Lung Consolidation: What It Feels Like and How To Treat It

What Is Heart Failure?

Heart failure occurs when your heart is unable to pump an adequate supply of blood to the body. It may require ongoing treatment to keep your body's major functions working properly.

Approximately 6.2 million people have heart failure in the United States, according to the Centers for Disease Control and Prevention (CDC).

Heart failure happens in the ventricles, which are two chambers located in the lower part of your heart. They're responsible for pumping blood out of your heart.

Heart failure can be classified by the side of the heart that's affected (left or right). Both sides are often affected.

Congestive heart failure (CHF) is sometimes used synonymously with heart failure since the symptoms of both right and left sided heart failure include congestion.

In right sided heart failure, there is congestion with fluid buildup in the abdomen and lower extremities. In left sided heart failure, fluid builds up in the lungs.

Heart failure is a serious health condition that requires immediate medical treatment. Early treatment decreases your risk of complications over time.

The most common symptoms of heart failure include:

Shortness of breath: This is more common during activities. However, it may occur when you're resting or come on suddenly at night.

Fatigue: You may feel tired all the time, especially during daily activities like walking, shopping, or getting up.

Edema (swelling): You may experience a fluid buildup in your body, especially in the legs, feet, and ankles.

Feeling faint, weak, or lightheaded: Because the heart cannot pump enough blood to all your body's tissues, it prioritizes blood supply to your heart and brain, which can leave your body feeling tired.

Other symptoms of heart failure may include:

sudden weight gain

a loss of appetite

bloating

confusion, memory loss, or impaired thinking

persistent coughing

heart palpitations

abdominal swelling

protruding neck veins

Heart failure is a chronic condition. This type of condition requires ongoing, lifelong management.

However, you may experience acute heart failure, which is when symptoms come on suddenly. This is sometimes referred to as heart failure exacerbation or flares.

It may happen as an initial symptom when heart failure is diagnosed for the first time. Or, it may happen on top of chronic heart failure when your symptoms worsen.

Heart failure may affect the left or right side of your heart.

Left sided heart failure

Left sided heart failure occurs when the left ventricle in the bottom left of your heart doesn't pump blood out efficiently. Heart failure in this ventricle prevents your body from getting enough oxygen-rich blood.

There are two types of left sided heart failure:

Systolic: This occurs when the heart muscle weakens and loses its ability to contract. A weaker left ventricle cannot generate enough force to pump oxygen-rich blood through the body. This may cause blood to back up into your lungs, leading to fluid buildup. This is known as congestive heart failure.

Diastolic: This occurs when the heart muscle stiffens and impairs the heart's ability to relax. It prevents your heart from filling with enough oxygenated blood, resulting in less blood pumped back to the rest of your body.

Systolic heart failure is more common in males. Diastolic heart failure is more common in females.

Right sided heart failure

The right ventricle is located in the bottom right side of your heart. It's responsible for pumping blood to your lungs to collect oxygen.

Left sided heart failure usually triggers right sided heart failure. The accumulation of blood in the lungs makes the right ventricle work harder. This can stress the right side of the heart and cause it to fail.

Heart failure happens when your heart muscle gets weak or stiff. This may then block or reduce blood flow to the heart.

The most common cause of heart failure is coronary artery disease (CAD). It happens when fatty deposits build up in your arteries, reducing the supply of blood and oxygen to the heart.

Other conditions that may increase your risk of developing heart failure include:

heart attack

inherited heart disease

a condition that weakens the heart muscle, like cardiomyopathy

heart inflammation, like myocarditis

high blood pressure, also called hypertension

arrhythmia, which is an irregular heart rhythm

viral infection

congenital heart disease

diabetes

obesity

pressure in your lungs, called pulmonary hypertension

overactive thyroid, also known as hyperthyroidism

Certain behaviors may also increase your risk of developing heart failure, including:

smoking

drinking alcohol

eating foods high in fat or cholesterol

not getting enough physical activity

A will doctor start by performing a physical exam and assessing your medical history to check for signs of heart failure.

