Heart Failure Detection & Treatment

The Basics | Symptoms | Detection & Treatment | Prevention

How Do I Know If I Have Heart Failure?

Doctors diagnose heart failure by taking a medical history and conducting a physical exam and tests. During the medical history your doctor will want to know if:

• You have any other health problems such as diabetes, kidney disease, angina, high blood pressure, or other heart problems
• You smoke
• You drink alcohol and if so, how much
• You are taking medications
• Any of the symptoms listed in section above for heart failure.

During the physical, the doctor will check your blood pressure, use a stethoscope to hear sounds associated with heart failure in the heart and lungs, and look for swollen neck veins, an enlarged liver, and swollen feet.

Further testing to confirm the diagnosis may include:

Blood tests — to check for anemia, thyroid problems, and high cholesterol. These Conditions that can be related to heart failure. There is also a newer test for B-type natriuretic factor (BNP), which indicates heart failure.

Urine tests — to look for signs of kidney problems or diabetes (which can cause heart disease.)

Electrocardiogram (ECG or EKG) — to assess the heart rate and rhythm. It can often detect heart disease, heart attack, an enlarged heart, or abnormal heart rhythms that may cause heart failure.

Chest X-ray — to see if the heart is enlarged and if the lungs are congested with fluid.

Echocardiography — an ultrasound test to evaluate heart muscle function, how well the heart is pumping, and detect problems with the heart valves that may cause heart failure. Ejection fraction (EF) also can be measured. EF is a measure of how much blood is pumped out of the heart with each beat, and how much blood pumps through the heart with each beat. A normal EF is generally greater than 50%, which means that over half of the blood volume is pumped out of the heart with each beat.

Radionuclide ventriculography — a sophisticated imaging study that specifically shows the function of the ventricles (the heart's large pumping chambers) during heart contractions. This test can also measure EF.

Exercise Stress Test (an ECG performed while exercising — either walking on a treadmill, riding a stationary bike, or using medications to simulate exercise) — to check for any heart function problems brought on by exercise, which indicates of heart disease.

In addition, your doctor may perform a variety of more invasive tests such as cardiac catheterization to directly visualize the heart's chambers and inject dye to view the heart's arteries. This test can determine if coronary artery disease is present and can measure EF.

What Are the Treatments?

Treatment of CHF focuses on slowing or reversing its progression. The earlier you are diagnosed and treatment is initiated, the better the outcome.

First, your doctor will recommend a series of lifestyle changes. You may be asked to reach and maintain a healthy weight, increase your activity level (as recommended by your doctor), restrict salt intake, restrict fluid intake, and avoid alcohol. If you smoke or chew tobacco, you'll be advised to stop. You will need to work with your doctor to find the right balance of rest and activity - mobility is important to keep blood circulating. You will also need to weigh yourself daily and record your weight to detect fluid retention.

In addition, your doctor will prescribe several medicines to manage your heart failure or the underlying problem that caused the heart failure. Drugs used to treat heart failure include:

Diuretics or water pills — help the body eliminate excess salt and water. Examples include Aldactazide, Aldactone, Bumex, Demadex, Diuril, Dyazide, Hydrodiuril, Lasix, Lozol, Maxide, and Zaroxolyn.

ACE inhibitors — which are vasodilators, meaning they expand blood vessels and increase blood flow, thus helping the heart pump more efficiently. ACE inhibitors are important heart failure drugs, they have been shown to significantly prolong life and improve the quality of life for most people with heart failure. ACE inhibitors include: Accupril, Altace, Captopril, Mavik, Monopril, Prinivil, Vasotec and Zestril.

Beta-blockers — can improve the heart's ability to relax and decrease the production of harmful substances produced by the body in response to heart failure. Beta-blockers used to treat heart failure include Coreg and Toprol-XL.

Digoxin — sold under the brand name Lanoxin, this drug makes the heart pump better and can control certain heart rhythm problems.

Inotropic (heart pump) therapy — these drugs stimulate an injured or weakened heart to pump harder to send blood through the body. Often they're given in the hospital for cases of severe heart failure. Dobutamine is one drug used for inotropic therapy. Other medications given in the hospital to help the heart pump include drugs that expand the blood vessels, also helping the heart to pump blood more easily.

Potassium supplements — replace the potassium that may be lost because of increased urination from diuretics. You may need to take more than one drug.

Most people with heart failure take a combination of these drugs. Some of these drugs may cause unwanted side effects. It is very important to discuss with your doctor any problems before you stop taking or decrease the dose of any prescribed medications.

In some cases, when drugs don't improve heart function enough or cannot be tolerated, surgery or other intervention is necessary.

Doctors recommend surgery for three major reasons: to correct certain problems that cause CHF (such as coronary-artery bypass graft surgery, or CABG, to ease coronary artery disease), to repair valves, to implant devices (such as an intra-aortic balloon pump, specialized pacemakers, ICDs, or ventricular-assist device) to help the heart pump, or to transplant a new heart. Heart transplants are used to treat severe CHF.

Medically Reviewed by Michael Aronson, MD, July 2005.

SOURCES: Silver, W., "Success With Heart Failure: Help and Hope for Those with Congestive Heart Failure," HarperCollins, 3rd edition October 16, 2002. WebMD Medical Reference provided in collaboration with The Cleveland Clinic content: "Heart Failure."

The Basics | Symptoms | Detection & Treatment | Prevention

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