Understanding heart failure

The condition that took Elizabeth Taylor’s life affects millions of Americans.

Reports of Elizabeth Taylor’s death focused, as they should, on her life, not on her death from heart failure. But given how common this condition is—the American Heart Association says nearly 6 million Americans are living with heart failure and it kills about 300,000 each year—a little attention to it might be a good idea.

What is heart failure?

The term “heart failure” is a scary one, conjuring up images of a heart that is suddenly unable to work. In truth, it represents a gradual decline in the heart’s ability to pump enough blood to meet the body’s needs. As the heart weakens, all parts of the body suffer the consequences.

The main signs and symptoms of the heart’s reduced ability to supply the body with oxygen-rich blood are shortness of breath with exertion or lying down; fatigue and weakness; swelling in the legs, ankles, and feet; and reduced ability to exercise.

What causes heart failure?

In most people, heart failure is caused by damage to the heart muscle. Scar tissue from a heart attack can make the heart pump less efficiently. Years of slow damage from high blood pressure or cholesterol-clogged arteries can cause the condition. Damage to a heart valve, or diabetes, can contribute to heart failure. Sometimes it is caused by a mechanical defect of the heart muscle that can be present from birth or brought on by disease or infection later in life.

Are there other names for heart failure?

Once known as dropsy, this condition was more recently referred to as congestive heart failure because it often caused congestion in the lungs. Experts are trying to drop the “congestive” and just call it heart failure.

Are there different types?

There are two basic types of heart failure. In systolic heart failure, the heart muscle becomes stretchy and weak. Diastolic heart failure stems from the opposite problem—the heart muscle becomes too stiff and can’t relax enough to completely fill with blood. The end result in both is a reduction in the amount of blood that each heartbeat pumps into circulation.

Can heart failure be cured?

Heart failure is manageable, but so far it usually isn’t curable.

How is it treated?

Managing heart failure initially involves a combination of lifestyle changes and medications. A healthy diet, minimizing salt intake, controlling fluid intake, and regular exercise all help keep heart failure under control. Treating an underlying cause, such as a faulty heart valve or diabetes, can help. Medications such as diuretics (water pills), ACE inhibitors, and beta blockers are commonly used. Sometimes a special pacemaker called a biventricular pacemaker is used to help both lower chambers of the heart beat in unison; an implantable cardioverter-defibrillator (ICD) may also be needed.

Advanced heart failure requires more intense medical therapy. Sometimes a heart transplant is needed. When this isn’t possible, a left-ventricular assist device can take over the pumping job of the left ventricle

More information on heart failure is available from the National Heart, Lung, and Blood Institute.