Heart Failure – Diagnosis and Treatment
Diagnosis
Doctors diagnose heart failure by reviewing a person’s medical history and discussing symptoms such as shortness of breath, fatigue, and swelling.
They examine patients for signs like high blood pressure, fluid retention, rapid heart rate, and swelling in the legs or abdomen.
Doctors also check for breathing problems, listen for abnormal heart sounds, and look for jugular venous distention as signs of congestive or right-sided heart failure.
They use several tests to confirm heart failure and find its cause. These tests help them understand how severe the condition is and plan treatment.
Important Medical Tests
Doctors use a range of diagnostic tools:
- Blood Tests: Blood samples show markers of heart muscle stress or damage. They can also screen for kidney or thyroid problems that might affect the heart.
- Chest X-ray: A chest X-ray reveals the size and shape of the heart. It can show fluid buildup in the lungs, which is common in heart failure.
- Electrocardiogram (ECG or EKG): The ECG measures the heart’s electrical activity. It helps doctors find rhythm problems, past damage, or thickened heart muscle.
- Echocardiogram: This ultrasound gives clear images of the heart’s chambers and valves. Doctors use it to see how well the heart pumps and fills with blood.
- Ejection Fraction Measurement: Ejection fraction (EF) shows the percentage of blood the left ventricle pumps with each beat. Doctors use EF to check for left ventricular dysfunction and guide treatment.
- Exercise and Stress Tests: These tests show how the heart reacts to physical activity. If someone cannot exercise, doctors may use medicine to simulate stress.
- CT and MRI Scans: Cardiac CT and MRI scans give detailed pictures of the heart. They help find structural problems or tissue damage.
-
Coronary Angiogram
This test uses contrast dye and X-rays to spot blockages in the heart’s blood vessels. It helps doctors find coronary artery disease. - Myocardial Biopsy: Rarely, doctors remove a small piece of heart muscle to check for diseases that weaken the heart.
Below is a table summarizing the main tests for heart failure:
| Test Name | What it Shows | Purpose |
|---|---|---|
| Blood tests | Heart stress markers, kidney and thyroid function | Detect disease, rule out other causes |
| Chest X-ray | Heart and lung size, fluid overload | Spot pulmonary congestion and an enlarged heart |
| ECG/EKG | Heart rate, rhythm, old damage | Detect arrhythmias or earlier heart attacks |
| Echocardiogram | Chamber size, valve function, pumping strength | Assess structure, diagnose heart failure type |
| Ejection fraction | Percentage of blood ejected with each heartbeat | Classify severity and guide management |
| Exercise/Stress test | Heart’s reaction to activity or medicine | Evaluate symptoms under load |
| CT/MRI scan | Heart structure, tissue status | Detect subtle abnormalities |
| Coronary angiogram | Blood flow in heart’s arteries | Identify blockages or narrowed vessels |
| Myocardial biopsy | Tissue samples for disease analysis | Diagnose rare causes of heart failure |
Assessing Heart Failure Stage
Doctors use two main systems to classify heart failure:
-
New York Heart Association (NYHA) Functional Classification:
- Class I: No symptoms with normal activity
- Class II: Symptoms with more activity
- Class III: Symptoms with very little activity
- Class IV: Symptoms even when resting
-
American College of Cardiology/American Heart Association Staging:
- Stage A: Risks are present, but no heart disease yet
- Stage B: Evidence of heart disease, but no symptoms
- Stage C: Confirmed heart disease with symptoms
- Stage D: Severe symptoms, needs advanced interventions
Doctors use both systems to plan treatment and explain how heart failure progresses.
Treatment
Medicine Choices
Doctors usually treat heart failure with a mix of medicines to manage symptoms and help the heart work better. Some medicines lower blood pressure, reduce swelling, help the heart pump, or treat other conditions.
Common types include:
| Medicine Type | What It Does |
|---|---|
| Angiotensin-Converting Enzyme (ACE) Inhibitors | Relaxes blood vessels, lowers blood pressure |
| Angiotensin II Receptor Blockers (ARBs) | Same as ACE inhibitors, alternative option |
| Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) | Combined treatment for some cases |
| Beta blockers | Slows heart rate, reduces blood pressure |
| Diuretics | Reduces fluid buildup, eases breathing |
| Aldosterone antagonists | Reduces mortality, manages potassium |
| SGLT2 inhibitors | Lowers heart failure risk |
| Cardiac Glycosides | Helps the heart squeeze better |
| Vasodilators | Relaxes blood vessels |
| Soluble Guanylate Cyclase Stimulators | Reduces hospital stays and risk |
| Intravenous Inotropic Agents | Helps the heart pump during serious cases |
Diuretics increase urination and help manage swelling in the legs or lungs. Beta blockers or ACE inhibitors control blood pressure and reduce strain on the heart.
Doctors may start with one medicine and add others as needed. For fluid buildup, diuretics are often the first choice. For heart rhythm problems, digoxin or other drugs may be used.
Sometimes, doctors add supplements like potassium or magnesium, especially when using certain diuretics. Doctors monitor patients carefully when starting or changing medicines.
