure can be measured by having an echocardiogram, a test that provides images of the heart.

When the heart muscle is weakened, the body compensates by working harder, which causes the heart walls to become thicker, and the heart becomes enlarged. This also causes stress hormones to be released, which cause the arteries to tighten. The tightened arteries make it even more difficult for the heart to pump. In addition, the stress hormones cause the kidneys to hold onto salt and water, which increases the amount of blood that must be pumped. It is important to take medications regularly to block the actions of these hormones and to make it easier for the heart to pump.

Types of Heart Failure

Systolic Heart Failure
Systolic heart failure is diagnosed when the echocardiogram shows that not enough blood is being pumped by the heart. The amount of blood being pumped is called the ejection fraction. If this is less than 50 percent, it is weak and results in systolic heart failure. After an injury, the heart cannot pump the amount of blood the body needs. The blood backs up into the lungs, which causes shortness of breath, and/or backs up into other parts of the body which causes swelling in the legs. These symptoms can be controlled with medications and a low-sodium (salt) diet.

Diastolic Heart Failure
Diastolic heart failure is diagnosed by an echocardiogram showing a stiff heart. In this case the heart cannot relax, so it cannot properly fill with blood to circulate to the body. This causes increased pressure and blood to back up in the lungs, liver, legs and other areas of the body, causing symptoms of swelling, shortness of breath and the inability to tolerate activity. These symptoms also can be controlled with medications and a low-sodium (salt) diet.

Valvular Heart Failure
Valvular heart failure is caused by either a backward flow of blood, a leaky valve in your heart, or a narrowing of the valve area through which blood can flow. These are both abnormalities of the heart valves. This may cause the heart muscle to weaken and pump less effectively, and/or can cause increased pressure in the lungs.

Heart Failure Medications

Medications play an important role in the treatment of heart failure. Research shows that heart failure medications can stabilize the function of the heart, slow down the progression of heart failure and even improve heart function. Always stick to the medication plan unless you are instructed otherwise by a healthcare provider. Following a prescribed medication plan can:
  • Help extend life
  • Alleviate symptoms
  • Make breathing easier
  • Increase energy and activity levels
  • Alleviate swelling in the legs or ankles
  • Reduce hospital readmissions

Types of Medications

Beta blockers are a class of drugs that block certain hormones that can put stress on the heart. These stress hormones can cause high blood pressure and/or a fast heart rate. Beta blockers slow heart rate and widen (dilate) arteries, which lowers blood pressure. They allow a stiff heart more time to relax so it can properly fill with blood. Also, by widening the arteries, there is more blood flow to the kidneys. It is important to remember that beta blockers are beneficial to the heart even if there is not a fast heart rate or high blood pressure because they decrease the hormones that can put stress on the heart.

ACE (Angiotension Converting Enzyme) inhibitors make it easier for the heart to pump by widening the blood vessels. ACE inhibitors limit the amount of stress hormones in the body. Stress hormones may cause tightening of arteries, increasing the blood pressure and the workload of the heart. Like beta blockers, ACE inhibitors decrease the amount of stress hormones in the body that can worsen heart failure. The long-term effects of ACE inhibitors can slow the progression of heart failure and improve symptoms. ACE inhibitors can increase the amount of blood the heart pumps or ejection fraction over time.

Angiotensin receptor blockers, also known as ARBs, are a medication for patients who cannot tolerate ACE inhibitors. Like ACE inhibitors, ARBs block certain stress hormones from tightening the arteries, thus decreasing the stress hormones which can negatively affect the heart. Diuretics, often called "water pills," help the body get rid of extra fluid, so there is less fluid for the heart to pump. Diuretics decrease the swelling in the legs and feet and an improve breathing. Most diuretics lower potassium levels, an important electrolyte for the heart, and increase urination, so these should be taken as advised by a physician. Digoxin is a class of medications that help the heart pump slower and more effectively. This drug may not be appropriate for all types of heart failure patients. Aldosterone antagonists are a group of medications that block a hormone called aldosterone, which causes fluid retention and can make the symptoms of heart failure worse. Aldosterone antagonists are a type of diuretic that prevent the body from losing potassium. Lab work may be ordered when starting this medication.

Lifestyle Changes

Fluid Restriction

In addition to taking medications to control heart failure, there are other lifestyle changes that can be made, including reducing fluid intake. Fluid is necessary to keep the body functioning properly. However, in heart failure extra fluid builds up in the body, which makes the heart work harder. Restricting fluid intake can help limit the build-up of fluid in the body. Intake of fluid may be limited to 1.5 to 2 liters, which equals 1,500 to 2,000 ml or six to eight cups of fluid per day. Count all fluids that are consumed, including water, coffee, tea, juice, milk, soft drinks, ice cubes, soup and fluids. Also include the fluids in foods that become liquid at room temperature, such as Jell-O, sherbet, ice pops and ice cream.