They may also use an echocardiogram. This test is the most effective way to diagnose heart failure. It uses sound waves to create detailed pictures of your heart. An echocardiogram can help a doctor evaluate the damage to your heart and how it's functioning.

Other tests to help diagnose heart failure or its underlying causes include:

Treating heart failure depends on the severity of your condition and the type of heart failure you have.

Early treatment can improve symptoms fairly quickly. However, you should still get regular testing and follow up with a healthcare professional at least every 6 months.

The main goal of treatment is to increase your life span, prevent complications, and improve your quality of life.

Medication

Medications may treat early stages of heart failure. They can help relieve your symptoms and prevent your condition from worsening.

Certain medications are prescribed to:

improve your heart's ability to pump blood

reduce blood clots

reduce your heart rate, when necessary

remove excess sodium and replenish potassium levels

reduce cholesterol levels

reduce adverse hormones and reactions that occur in your body that can make the heart weaker

These medications can include:

angiotensin converting enzyme (ACE) inhibitors

angiotensin II receptor blockers (ARBs)

angiotensin receptor-neprilysin inhibitors (ARNIs)

beta-blockers

mineralocorticoid receptor antagonists

sodium-glucose cotransporter-2 (SGLT2) inhibitors

nitrates

hydralazine

ivabradine

Verquvo (vericiguat)

cholesterol-lowering medications

blood thinners

Speak with a doctor before taking new medications. People with heart failure should avoid some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve, Naprosyn) and ibuprofen (Advil, Motrin). These can worsen fluid retention in heart failure.

Surgery

You may require surgery if you have heart failure. Options include:

Bypass surgery: A surgeon takes a healthy piece of an artery or vein and attaches it to the blocked coronary artery. This allows the blood to bypass the blocked, damaged artery and flow through the new one.

Percutaneous coronary intervention (PCI): A catheter with a small balloon attached to it is inserted into the blocked or narrowed artery. When it reaches the damaged artery, a surgeon inflates the balloon to open the artery.

Transplant surgery: Heart transplants are used in the final stages of heart failure when all other treatments have not worked. A surgeon removes all or part of your heart and replaces it with a heart from a donor.

Devices

You may require surgery to implant a device to help monitor your heart rhythm.

Pacemakers

These small devices are placed into the chest to help control heart rhythms. They may slow your heart rate when the heart is beating too quickly, or increase your heart rate if it's beating too slowly.

Biventricular pacemakers are sometimes used for cardiac resynchronization therapy. These may help your heart chambers pump in sync.

Left ventricular assist device (LVAD)

An LVAD helps your left ventricle pump blood out to the rest of your body.

Implantable cardioverter defibrillator (ICD)

This battery-powered device keeps track of your heart rate. It shocks your heart if it detects an abnormal heart rhythm. This restores the heart rate to a normal rhythm.

Doctors suggest an ICD for people with an ejection fraction of less than 30–35%. An ejection fraction refers to how much blood your heart pumps out of the left ventricle with each contraction. A normal range is 55–70%.

Some lifestyle measures can help treat heart failure and prevent the condition from developing.

These may include:

getting regular physical activity

maintaining a moderate weight

limiting alcohol intake

eating a well-balanced diet

not smoking

getting the right amount of sleep

Untreated heart failure can eventually lead to CHF, which could be life threatening. This is when blood builds up in other areas of your body. You may experience fluid retention in your limbs and organs, such as the liver and lungs.

Additional complications of heart failure include:

stroke

kidney dysfunction

liver dysfunction

thromboembolism

arrhythmias, like ventricular arrhythmias

heart attack

What are the 4 stages of heart failure?

The four stages of heart failure are A, B, C, and D. These indicate the severity of your symptoms and the function of your heart as your condition progresses:

Stage A: You may be at risk of heart failure but have no symptoms.

Stage B: You have symptoms of heart failure due to other conditions or risk factors, such as heart disease.

