Heart failure is a chronic and progressive disease, but recognizing symptoms early and creating a plan with your medical team can help slow its advancement — here’s what you should know.
According to research from the American Heart Association (AHA), cardiovascular disease, which includes heart failure, is the leading cause of death in the modern world. In fact, more people die each year of heart disease than all forms of cancer and chronic lower respiratory diseases combined.
Patients often develop heart failure after their hearts have been weakened or damaged by other cardiovascular conditions, including coronary artery disease, heart attack, high blood pressure, cardiomyopathy or congenital heart disease, among others.
The human heart consists of four chambers: the two upper chambers are the left and right atria, and the two lower chambers are the left and right ventricles. Typically, the left ventricle is the first to fail because it has to pump blood to the entire body, which means it does more work than the right ventricle. However, left ventricle failure can also hide right ventricle failure, which can make heart failure affecting both ventricles (biventricular failure) difficult to identify.
Symptoms of Heart Failure
According to the AHA, patients suffering from heart failure may experience the following symptoms:
- Shortness of breath (dyspnea): Blood “backs up” in the vessels that return blood from the lungs to the heart because the heart can’t keep up with the supply. This causes fluid to leak into the lungs. Breathlessness can occur during activity, at rest or while sleeping, which may come on suddenly and wake you up.
- Chronic coughing or wheezing: Fluid builds up in the lungs (see above). Coughing may produce white or pink blood-tinged mucus.
- High heart rate: In an effort to make up for its lost pumping capacity, the heart will beat faster, making it feel like your heart is racing or throbbing.
- Build-up of fluid (edema): As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues. This can cause swelling in the feet, ankles, legs or abdomen, as well as weight gain. You may find that your shoes feel tight.
- Nausea or lack of appetite: When the digestive system receives less blood, it can cause problems with digestion, such as feelings of being full or sick to your stomach.
- Fatigue or feeling light-headed: The heart can’t pump enough blood to meet the needs of body tissues, so the body diverts blood away from less vital organs — particularly muscles in the limbs — and sends it to the heart and brain. You may find yourself feeling tired all the time and/or struggling with everyday activities like climbing stairs or carrying groceries into the house.
- Confusion or impaired thinking: Changing levels of certain substances in the blood, such as sodium, can cause confusion, memory loss and feelings of disorientation.
Progression of Heart Failure
The New York Heart Association (NYHA) developed a system for classifying the severity of heart failure, divided into four classes based on the patient’s symptoms and quality of life.
Depending on the severity of your heart failure, there are several treatment options available. These options can range from lifestyle changes and medications to devices like pacemakers and defibrillators, as well as surgery.
For patients who reach end-stage heart failure, heart transplantation is the gold standard. However, many patients won’t survive the wait for a matching donor heart or aren’t eligible to receive a heart transplant due to age or a medical condition.
When a heart transplant isn’t an available option, mechanical circulatory support devices, such as left ventricular assist devices (LVADs) and the SynCardia temporary Total Artificial Heart (TAH), can be used as a bridge to transplant for those eligible to receive a transplant or as destination therapy for those not eligible to receive a transplant.
End-stage biventricular failure occurs when both ventricles of the heart are no longer able to pump enough blood to sustain the body. Vital organs, such as the kidneys, liver and brain, are starved of the oxygen and nutrients they need to function properly, resulting in damage that can eventually lead to these organs shutting down. For these patients, there are only two options: an immediate donor heart transplant or the SynCardia TAH as a bridge to transplant.
Because heart failure is progressive and unpredictable, it’s important that patients who have been told they need a transplant (either now or in the future) ask their doctor about all possible cardiac devices they could require, as well as how many of those devices are currently in use at their hospital. For many of our patients, the TAH was the only device that could save them. Had they not been listed at or transferred to a SynCardia Certified Center that had all device options available, their outcomes might have been different.