If limited to 2,000 ml or 2 liters, use a 2-liter container to help measure fluid consumption. Before drinking anything, remember to measure and pour the same amount of fluid into the container. This will help keep track of how much fluid intake is left for the day. Be sure to use the fluid allowance evenly throughout the day and save enough fluid to take the medicines needed later in the day. Patients with a dry mouth can,
  • Suck on hard, sugar-free candy, a lemon wedge, frozen orange sections, frozen grapes, or chew gum to moisten the mouth. Frequently brushing teeth will also help moisten the mouth.
  • Prepare a measured amount of ice chips and flavor with lemon or lime juice, if desired. This still counts as fluid, but ice melts to about half its original amount so you will be more refreshed than drinking the same amount of beverage. (Example: 1 cup ice = ½ cup fluid).

Sodium Restriction

Sodium restriction is another important lifestyle change for managing heart failure. That means it will be easier to manage heart failure symptoms by reducing the sodium in a diet. The recommended amount of sodium for heart failure patients is 2,000 milligrams daily. Heart failure patients should avoid adding table salt or sea salt to food or cooking. One teaspoon of salt has about 2,300 milligrams of sodium - more than the daily recommended amount. Fresh or dried herbs or spices may be used to season food, or a salt substitute.

Daily Weights

Heart failure patients should keep track of their weight. A weight gain of as little as two to three pounds may be a signal that any medications may need to be adjusted or cause to call the physician's office. It is best to record weight at the same time every day in the same state of dress or undress.

Heart Failure Devices

The heart has its own special electrical system that enables the heart to beat and pump. There are special cells in the heart that create electrical impulses. These electrical impulses begin in the right atrium, the heart's natural pacemaker, and spread through the entire muscle, causing it to contract. If the heart’s electrical system does not follow the normal pathway to generate a heartbeat that causes the chambers to work together, the heart may not pump effectively. The regular contractions are what we know as heartbeats. Sometimes heart failure is related to problems with the electrical system in the heart. As a result, irregular beats or other abnormalities may occur.

Internal Cardiac Defibrillator (ICD)

Those with weakened heart muscles and a low ejection fraction may be at risk for lethal arrhythmias or abnormal heart rhythms. Because of this, the physician could recommend an internal cardiac defibrillator (ICD), which is inserted through a small incision in the upper chest. Similar to a pacemaker, the ICD paces the heart back into a normal rhythm or delivers a shock to restore normal rhythm if a lethal rhythm abnormality occurs.

Bi-ventricular Pacemakers or Bi-ventricular ICD

If the heart shows signs of dysynchrony, meaning it doesn't beat effectively, the doctor could recommend a bi-ventricular pacemaker or ICD. Pacemaker leads would be placed in both sides of the heart, helping it beat in sync and more effectively while protecting against potentially dangerous abnormal heart rhythms. This therapy has been shown in research to improve heart function, improve symptoms and improve quality of life with heart failure.

Living with Heart Failure

Heart failure is a progressive and chronic disease, but with proper treatment and lifestyle changes, many patients will experience a full and rewarding life. Be sure to talk with a healthcare provider about other possible treatment options and how to manage heart failure, as they may have other suggestions and treatment options. As with any health improvement or recovery program, the outcome depends a great deal on what the patient can do regularly. Here are some areas that can make a difference in the overall health of a heart failure patient:
  • Become informed. Develop a good understanding of your condition and be certain that you know exactly what you need to do to take proper care of yourself at home. Ask your physician and the other members of your healthcare team specific questions.
  • Understand your prescriptions and treatment plan. Know the type, amount and frequency of your medication. Do not stop or change a medication unless you have consulted with your physician and have been directed to do so. Stop using tobacco if you use it and reduce any alcohol consumption to the least amount.
  • Manage your fluid intake.
  • Record your weight every day. Notify your healthcare professional if your weight increases by more than 2 pounds in 24 hours or if it increases by 3-4 pounds in 2 days.
  • Monitor your blood pressure. Know your blood pressure. Keep a chart of your blood pressure. Notify your healthcare professional when your blood pressure changes significantly.
  • Speak up. Follow your healthcare provider's orders and communicate. Speak up if you have any questions or changes in your condition. If you experience discomfort or an unusual symptom, contact your physician. Keep your scheduled appointments with your doctor. Your doctor wants to help you do as well as possible but needs to be informed how you are doing to provide quality care. Do not hesitate to call.
  • Stay active. If you are able, and only on the advice of your healthcare provider, you should plan to exercise. It will be important for you to have set times during the day for exercise. Research has shown that exercise may decrease symptoms and improve your quality of life. Ask your doctor if you are a candidate for cardiac rehabilitation.
  • Reach out. It is important for you to maintain your friendships and interests, as well as develop new ones. Changes in your lifestyle habits can lead to other positive changes in your health.
For more information regarding the heart transplant program at Baylor University Medical Center, part of Baylor Scott & White Health, visit BSWHealth.com/HeartTransplant.

For additional information, visit Heart Failure Society of America and American Heart Association.


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