Stage C: You have symptoms of heart failure.

Stage D: Your symptoms of heart failure affect your daily activities or require repeated hospitalization.

How long can a person live with heart failure?

The authors of a 2019 review of studies found that approximately 60% of people were alive 5 years after their chronic heart failure diagnosis. After 10 years, approximately 1 in 3 people were still alive.

Survival rates are just estimates. Your outlook depends on several factors, such as age, lifestyle habits, other medical conditions, and stage at diagnosis.

What are the serious signs of heart failure?

The most common signs of heart failure include:

fatigue

edema (swelling)

shortness of breath

exercise intolerance

What's the difference between heart failure and congestive heart failure?

Congestive heart failure (CHF) is another term used for heart failure. It emphasizes the congestion that occurs due to a backup of blood flow, which causes fluid retention, swelling, and pulmonary edema (fluid in the lungs).

Heart failure happens when your heart is unable to pump enough blood throughout your body.

It's typically a chronic condition that requires ongoing treatment to prevent complications and increase your quality of life.

Your outlook and treatment of heart failure varies depending on the type of heart failure you have. Early treatment is key in preventing the most serious cases of heart failure.

Congestive Heart Failure (CHF) Diet For Heart Health

Certain dietary changes, such as limiting sodium and excess fluids, may help reduce fluid buildup caused by heart failure.

Congestive heart failure (CHF) occurs when extra fluid builds up and affects your heart's ability to pump blood effectively.

Read on to learn tips on how to limit sodium and fluids, and how to eat with CHF.

As a first-line treatment, doctors usually recommend making dietary changes to reduce extra fluid. This generally involves reducing your sodium consumption and restricting your fluid intake.

Too much sodium can cause fluid retention. Drinking too many fluids can also impair your heart's ability to pump blood properly.

Research from 2020 suggests reducing the amount of sodium you consume could help you decrease fluid retention.

However, additional 2022 research also found that restricting sodium too much may actually lead to additional problems in people with heart disease.

The findings in this area are not consistent, so more research is necessary. That said, most doctors and nurses will still recommend you choose lower sodium foods.

When it comes to reducing fluid, while the amount of fluid restriction varies from person to person, doctors often recommend people with CHF aim for 1.5–2 liters a day. This is equivalent to up to 2 quarts of fluid.

In addition, there's research suggesting that following the DASH diet has benefits for people with CHF. For example, in a 2021 study with 412 participants, following the DASH diet alongside reducing salt intake lowered certain heart disease markers by 20–23%.

While it's unclear whether people with existing heart failure would experience similar benefits, many doctors believe such dietary changes are still beneficial.

Your body constantly tries to strike the perfect balance between electrolytes, including sodium, and water. When you consume a lot of sodium, your body hangs on to extra water to balance it. For most people, this results in some bloating and mild discomfort.

However, people with CHF already have extra fluid in their bodies. This makes fluid retention a more serious health concern.

How much salt can someone with congestive heart failure eat?

The first thing to do is to try to look for foods that contain the least amount of sodium.

Alternatively, if sodium is one of the first five ingredients listed, it's probably best to avoid it.

What about foods labeled as "low sodium" or "reduced sodium"? Here's what labels like this actually mean:

Light or reduced sodium: The food contains one-quarter less sodium than the food usually would.

Low sodium: The food contains 140 mg of sodium or less in one serving.

Very low sodium: The food contains 35 mg of sodium or less per serving.

Sodium-free: The food contains less than 5 mg of sodium in one serving.

Unsalted: The food might contain sodium but not any added salt.

In addition, there are several other things you can do to eliminate extra salt from your diet without sacrificing flavor:

Experiment with alternative seasonings: Salt is about 40% sodium. It might be one of the more common seasonings, but it's definitely not the only one. Try swapping salt for savory herbs, such as parsley or basil. Pepper and lemon juice also add a good amount of flavor without any added salt.

