Understanding Heart Failure: Signs, Causes & Treatments

Heart failure is a chronic, progressive condition where the heart cannot pump blood throughout the body effectively, leading to insufficient oxygen delivery to organs and tissues. This condition can stem from a variety of underlying heart issues, such as coronary artery disease, high blood pressure or previous heart attacks. The heart's inability to circulate blood properly often results in symptoms like shortness of breath, fatigue and swelling in the legs or feet. While heart failure is serious and can significantly impact quality of life, early detection, lifestyle changes and medical interventions can help manage symptoms and improve overall heart function.

Importance of Early Detection and Management

Timely diagnosis is crucial in heart failure to prevent the condition from advancing to more severe stages. When left untreated, heart failure can lead to a cascade of severe complications, such as kidney damage, arrhythmias (irregular heartbeats), liver congestion and even life-threatening cardiac events, including heart attacks and sudden cardiac arrest. Early detection of heart failure allows healthcare providers to implement a comprehensive care plan tailored to the individual’s needs. This plan often combines lifestyle modifications, such as a heart-healthy diet, regular exercise and weight management, with medications designed to improve heart function, reduce symptoms and slow the disease's progression. Medications may include ACE inhibitors, beta-blockers, diuretics and other therapies that target specific symptoms and underlying conditions contributing to heart failure.

Regular monitoring and early intervention also empower patients to actively participate in managing their condition. Engaging in cardiac rehabilitation programs, monitoring daily fluid intake, adhering to prescribed medications and staying vigilant about symptom changes are just some of the ways patients can enhance their quality of life and reduce the likelihood of complications.

When detected early, healthcare providers can also address contributing factors, such as high blood pressure, coronary artery disease, diabetes or valve disorders, that may be exacerbating heart failure. By controlling these underlying conditions, it is often possible to slow or even partially reverse the disease's impact on heart function.

Overall, timely diagnosis and intervention offer a window of opportunity to improve patient outcomes, extend longevity and support a more active and fulfilling life despite a heart failure diagnosis.

What Are the Types of Heart Failure?

Heart failure is a complex condition that can manifest in several forms, each affecting the heart's structure and function in distinct ways. Understanding these different types is essential for accurate diagnosis and effective treatment. Here’s an in-depth look at the common types of heart failure:

Left-Sided Heart Failure

Left-sided heart failure is the most prevalent form and can be further categorized into two main types based on how it affects the heart's ability to pump or fill with blood. It can occur as:

• Systolic failure (heart failure with reduced ejection fraction, or HFrEF) - In systolic failure, the left ventricle loses its ability to contract normally. This reduced pumping function means the heart cannot push blood effectively into circulation, leading to a decrease in oxygen-rich blood reaching the body. Over time, this can cause fatigue, shortness of breath and fluid buildup in the lungs (pulmonary congestion).
• Diastolic failure (heart failure with preserved ejection fraction, or HFpEF) - In diastolic failure, the left ventricle becomes stiff and less elastic. This limits the heart’s ability to fill with blood between beats. As a result, less blood is pumped out to the body, causing similar symptoms to systolic failure, such as swelling (edema), fatigue and difficulty breathing. Diastolic heart failure is often linked to aging, high blood pressure and other conditions that cause the heart to thicken.

Right-Sided Heart Failure

Right-sided heart failure often develops as a consequence of left-sided heart failure. When the left ventricle fails, increased fluid pressure transfers back through the lungs, ultimately damaging the heart's right side. The right side of the heart is responsible for pumping blood to the lungs for oxygenation. When it becomes compromised, blood backs up in the veins, leading to fluid accumulation in the lower extremities, abdomen and even vital organs. Symptoms may include swelling (edema) in the legs and feet, ascites (fluid in the abdomen) and liver congestion. Right-sided failure can also stem from lung diseases like chronic obstructive pulmonary disease (COPD) or pulmonary hypertension.

Congestive Heart Failure (CFH)

Congestive heart failure is a term that describes the stage of heart failure in which fluid builds up around the heart and affects its ability to pump efficiently. Blood flow through the heart and body slows down, causing the kidneys to retain fluid and salt. This leads to swelling in the extremities and organs and often manifests as severe shortness of breath, persistent coughing or wheezing (sometimes with pink-tinged phlegm) and sudden weight gain due to fluid retention. Congestive heart failure requires prompt medical attention to manage fluid levels, relieve symptoms and prevent life-threatening complications.

Acute Heart Failure

This type occurs suddenly and requires emergency care. It can develop due to a sudden heart attack, severe infection or a sudden spike in blood pressure. Symptoms appear rapidly and can include intense shortness of breath, chest pain and rapid swelling of the limbs.

