Atrial Septal Defect (ASD): Symptoms, Causes and Treatment

Signs That Chronic Heart Failure Is Getting Worse

By Maya Guglin, MD, as told to Mary Jo DiLonardo

Your heart's job is to pump blood around your body to supply all your organs with the oxygen they need to work well. When your heart doesn't pump as strong and as efficiently as it's supposed to, you have heart failure.

As your heart struggles to pump blood, fluid levels build up in your body. This excessive fluid causes almost all symptoms of heart failure.

Typically, people with heart failure complain of shortness of breath and fatigue. They might also gain some weight.

Shortness of Breath

There are two pumping chambers in the heart: the left and right ventricles. The left side of the heart collects oxygen-rich blood from the lungs. So, if the left ventricle is more affected by heart failure, the fluid builds up in the lungs, and the main symptom is shortness of breath.

At first it happens only when you try to do something really physically challenging like running. But as the disease progresses, it becomes difficult to walk up the steps. Then it becomes harder to walk fast, then harder to walk at all. You have to stop often and catch your breath.

Cough

Eventually, you start waking up at night because your lungs fill with "unpumped" fluid. You have to sit up, then the gravity pulls the fluid down, and your lungs can breathe again.

At this stage, you may even have wheezing like in asthma and you may even start coughing. The cough follows the same pattern as shortness of breath: It's worse when you are lying down and better when you sit up.

But if it gets this far, it's time to go to the emergency room or call an ambulance. This is serious.

Fluid and Swelling

The right side of your heart collects the blood from your whole body. If your right ventricle fails, extra fluid accumulates in your liver, kidneys, gut, and legs.

At first, you might notice that your ankles and feet swell by the end of the day. It's not unusual at all for this to happen to people who spend a lot of time on their feet, so this symptom is easily overlooked.

Next, the swelling can continue to creep up your body and move into the shins, thighs, and pelvis. If you put your fingertip on your leg and press lightly, the pit where your fingertip was stays and slowly goes away over the next minute. The medical term for that is "pitting edema."

Eventually blisters may form, skin may break, and the clear fluid inside can start to seep out. When the tissues are in that condition, it's easy to catch an infection called cellulitis, and legs become purple and angry.

Don't let that happen! See a doctor before it gets that bad.

It's more common to have the left ventricular failure first. For example, a large heart attack almost always involves the left ventricle. But if you allow the fluid accumulation in the lungs to persist, this will spread to the rest of the body.

It's important to be aware that heart failure is not the only condition that causes feet and legs to swell. Dilated veins called varices can cause very similar symptoms. That's why you should always let your doctor know about any symptoms you're having. Let the specialists sort this out.

Stomach Pain and Weight Gain

Sometimes you might eat just a little, yet suddenly feel very full. But even though you are barely eating, you notice that you're somehow gaining weight. That's also from all the fluid that you're collecting in your body.

When the liver gets swollen from it (your doctor may call it "distended"), it may cause stomach pain on the upper right side. Some people think they might have an inflamed gallbladder. It's actually an enlarged liver.

Fatigue and Activity Changes

The easiest way to know that heart failure is getting worse is you're able to do less and less.

People start pacing themselves. They stop doing hobbies that involve any physical activity. They used to go fishing, but not anymore. They used to play 18 holes -- now they are down to nine. They avoid stairs whenever they can.

They choose to only walk short distances, and they do it very slowly. They don't use the bedroom upstairs and instead sleep on the couch in the living room. Then they decide to sleep in a recliner. Then they can't sleep at all.

If you notice that the disease makes you change your habits, it's time to visit a doctor. They will almost always be able to help.

There are medications that can treat heart failure, including diuretics -- or water pills -- that work the fastest. There are also plenty of other treatments that can help.

Heart failure is a chronic condition and doesn't go away. But you can always work with your doctor to treat the symptoms and in some cases even improve the course of your disease.

Acute Rheumatic Fever Presenting As Fulminant Myocarditis

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Upcoming Trial To Test Diabetes Drug For Right Heart Failure In PAH

An upcoming clinical trial will test whether empagliflozin, a drug widely approved to treat diabetes and heart failure, might be able to improve heart health in people with pulmonary arterial hypertension (PAH).

The trial will be led by scientists at Cleveland Clinic, with study sites planned at two other U.S. Medical centers.

The National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) has awarded two grants, totaling more than $6 million, to help fund the research, the nonprofit medical center said in a Cleveland Clinic press release.

"If this trial shows empagliflozin is effective, I expect significant improvements in PAH patients' symptoms, quality of life and, critically, the function of their right heart," said Gustavo Heresi, MD, a pulmonologist and researcher at Cleveland Clinic who will be helping to lead the trial.

Unlike available PAH therapies that target lungs, diabetes drug acts on heart

PAH is characterized by unusually high pressure in the blood vessels of the lungs. This pressure puts strain on the right side of the heart, which is responsible for pumping blood to the lungs to pick up oxygen. The left side of the heart then pumps the oxygen-rich blood out to the body.

Over time, people with PAH typically develop right heart failure, in which the right side of the heart cannot adequately perform its job. This can contribute to symptoms like shortness of breath, and it's a major cause of death in PAH.

While several treatments for PAH are available, all of them target the lungs; there are no current PAH therapy options that act on the heart.

We chose to investigate empagliflozin because of its proven success as a treatment for managing left heart failure and its ability to modulate key metabolic pathways dysregulated in heart failure.

Empagliflozin, a drug sold under the brand name Jardiance among others, is approved as a treatment for type 2 diabetes and chronic heart failure. It acts to reduce blood sugar by increasing the amount of sugar excreted into the urine. The medication also has other effects on metabolism and heart health that aren't fully understood.

"We chose to investigate empagliflozin because of its proven success as a treatment for managing left heart failure and its ability to modulate key metabolic pathways dysregulated in heart failure," Heresi said.

The newly funded clinical trial will enroll people with PAH who have right heart failure and are already taking available PAH drugs that target the lungs. Participants will be randomly assigned to take empagliflozin or a placebo for about six months, at which point their right heart health will be assessed via an MRI scan.

In addition to Cleveland Clinic, the upcoming study will take place at Vanderbilt University Medical Center in Tennessee and the Johns Hopkins Medical Center in Maryland. Cleveland Clinic did not specify when the trial is expected to begin.

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