Blood tests check kidney function and potassium levels, since some medicines can affect these. Some people need hospital care for more intensive medicine, oxygen therapy, or to stabilize their condition.
For severe heart failure, doctors may give intravenous (IV) medicines for quicker relief.
Surgical and Device Interventions
Doctors may recommend procedures or surgery if medicines do not control heart failure or if another heart problem is present.
Some treatment options include:
- Coronary Artery Bypass Graft (CABG): Doctors use a healthy blood vessel to bypass blocked heart arteries. This improves blood flow and can help prevent a heart attack.
- Heart Valve Repair or Replacement: If a faulty valve weakens the heart, doctors may repair or replace it. They can do this with open surgery or less invasive methods.
- Implantable Cardioverter-Defibrillator (ICD): Doctors place this small device under the skin to monitor the heart’s rhythm. If it detects dangerous rhythms, it delivers a shock to restore a normal beat.
- Cardiac Resynchronization Therapy (CRT): This device helps coordinate the heart’s beats if the chambers are not pumping in sync. Doctors may pair CRT with an ICD.
- Ventricular Assist Devices (VADs): These mechanical pumps help the heart move blood to the body. Doctors use them as a bridge to transplant or as a longer-term solution if a transplant is not possible.
- Heart Transplant: Some people need a new heart if other treatments do not work. Doctors consider this for severe heart failure.
These procedures can treat the cause of heart failure and improve quality of life. They can also lower the risk of complications.
Comparison Table: Procedures and Devices
| Treatment | Purpose | Suitable For |
|---|---|---|
| Coronary artery bypass (CABG) | Improves blood flow in blocked arteries | Coronary artery disease, ischemic heart disease |
| Valve repair/replacement | Fixes faulty heart valves | Valvular disease |
| ICD (defibrillator) | Prevents sudden death | Arrhythmia, high mortality risk |
| CRT (biventricular pacing) | Synchronizes heart chamber pumping | Systolic dysfunction, ventricular issues |
| VAD (mechanical pump) | Assists heart pumping | Awaiting transplant, transplant not possible |
| Heart transplant | Replaces failing heart | End-stage heart failure |
Devices like the ICD do not cure heart failure, but they help prevent life-threatening events. CRT improves the heart’s pumping by correcting abnormal electrical patterns.
VADs provide mechanical support, especially when both sides of the heart are weak or while waiting for a transplant.
Supportive and Comfort Care
Managing heart failure goes beyond treating the heart. Doctors also focus on symptom control and planning for later stages.
Key topics:
- Managing Symptoms: Doctors use medicines, exercise, and diet changes to control shortness of breath, swelling, tiredness, and chest pain. Oxygen, adjusted medicine doses, and regular monitoring may help.
-
End-of-Life Care: For advanced heart failure, symptoms may get worse.
Planning for home care, comfort, and support—called palliative care—can help. This care focuses on comfort, daily needs, and respecting personal wishes about treatment.
- Emotional Support: Living with heart failure can affect mood. Support from family, friends, or counselors can help with anxiety or depression.
- Discussing Choices: Some people may focus on comfort and quality of life instead of aggressive treatments. Patients, families, and care teams should talk early about goals and wishes to make sure the right support is in place.
Symptom Management Checklist:
- Take medicines as prescribed.
- Visit the doctor regularly.
- Eat a low-salt diet and manage fluids.
- Weigh daily to notice sudden fluid changes.
- Report new or worse symptoms quickly.
Planning Ahead:
- Make advance care plans (like DNR orders).
- Arrange home health or hospice care if needed.
- Build a strong support system.
Hospitals and care teams work closely with patients and families to explain options at every stage of heart failure.
Daily Habits and At-Home Strategies
Adopting healthy routines helps people with heart failure manage symptoms and slow the condition’s progress. Small, steady changes often make a big difference.
The following habits support better heart health and improve quality of life:
Stop Smoking
Quitting smoking is crucial. Smoking damages blood vessels, raises blood pressure, and lowers the body’s oxygen supply.
Giving up cigarettes may improve eligibility for future treatments, such as a heart transplant. Health professionals can offer support and tools if quitting feels difficult. Stay away from secondhand smoke as well.
Watch for Swelling
Check your legs, ankles, and feet for swelling every day. Swelling can warn you that your body is holding onto too much fluid.
Track Your Weight
Weigh yourself regularly to spot sudden weight gain, which can signal extra fluid retention. If your weight increases by 5 pounds (about 2.3 kilograms) or more in a few days, contact your doctor.
Tracking your weight helps healthcare teams adjust medications when needed.
Healthy Weight Management
Extra weight makes the heart work harder and increases the risk of complications. Doctors or nurses can help set a healthy weight goal. Even small weight loss helps, so focus on slow and steady progress.
Eat for Heart Health
| Recommended Foods | Foods to Limit or Avoid |
|---|---|
| Fruits and vegetables | Salty snacks |
| Whole grains | Foods with added salt |
| Fat-free or low-fat dairy | Saturated/trans fats |
| Lean protein sources | Fried foods |
A diet high in fruits, vegetables, and whole grains but low in saturated or trans fats supports heart function. Choose foods with less salt. Packaged and restaurant foods often contain a lot of sodium, even if they don’t taste salty.