Chronic Heart Failure

Unlike acute heart failure, chronic heart failure develops gradually over time as the heart becomes weaker. It is a long-term condition that often requires continuous management with medications, lifestyle changes and regular monitoring.

What Are the Causes and Risk Factors of Heart Failure?

Heart failure typically develops as a result of other heart conditions that gradually weaken or damage the heart’s ability to function properly. Major contributors to heart failure include:

• Coronary artery disease (CAD) – This condition occurs when the arteries that supply blood to the heart become narrowed or blocked, reducing blood flow and potentially leading to heart damage.
• High blood pressure (hypertension) – Chronic high blood pressure forces the heart to work harder to pump blood, which can lead to the heart muscle thickening or weakening over time.
• Diabetes - Diabetes increases the risk of heart failure due to its impact on blood vessels and because high blood sugar levels can contribute to other heart-related issues.
• Previous heart attack (myocardial infarction) - Damage from a past heart attack can weaken areas of the heart, making it harder for it to pump effectively.
• Heart valve disorders - When one or more heart valves fail to open or close properly, the heart must work harder, potentially leading to heart failure over time.

While heart failure can affect different people for different reasons, certain risk factors may increase the likelihood of developing heart failure. These include:

• Age - The risk of heart failure increases with age, particularly in individuals over 65, as the heart muscle can naturally weaken over time.
• Lifestyle - Smoking, sedentary behavior, poor diet (especially one high in sodium, fat and sugar) and excessive alcohol consumption are all lifestyle factors that heighten the risk.
• Coexisting health conditions - Health conditions like diabetes, obesity, chronic kidney disease and sleep apnea are closely linked to heart failure as they put added strain on the cardiovascular system.
• Family history - A family history of heart disease increases the likelihood of developing heart failure due to genetic and hereditary factors.

What Are the Symptoms and Warning Signs of Heart Failure?

Heart failure symptoms vary depending on the severity of the condition, but common signs include:

• Shortness of breath (during activity or while resting)
• Fatigue and weakness
• Swelling in the ankles, feet and legs
• Persistent cough or wheezing
• Rapid or irregular heartbeat (arrhythmia)

It is crucial to seek prompt medical attention if you experience symptoms such as sudden or severe shortness of breath, chest pain, fainting or a rapid arrhythmia. Early diagnosis and intervention are key to preventing these symptoms from worsening and improving quality of life.

Diagnosis & Testing for Heart Failure

Diagnosing heart failure involves a thorough evaluation to identify symptoms, risk factors and underlying causes contributing to heart dysfunction. A comprehensive medical assessment typically includes a detailed review of your symptoms, medical history and lifestyle factors such as diet, exercise habits and family history of heart disease. Your healthcare provider may recommend various diagnostic tools to obtain a clearer picture of heart health, including:

Echocardiogram

An echocardiogram is an ultrasound-based test that evaluates the heart's structure and function by creating moving images of the heart. It can detect how well the heart pumps blood (ejection fraction), the condition of the valves and any structural abnormalities. It is one of the most common tests used to diagnose and monitor heart failure.

Electrocardiogram (ECG)

An ECG measures the heart's electrical activity and can detect irregular heart rhythms, signs of previous heart damage or other electrical abnormalities that may indicate heart disease.

Blood Tests

Blood work can provide critical insights into heart function. For example, tests for brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) measure levels of hormones released when the heart is under stress, indicating the presence and severity of heart failure. Additional blood tests may assess kidney function, electrolytes and other markers of cardiovascular health.

Chest X-Ray

A chest X-ray is an imaging test that may reveal fluid buildup in the lungs (pulmonary congestion) or an enlarged heart, both of which are common signs of heart failure.

Stress Test

A stress test evaluates how well the heart works during physical exertion and can help identify coronary artery disease or other contributing factors.

Collectively, these tests can help your healthcare provider understand how effectively your heart is functioning, identify muscle damage and tailor an appropriate treatment plan.

How is Heart Failure Treated?

The treatment for heart failure depends on its cause, severity and how the condition progresses in each individual. A multidisciplinary approach is often necessary, combining medications, lifestyle changes and potentially surgical interventions. Possible recommendations may include:

Medications

Managing heart failure commonly involves several classes of medications that target different aspects of heart function and symptom relief:

• Angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs) - These medications relax blood vessels, reduce blood pressure and decrease the workload on the heart.
• Beta-blockers - These drugs slow the heart rate, reduce blood pressure and lessen the impact of stress hormones, which can exacerbate heart failure.
• Diuretics - Sometimes called "water pills," diuretics help reduce fluid buildup, relieving symptoms like swelling and shortness of breath.

