Understanding Heart Failure (Cleveland Clinic)

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What is heart failure?
Heart failure does not mean that your heart has stopped working. Heart failure means the left ventricle (lower chamber of the heart) is not pumping with enough force (systolic heart failure), or the ventricles are stiff and do not relax and fill properly (diastolic heart failure or heart failure with preserved pumping power).

With heart failure, blood moves through the heart and body at a slower rate, and pressure in the heart increases. Therefore, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart respond by stretching to hold more blood to pump through the body or by becoming thicker and stiffer. This helps to keep the blood moving for a short while, but then the heart muscle walls weaken and are not able to pump as strongly. The heart muscle walls are damaged and do not pump or fill normally. The kidneys often respond by causing the body to retain fluid (water) and sodium.

If fluid builds up in the arms, legs, ankles, feet, lungs or other organs, the body becomes congested; congestive heart failure is the term used to describe this condition.

What are the symptoms of heart failure?
You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant, or can come and go. The symptoms are related to the changes that occur in your heart and body, including:

  • Shortness of breath or difficulty breathing with exercise, at rest, or when lying flat in bed. Shortness of breath occurs when fluid backs up into the lungs (congestion) or when your body does not have enough oxygenated blood to allow you to continue your activity or exercise without a rest period. Even though you think of shortness of breath as a lung problem, it can be your heart condition that causes episodes of shortness of breath. In some cases, these symptoms may cause you to wake up suddenly at night, disrupting your normal sleep patterns.
  • A dry, hacking cough or wheezing.
  • Swollen ankles, legs and abdomen and weight gain. Less blood to the kidneys causes fluid and water retention, resulting in edema (swelling) and water weight gain.
  • Need to urinate while resting at night. This occurs because while lying down more blood gets to the kidneys due to gravity.
  • Tiredness (fatigue) and weakness during exercise or activities occur because the heart is not pumping enough oxygen-rich blood to major organs and muscles.
  • Dizziness, confusion, difficulty concentrating, or fainting may occur because the heart is not pumping enough oxygen-rich blood to the brain.
  • Rapid or irregular heartbeats (palpitations): When the heart muscle does not pump well, the heartbeat speeds up to help the heart get enough oxygen-rich blood to major organs and muscles. An abnormal heartbeat can occur from many problems, including an enlarged heart, not enough oxygen-rich blood to the heart muscle, and too much volume or pressure in the heart. In addition, heart failure causes the electrical conduction system in the chambers of the heart to be sensitive, leading to abnormal heartbeats.

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Last Updated: 9/1/2010

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