Heart failure is one of those conditions that you rarely (or ever) think about—until it personally affects you. Maybe someone you love was recently diagnosed with heart failure or your doctor warned you about it during a recent physical. Whatever the reason is for it to be on your radar, heart failure sounds pretty scary. You might think it means that your heart suddenly stops working, but heart failure is actually a gradual process in which your heart doesn’t work as efficiently as it should, and it affects roughly 6.2 million people in the U.S., according to the Centers for Disease Control and Prevention (CDC). Here’s everything you need to know about this condition, including what causes heart failure in the first place.
What is heart failure? | What are the risk factors for heart failure? | Who is at risk for heart failure? | What are the heart failure stages?
What is heart failure?
Your heart is tasked with a big job: pumping oxygen and nutrients to all of your organs. Heart failure happens when your heart muscle can’t keep up with the demands of its role, and the rest of the body starts failing, Tariq Ahmad, MD, MPH, associate professor of medicine at Yale Medical School and medical director of advanced heart failure at Yale Medicine, tells SELF.
Heart failure can involve the left, right, or both sides of a person’s heart. Left-sided heart failure happens when things go wrong in the left ventricle, which is the muscle’s main pumping chamber. There are two types of left-sided heart failure: systolic heart failure, which means the left ventricle can’t push blood out very well, and diastolic heart failure, which is when the heart is stiff so it can’t relax and fill with enough blood in between beats, according to the National Heart, Lung, and Blood Institute (NHLBI). When blood doesn’t pump in and out of the heart effectively enough, “congestion” can happen. (That’s why heart failure is also sometimes called congestive heart failure.)
Right-sided heart failure usually occurs as the result of left-sided heart failure. When both sides are affected the condition is called biventricular heart failure. That said, right-sided heart failure can happen on its own if you have a condition that affects the lungs, such as chronic obstructive pulmonary disease, which causes lung damage.1
As the heart gets weaker, people who have developed heart failure may experience the following symptoms, per the National Library of Medicine (NLM):
- Swelling in your feet, ankles, legs, or abdomen: This can happen because poor circulation causes water and other fluids to build up in the body.
- Wheezing or coughing: Fluid may build up in the lungs when the heart doesn’t contract properly, causing coughing fits.
- Shortness of breath: You may be huffing and puffing more than usual when doing everyday activities like walking. This can result from fluid build-up in the lungs or from a lack of oxygen-filled blood.
- General fatigue: Being robbed of oxygen can really deplete your body.2 “It’s like going from an 800-horsepower engine to one with 100 horsepower,” Dr. Ahmad says.
Because heart failure can affect different parts of the heart, symptoms may vary from person to person. Some people might not have any symptoms at all. Heart failure happens in stages, so symptoms can change or worsen over time, according to the Cleveland Clinic.
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What are the main causes and risk factors of heart failure?
Heart failure can happen any time the heart is severely strained or damaged. And that can happen in numerous ways:
Coronary artery disease
This is the most common form of heart disease, and it occurs when cholesterol, which is a type of fat, builds up in the arteries. As cholesterol continues to accumulate, the coronary arteries narrow and start to inhibit blood flow, according to the CDC.
Diabetes happens when a person’s blood-glucose (or sugar) levels are higher than the recommended range. This occurs when your body doesn’t make enough insulin (a hormone that regulates blood sugar) or when your body can’t use the hormone efficiently, according to the CDC. Over time, high blood sugar can lead to complications such as high blood pressure and heart disease.
High blood pressure
Medically known as hypertension, high blood pressure is used to describe the force of blood against artery walls. Hypertension is one of the most common causes of heart failure because it makes the heart work so much harder than it should need to, according to the NLM.
A heart attack occurs when the heart doesn’t get enough blood or oxygen. “The heart muscle needs oxygen to live,” Dr. Ahmad explains. “If the heart doesn’t get that blood flow, the muscle will die and it won’t be able to come back.” After a heart attack, some people’s hearts may be working at a reduced capacity, which can lead to heart failure.
Congenital heart defects (CHD)
Sometimes, a person’s heart doesn’t develop properly before birth, resulting in a congenital heart defect, according to the CDC. There are numerous types of CHD, and some may be minor, while others can negatively affect blood flow.
The immune system fends off viruses by triggering inflammation throughout the body. In rare cases, that inflammation can damage the heart, according to the Mayo Clinic. This is called myocarditis, and it most often leads to left-sided heart failure.
Infection can also affect the heart more directly. For example, bacterial infections may cause germs to stick to and ultimately damage the heart valve, which is known as endocarditis, according to the Mayo Clinic. Generally, this happens when people already have heart damage.
Heart valve disease
Sometimes, the heart valves have a hard time opening and closing. This can happen for a variety of reasons, such as being born with a heart defect or getting a severe infection like the flu, which can lead to heart inflammation.
Abnormal heart rhythms, medically known as arrhythmias, simply mean the heart beats very quickly or slowly at rest. According to the Mayo Clinic, a fast resting heart rate is defined as greater than 100 beats per minute, while a slow resting heart rate is below 60 beats per minute. Everyone experiences a fast or slow heart rate at some point. For example, heart rate generally declines during sleep. But sudden consistent changes in heart rate can indicate an underlying issue, like diabetes or coronary artery disease, which can potentially cause arrhythmias.
Sleep apnea (when you stop breathing periodically throughout the night) deprives the body of oxygen, which can eventually lead to heart failure, according to the NHLBI. There are three types of sleep apnea, and they can all contribute to developing high blood pressure and structural heart changes due to oxygen deprivation, according to the Cleveland Clinic. Sleep apnea can often cause right-sided heart failure, but it can worsen left-sided heart failure as well.
Metabolic syndrome refers to several conditions, including high blood pressure, excess body fat around your stomach, elevated blood sugar, high triglycerides (a fat found in the blood), and low HDL cholesterol levels. Together, these issues can increase your risk of developing medical conditions, such as heart disease and diabetes, according to the NHLBI.
Also known as postpartum cardiomyopathy, this is a rare form of heart failure that can impact people who are pregnant during their last month of pregnancy and up to several months after giving birth, according to the American Heart Association. The heart chambers get bigger and the heart gets weaker, decreasing blood flow and oxygen to other organs. People with elevated blood pressure, Black people, and people who are medically considered overweight have a higher risk of developing this form of heart failure.
Certain medications can potentially damage the heart muscle, Sanjiv J. Shah, MD, director of the Heart Failure with Preserved Ejection Fraction Program at Northwestern University Feinberg School of Medicine, tells SELF. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can cause water retention, which interferes with blood flow, increasing your risk of heart failure, heart attack, and stroke. Even certain meds to treat high blood pressure can actually increase the risk of heart failure, as can some chemotherapy drugs. Talk to your doctor to understand the risks versus the benefits of taking these medications.