Tell your waiter: When dining out, ask your server to limit the salt in your dish or advise you on low sodium options. You can also bring your own salt-free seasoning to use instead.

Avoid prepackaged foods: Prepackaged foods often contain high levels of sodium due to added salt. Even those labeled "light" or "reduced" are still above recommended amounts. But you don't have to eliminate salt entirely. Here are low sodium frozen meals for the next time you're in a time crunch.

Watch for hidden sodium sources: Salt is used to enhance flavor and texture in many foods, such as condiments like mustard, steak sauce, lemon pepper, and soy sauce. Salad dressings and prepared soups are also often high in sodium.

Get rid of the salt shaker: Simply getting rid of the salt shaker in your kitchen or on the dinner table can make a big impact. Since it's difficult to gauge how much salt you're putting on the food from the salt shaker, you risk coming close to your daily limit.

How much water should someone with congestive heart failure drink?

In addition to limiting sodium, a doctor may also recommend limiting fluids. This helps keep the heart from getting overloaded with fluids throughout the day.

When it comes to restricting fluid, make sure to account for anything that's a fluid at room temperature. This includes things like soups, gelatin, and ice cream.

You can follow these suggestions:

Find alternative thirst quenchers: The next time you're tempted to drink some water, try to just swish water around your mouth and spit it out. You can also suck on sugar-free candy, chew sugar-free gum, or roll a small ice cube around the inside of your mouth.

Track how much you drink: Keeping a daily log of your fluid intake can be a big help. You might be surprised by how quickly fluids add up. With a few weeks of diligent tracking, you can start making more accurate estimates about your fluid intake and ease up on the constant tracking.

Portion your fluids: Budget the recommended 2 liters, or 2,000 milliliters (mL), throughout your day. For example, have 500 mL for breakfast, lunch, and dinner. This leaves room for two 250-mL drinks between meals. Work with your doctor to determine how much you need to restrict your fluid intake.

Eat water-heavy or frozen fruit: Fruits high in water, such as citrus or watermelon, are a great snack that can quench your thirst, plus they're sodium-free. You can also try freezing grapes for a cooling treat.

Track your weight: Call your doctor if you gain more than 3 pounds in a day or consistently gain a pound a day. This could be a sign you may need to take other measures to reduce your fluid intake.

In addition to managing your salt and fluid intake, following the DASH diet may help you manage some of the symptoms of CHF by reducing certain inflammatory markers and giving you the right amount of macronutrients.

With the DASH diet, you focus on eating foods such as:

whole grains

fruits and vegetables

low fat dairy

lean red meat

fish

poultry

nuts and seeds

legumes

On the other hand, you want to limit sugar as well as saturated and trans fats, which are found in processed foods, high fat dairy, red meats, and desserts.

You can also consider following a Mediterranean or vegetarian diet, which are also good alternatives. However, they are not as well studied for CHF as the DASH diet.

What should you not drink with congestive heart failure?

You should avoid or significantly limit both alcohol and beverages containing caffeine.

What helps congestive heart failure naturally?

Other than dietary changes, things that can help include quitting smoking, exercising as suggested by your doctor, reducing stress, and getting enough sleep.

What is the best fruit for congestive heart failure?

Heart-healthy fruits include mangoes, guava, papaya, citrus fruit, apples, and bananas. This also includes savory fruits like avocado and tomatoes.

CHF involves a buildup of fluid that makes it hard for your heart to work efficiently. Reducing the amount of fluid in your body is an important aspect of any CHF treatment plan.

Work with your doctor to determine your ideal fluid intake. When it comes to sodium, try to stay under 140 mg per serving unless your doctor recommends a different amount.

You and your doctor can work together to determine the diet that's best for you.

Heart Failure Undertreated In Duchenne Muscular Dystrophy

With improved survival becoming more common among individuals who have Duchenne muscular dystrophy (DMD), cardiomyopathy is also increasing in prevalence among this population.

