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When the heart is functioning correctly, its lower chambers (ventricles) pump in unison with its upper chambers (atria). Heart failure — also called congestive heart failure — can develop when the upper and lower chambers are out of sync. This prevents the heart from pumping enough blood to the brain, organs and throughout the body.

A failing heart keeps working, but not as efficiently as it should. People with heart failure can’t overexert themselves because they become short of breath and tired. The heart muscle becomes weakened and must work harder to keep blood flowing through the body. 

WakeMed Congestive Heart Failure Program

The specialized clinicians of WakeMed’s Congestive Heart Failure (CHF) Program partner with our patients’ primary care physicians and cardiologists. Launched in 1999, our comprehensive program educates patients about heart failure, helps them manage this chronic condition and relieve symptoms, and provides emotional support.

Patients with advanced disease may be cared for by the heart-failure experts of WakeMed Heart & Vascular Physicians – Advanced Heart Failure.

Causes of Heart Failure

Heart failure usually develops slowly, following an injury to the heart, and can be caused by a number of factors:

  • Coronary artery disease, which is the narrowing of arteries that supply blood to the heart
  • Scar tissue from a previous heart attack that interferes with heart function<
  • Long-term high blood pressure
  • Diabetes
  • Heart valve disease, sometimes caused by rheumatic fever or other conditions
  • Cardiomyopathy, or primary disease of the heart muscle
  • Congenital heart disease, or heart defects present at birth
  • Endocarditis and/or myocarditis, which is an infection of the heart muscle and/or valves
  • Viruses
  • Pulmonary (lung) problems 

Symptoms of Heart Failure

Symptoms of heart failure may include:

  • Dry hacking cough
  • Fatigue, loss of energy, and constant feeling of exhaustion
  • Sudden weight gain
  • Shortness of breath, especially with activity
  • Awakening at night short of breath
  • Unable to sleep lying flat, needing an extra pillow or to sit up to sleep
  • Swelling of ankles, legs and/or stomach
  • Lack of appetite or bloated feeling
  • Less daytime urination, and increased nighttime urination
  • Rapid, irregular heart beat

If you experience these symptoms, you should contact your doctor. 

Diagnosing Heart Failure

A variety of tests and studies can be used to evaluate and diagnose heart failure and look at overall cardiovascular health. These may include:

  • Blood tests for heart disease: The blood can offer many clues about heart health.
  • Cardiac CT and MRI: Cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are two advanced, non-invasive ways to look inside the heart and thoroughly assess the cardiovascular structures. These can be performed with or without calcium scoring.
  • Holter and event monitoring, which is a portable electrocardiogram
  • 64-slice CT scanning: A highly precise type of CT imaging
  • Chest X-ray
  • Electrocardiogram (EKG or ECG) diagnostics: This non-invasive test records the heart’s electrical activity.
  • Echocardiogram ("echo") tests: Echocardiography is a type of cardiac imaging that uses sound waves to create moving pictures of the heart and its blood vessels at rest and during exercise. Echocardiogram images help cardiologists diagnose, evaluate and monitor many heart conditions. Types of echo tests include:
    • Transthoracic 2-D echocardiography (TTE): This common, non-invasive echo study is performed externally, outside of the chest. TTE can be performed using bubbles (to identify problems with cardiac blood flow) or DEFINITY® contrast (to further clarify imaging).
    • Transesophageal echocardiography (TEE): This minimally invasive study can help cardiologists get a closer look at cardiovascular structures if more information is needed after a TTE study.
  • Nuclear medicine testing: These outpatient diagnostic exams — typically stress testing and nuclear stress testing for heart patients — are used to evaluate the supply of blood to the heart muscle.
  • Treadmill stress test
  • Cardiac catheterization procedures: Minimally invasive tests in which a long, thin tube (catheter) is placed in an artery in the groin, wrist or arm and used — along with a tiny camera and x-rays — to evaluate how well the heart is functioning. Types of cardiac catheterization procedures include diagnostic left- and right-side cardiac catheterization and Swan-Ganz catheterization. 

Treating Heart Failure

Heart failure treatments depend on the type and severity of the condition. Here are options:

  • Medical management: Medications used to manage and relieve the symptoms of heart failure include angiotensin-converting enzyme (ACE) inhibitors, beta blockers, angiotensin II receptor blockers, diuretics, angiotensin-receptor neprilysin inhibitors (ARNIs), hydralazine and isosorbide dinitrate, statins and blood thinners.
  • Biventricular pacemaker: This implanted device improves the heart’s electrical timing and promotes a coordinated response between the ventricles. It can offer symptom relief to some patients with diagnosed electrical dysfunction in the heart who are on medication.
  • Subcutaneous implantable defibrillator (S-ICD): This device — implanted under the skin — helps protect patients from sudden cardiac arrest (SCA), which is an abrupt loss of heart function.
  • Intra-aortic balloon pump (IABP): By helping the heart pump blood, this temporary implanted device reduces its workload for patients who are awaiting heart surgery or transplant.

Taking Control of Heart Failure

If you’ve been diagnosed with heart failure, there are many things you can do to help yourself feel well, reduce your symptoms, stay out of the hospital, lead a normal life and live longer and better. Recommendations include:

  • Weighing yourself daily:  Weigh yourself each morning after using the bathroom. Keep a weight diary by writing your weight down each morning. If you gain two pounds overnight or three to five pounds in a week, notify your doctor.
  • Limiting salt/sodium: Heart failure causes the body to hold onto salt/sodium, which causes extra fluid to build up in your body. This fluid makes your heart work harder and causes the symptoms of heart failure. People with heart failure should not consume more than 2,000 mg of sodium a day. Tips for staying within the recommended amount include checking both the amount of salt/sodium and the serving size when reading food labels and avoiding foods that have more than 350 mg of sodium per serving.
  • Managing fluid intake: Drinking too much fluid can cause fluid to build up in the body. For most people with heart failure, fluid intake should be limited to one-half to two quarts a day.
  • Taking prescribed medications: Your doctor may prescribe a combination of medicines to treat heart failure.
  • Engaging in physical activity: Staying active can help decrease symptoms, make you feel better and improve your sense of well-being. Ask your doctor about activities appropriate for heart-failure patients.
  • Keeping appointments with your doctor: Regular check-ups can help you keep your heart failure under control.
  • Eating a heart-healthy diet: This is an important way to keep your heart and body as healthy as possible.
  • Avoiding alcohol: Alcohol directly affects the heart muscle, decreasing the strength of the heart’s contraction in an already weakened heart.
  • Avoiding tobacco: Cigarette smoking can damage and weaken the heart. You should avoid all forms of tobacco, including second-hand smoke.
  • Consulting your doctor before taking any drugs or herbal supplements: Some prescription drugs, over-the-counter medications and herbal medicines should be avoided or taken with caution. They include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin), naproxen (Aleve) and ketoprofe. They can worsen heart-failure symptoms by interacting with other medicines or causing fluid retention. Remember, herbal medicines and supplements are drugs. Always check with your doctor or a pharmacist before using them. 

Make an Appointment

If you or someone you care for is experiencing heart failure symptoms, we encourage you to make an appointment with one of WakeMed’s experienced cardiologists.