Reduce Salt Intake
Sodium makes the body retain water, which can cause swelling and shortness of breath. Follow a no-salt or low-salt eating plan if your doctor recommends it. Read nutrition labels and prepare homemade meals when possible to control salt.
Limit Alcohol
Alcohol weakens the heart, causes abnormal rhythms, and can interact with heart failure medicines. Doctors often advise avoiding or strictly limiting alcohol.
Fluid Management
Some people with advanced heart failure need to limit daily fluid intake. The healthcare provider will give specific guidance. Sticking to this limit helps prevent fluid buildup.
Be Physically Active
Most people with heart failure benefit from exercise. Activities like walking boost energy and fitness.
Discuss the type and amount of activity with your healthcare provider to stay safe. Some hospitals offer special exercise programs for extra support.
Handle Stress Wisely
Feeling worried or upset can strain the heart. Practice relaxation techniques, such as mindfulness, or join a support group. Managing stress can make daily life easier and support heart health.
Improve Sleep
Shortness of breath at night can make sleep harder. Use extra pillows or a wedge to raise your head. If you snore or feel tired during the day, get checked for sleep conditions.
Vaccinations
Stay up to date with influenza, pneumonia, and COVID-19 shots to reduce the risk of infections that can strain the heart. Ask your healthcare provider for a current list of recommended vaccines.
Supplements
Your doctor may suggest omega-3 fatty acid supplements. These may help reduce hospital visits in some cases. Always talk to your healthcare provider before starting any supplement.
Handling Heart Failure and Seeking Support
Living with heart failure means building daily routines and working closely with healthcare professionals. Strong communication with your care team is key.
Share any changes in how you feel, side effects, or new symptoms to help guide care and medication decisions.
Take prescribed medicines as directed. If you have trouble paying for a medicine or notice side effects, bring this up at medical visits. Do not stop medicines or change doses without your healthcare provider’s direction.
Keep all scheduled medical appointments. If you miss one, reschedule soon.
Caution is needed with over-the-counter medicines and supplements. Some pain relievers, diet pills, and herbal supplements can cause problems for people with heart failure.
Tell your healthcare provider about everything you take, including vitamins and over-the-counter items, to prevent unwanted effects.
Daily self-checks help catch problems early. Here are a few helpful steps:
-
Weigh yourself each morning. Record your weight in a notebook or phone app.
Watch for sudden increases, which might mean fluid is building up. - Measure blood pressure at home. Write these numbers down and share them with your healthcare team.
- Stay organized with key contact information. Keep phone numbers for hospitals and clinics handy in case you need urgent help.
Support from others makes a real difference. Family and friends can join in routines, like reminding you about medicines or taking walks together.
Many people benefit from joining a cardiac rehabilitation program. These programs offer supervised exercise, stress management tips, and ideas for living better with heart failure.
A quick-reference table can help you stay organized:
| Task | How Often | Notes |
|---|---|---|
| Take medicines. | As prescribed | Talk to your doctor about issues. |
| Weigh yourself | Every morning | Track and share at check-ups. |
| Measure blood pressure | Daily | Share readings at visits. |
| Cardiac rehab | As scheduled | Ask about local programs. |
Getting Ready for Your Visit
Steps You Can Take
Before your clinic visit, you can prepare in several ways to help the appointment go smoothly.
- Ask About Special Instructions: When scheduling the visit, check if you need to follow any requirements. Some medical tests may require not eating or drinking for a set time.
- Track Your Symptoms: Write down any symptoms, even minor ones. Include issues that may not seem related to heart problems.
- Gather Family Medical History: Note any family members with heart issues, strokes, high blood pressure, or diabetes. If relatives have heart failure, mention this.
- Create a Medication List: List all medicines, vitamins, and supplements you take, including doses. Bring this list to your appointment.
- Bring Support: Ask a friend or family member to come with you if possible. They can help remember information and ask questions.
- Prepare Questions: Write down important questions for your healthcare provider. Start with the most important.
Some example questions to consider:
| Possible Question |
|---|
| What could be causing my symptoms? |
| Are there other reasons for these symptoms? |
| What tests will I need and do I need to prepare? |
| Which treatments are available and which do you suggest? |
| Are there any foods I should avoid or eat more of? |
| What amount and type of physical activity is best? |
| Should I avoid any particular activities? |
| How often will my condition be checked? |
| How can I manage any other health conditions together? |
| Are generic versions of my medicines available? |
| Should my family be tested for similar problems? |
| Are there reliable resources you recommend? |
Organize your time with the healthcare provider to make the most out of the visit. Add any other concerns to your list of questions. It’s always okay to ask whatever you need.
What Your Doctor Might Ask
During the appointment, your healthcare provider will ask questions to better understand your health. Being ready to answer helps focus the visit.
Typical questions include:
- When did these symptoms begin?
- Do symptoms stay the same or come and go?
- How strong or severe are the symptoms?
- What things seem to make symptoms better?
- Is there anything that makes them worse?
Take a few moments to think about these questions and jot down some answers before your appointment. This helps ensure you don’t forget important details.
