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Heart Failure Disease Management

Heart failure is a condition that occurs when the heart cannot pump blood efficiently enough to meet the body’s oxygen needs. This occurs because the heart muscle is significantly weakened. Common symptoms of heart failure include shortness of breath, fatigue and an inability to perform usual daily tasks easily. Fluid is also commonly retained in the lungs, abdomen, legs and feet, as a result of this condition. Heart failure patients are greatly affected by the disease, dealing with limitations of breathing, their ability to move about, and their quality of life.

The heart failure program at University Hospital can assist you in dealing with this disease process. We provide a team of caregivers: clinical Advanced Practice Nurses (APNs), nurses, nurse practitioners, a social worker, a dietician, an exercise specialist and physicians to provide the care you need.

How does your heart work?
The heart has four chambers: right atrium, right ventricle, left atrium and left ventricle. The right atrium and ventricle pump blood returning from the body to the lungs to be oxygenated again. The left atrium and ventricle pump the oxygenated blood to the body to deliver oxygen to the organs and tissues. The heart is designed to push blood in a forward motion. Valves, located between the atria and ventricles, open and close to keep blood moving in a forward motion and keep the blood from flowing backward. The normal path of blood through the heart: large vein (upper and lower)--right atrium--right ventricle--pulmonary artery--lungs--pulmonary veins--left atrium--left ventricle--aorta--body and brain. illustration > >

What is heart failure?
Heart failure is a group of symptoms caused by the heart muscle’s inability to pump oxygen rich blood effectively.

With heart failure, the heart muscle has lost its normal “squeezing” ability. This is called cardiomyopathy. When the heart muscle is unable to squeeze blood forward, it sometimes backs up into the lungs, abdomen (stomach), and lower extremities (legs and feet), causing symptoms of shortness of breath, abdominal fullness or nausea and swelling in the legs and feet. As the weak heart muscle strains to pump fluid, the fibers in the muscle stretch and the heart becomes enlarged and changes shape. This results in the heart muscle becoming even weaker. Heart failure is a chronic disease.

A person can have left heart failure and/or right heart failure, depending on what is wrong with the heart. Most people have left heart failure, which is caused by an injury to the left ventricle. Because of this injury the ventricle has lost its ability to “squeeze” and is unable to pump the normal amount (or percentage) of oxygen rich blood to the body. This percentage is referred to as “ejection fraction” (EF).

The normal ejection fraction is 50 to 60 percent. This means that 50 to 60 percent of the blood is squeezed out of the left ventricle with every heartbeat. Oxygen is carried to the organs and tissues by the blood. Because the ejection fraction is lower in heart failure, there is a smaller amount of oxygen being circulated by the blood. Because there is less circulating oxygen, shortness of breath and fatigue occurs more quickly than it does in someone with a normal heart.

What causes heart failure?
There are many known and unknown causes of heart failure. Damage to the heart muscle from blockage of the blood vessels, which supply blood to the heart, is the primary cause of heart failure. This is called ischemic cardiomyopathy.

Other causes include:

• Prolonged untreated high blood pressure which can weaken the muscle fibers and
  cause an enlarged heart and heart failure.
• Defective heart valves can allow blood to flow backward instead of forward causing
  heart failure.
• Viruses sometimes affect the heart muscle and cause heart failure.
• Drugs such as cocaine, diet pills (stimulants), and some chemotherapy agents can
  cause damage to the heart muscle.
• Radiation to the chest can cause damage to the heart muscle.
• Excessive intake of alcohol can damage the heart muscle.
• Sometimes the cause can not be determined and then is called idiopathic cardiomyopathy.

Right heart failure can be caused by untreated left heart failure, pulmonary hypertension (high blood pressure in the pulmonary artery), lung disease or abnormalities of the heart such as problems with the heart valves.

Symptoms of heart failure
The following are symptoms that are frequently associated with heart failure. These symptoms
are a result of too much fluid in the body and the decreased amount of oxygen circulating in the body:

• shortness of breath - this may occur while exerting yourself, at rest or at night when
  you try to lie down.
• increased fatigue, and you have to rest more often
• using an extra pillow at night to prop yourself up
• frequent coughing, that worsens at night when you lie down
• weight gain
• swelling in the legs, feet, or stomach
• not being able to eat a lot of food, even when you are hungry
• feeling sick to your stomach.

It is very important to tell your health care provider when you are experiencing any of these symptoms.