Other medications, such as aldosterone antagonists, may be prescribed to further optimize heart function and reduce symptoms.

Lifestyle Changes

Lifestyle modifications are essential in managing heart failure. Your doctor may recommend changes to any of the following to help you manage your risk:

• Diet - Limiting salt and fluid intake can prevent fluid buildup.
• Exercise - Regular, moderate activity can strengthen the heart.
• Stress management - Reducing stress helps lower strain on the heart.

Surgical and Procedural Interventions

In more severe or advanced cases of heart failure, medical devices or surgery may be necessary to support heart function. Examples include:

• Implantable devices - Devices such as pacemakers or implantable cardioverter-defibrillators (ICDs) help manage heart rhythm disorders and improve heart function.
• Ventricular assist devices (VADs) - These mechanical pumps help maintain heart function when it becomes severely weakened. VADs can be a long-term solution or a bridge to heart transplant.
• Heart transplant - In cases where other treatments are no longer effective, a heart transplant may be the only option for extending life expectancy and improving quality of life.

A personalized treatment plan, developed by your healthcare team, aims to relieve symptoms, slow disease progression and enhance overall quality of life.

Complications and Long-Term Effects of Heart Failure

Heart failure can lead to several potential complications, including serious issues such as:

• Kidney damage due to reduced blood flow
• Heart arrhythmias that increase stroke risk
• Liver damage from fluid buildup around the liver

Patients with heart failure benefit from a structured, long-term management plan that may include ongoing medications, regular check-ups and participation in support programs.

How Do You Prevent and Reduce Your Risk of Heart Failure?

Reducing your risk of heart failure involves a proactive approach that combines lifestyle changes, regular medical care and early intervention for any contributing health conditions. Taking preventative steps can significantly reduce the likelihood of developing heart disease and slow or prevent the progression of heart failure. Key preventative strategies include:

• Maintaining a balanced diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats
• Engaging in regular physical activity, including moderate aerobic activities
• Managing blood pressure and cholesterol through lifestyle changes and, if recommended by your doctor, the use of certain medications
• Avoiding tobacco and limiting alcohol consumption to avoid further damage to the to the heart and blood vessels
• Maintaining a healthy weight, as excess weight makes it harder for the heart to function effectively
• Managing stress with techniques like mindfulness, meditation and deep breathing exercises
• Controlling coexisting health conditions with proper management techniques, such as taking prescribed medications and following lifestyle changes

In addition to these lifestyle modifications, it is important to undergo routine medical screenings to monitor blood pressure, cholesterol levels and other potential risk factors. Early detection of any cardiovascular issues allows for timely intervention and the implementation of preventative measures, significantly reducing the risk of heart failure and enhancing long-term heart health. Regular check-ups with your healthcare provider can help you stay on top of your heart health and catch any warning signs early.

Living With Heart Failure

Patients can live healthy, fulfilling lives after treatment with the right adjustments. Adapting to a heart-healthy lifestyle involves:

• Following a low-salt diet
• Engaging in light to moderate physical activities
• Monitoring weight to detect fluid retention

Support Systems and Resources

In addition, certain support systems and resources may also aid in achieving a healthy lifestyle. Joining a support group and staying informed about heart failure resources can help patients manage the emotional and psychological challenges of the condition.

Heart Failure FAQs

Patients often have questions about the causes of heart failure, how treatments work and the prognosis. Education and open dialogue with healthcare providers are crucial in addressing these concerns.

The TGH Difference in Heart Failure Care

At Tampa General Hospital’s Heart and Vascular Institute and Heart Failure Center of Excellence, our cardiology team provides world-class, specialized care to manage heart failure. Our dedication to providing unmatched care helped us earn U.S. News & World Report’s recognition as One of the Nation's Best Hospitals for Heart & Vascular care in 2024-25, as well as special recognition as a High Performing Hospital for Heart Failure and Heart Attack Care for 2024-25. Additionally, we’re proud to have received full heart failure accreditation from the American College of Cardiology, ensuring that each patient receives comprehensive, state-of-the-art treatment tailored to their needs. And we are the only hospital in the Tampa Bay region recognized by Becker's Hospital Review on its list of 100 Hospitals and Health Systems with Great Heart Programs.

From early detection and lifestyle modification to advanced interventions like VAD implantation and heart transplantation, TGH offers a full spectrum of heart failure treatments to support patients in achieving better health outcomes.

For more information on our heart failure program, reach out to Tampa General Hospital and schedule a consultation with one of our expert cardiologists. You can call us at (813) 844-3900 or email heart-vascular@tgh.org.