New data from a 20-year observational study show that among individuals who have Duchenne muscular dystrophy (DMD), cardiomyopathy with systolic heart failure (HF) is the leading cause of death, leading investigators to emphasize the importance of HF drug therapy in this unique population.

"In this vulnerable population with a rare, inherited disease, conducting randomized controlled intervention trials is challenging," they write, "and despite the risk of various sources of bias, cohort studies are needed to understand the effect of interventions and to generate hypotheses that can be tested in controlled trials."

Cardiologist doctor examine patient heart functions and blood vessel on virtual interface.Image Credit: ckybe - stock.Adobe.Com

With their findings also showing that lower left ventricular ejection fraction (LVEF) is independently linked to death at a younger age in the setting of DMD—older age showed only a weak association with LVEF reduction—they underscore that future research needs to focus on identifying and ameliorating predictors of LVEF decline.

This retrospective observational research appeared in a recent issue of European Respiratory Journal Open Research. Primary end points were time to cardiac or noncardiac death and association between LVEF and survival. The 67 patients with DMD received treatment at the Department of Pulmonology at the University Hospital Zurich, and to be included, they had to have echocardiographies (EKG) from 3 age groups taken as part of their outpatient DMD disease management (ie, an EKG from an emergency department admission was not allowed).

There were 430 EKGs from the 67 patients, and the baseline study visit was considered the first visit when transitioning to adult care. The mean (SD) patient age at first visit was 19.1 (3.9) years, and at last visit, 27.8 (6.6) years. Mean LVEF at first visit was 47.1% (10.2%) compared with 37.5% (12.4%) at the last visit.

For the study duration, nocturnal home mechanical ventilation (HMV) and angiotensin-converting enzyme (ACE) inhibitors were the most common HF treatments, increasing from 50.7% and 49.3% to 88.1% and 836.6%, respectively; beta-blockers had the next highest jump, from 14.9% to 53.7% of the study population by the final visit. Patients started ventilation at a mean age of 20.0 (4.8) years and had a percutaneous endoscopic gastrostomy (feeding tube insertion) by age 32 (47.8) years.

Twenty-eight of the 67 patients were deceased when this study started, and of the 60.7% for whom case of death was known, a cardiac-related cause of death was seen in 53%; the mean age at death was 29.2 (6.4) years vs an overall median (IQR) survival of 33 (25-40) years. Of those who had a cardiac-related death, their LVEF was 11 (95% CI, –21.1 to –0.9; P = .035) percentage points lower at time of death (24.2% [11.55] vs 35.2% [8.2%]) and at least 71% were taking ACE inhibitors (71.4%) or beta-blockers (76.4%) or were on HMV (89.3%).

For predictors of change in LVEF, the investigators saw from the EKG data that older aged had a weak association with lower LVEF (P = .065), but that forced vital capacity, measures of respiratory failure (arterial partial pressure of carbon dioxide, bicarbonate concentration, and nocturnal transcutaneous partial pressure of carbon dioxide), and type of dystrophin mutation had no association with LVEF. ACE inhibitors and beta-blockers (both P = .002) were shown to be independent negative predictors of change in LVEF.

"Annual echocardiography from the age of 10 years is recommended in DMD and the use of ACE inhibitors and beta-blockers as soon as abnormalities are detected," the study authors wrote. "However, there is little evidence to guide the management of heart failure in DMD."

They add that due to the increased survival of patients living with DMD, the aging of patients necessitates more extensive follow-up of comorbidities.

"Close collaboration between neuromuscular centers treating DMD patients and cardiologists is important," they concluded, "and international studies of HF therapy in DMD are needed to determine specific recommendations."

Potential limitations on their findings include its small size and retrospective observational nature, and their inability to model a potential association between type of ACE inhibitor and LVEF.

Reference

Lechner A, Herzig JJ, Kientsch JG, et al. Cardiomyopathy as cause of death in Duchenne muscular dystrophy: a longitudinal observational study. ERJ Open Res. 2023;9(5):00176-2023. Doi:10.1183/23120541.00176-2023

---