There are many potential causes for heart failure. One of the most common causes of Heart Failure is a heart attack. Heart attacks can damage
and weaken the heart, reducing the ability of the heart to pump blood to the body. If severe enough, this damage can cause heart failure.
As mentioned before, even though heart attacks can be related to or the cause of heart failure, a heart attack is not the same as a heart
Another common cause is cardiomyopathy, which is a type of cardiac disease that affects the heart muscle. Cardiomyopathy can be caused by
many conditions like drug or alcohol use, metabolic disorders (such as high blood pressure, obesity or diabetes), viral infections or
Diagnosis of Heart Failure: What tests might I need?
As needed, the diagnosis of heart failure may require several scans or investigations. Your doctor will go over the specifics of any
particular diagnostic screening you may need. The following is a list of some of the most
common tests that heart failure patients may need:
Come prepared knowing your symptoms, medical and family history!
Measurements of blood pressure, height & weight and listening to heart & lungs stethescope
Be completely honest! It's your health!
Blood tests may be ordered from a lab
Measurements of substances like sodium, albumin and creatinine can indicate the health of organs that may
be effected by HF
Biomarkers like BNP might also be used for diagnosis of HF
Chest X-Ray (CXR)
Chest X-rays are performed in radiology labs
Chest x-rays can show whether the heart is enlarged (like in systolic heart failure)
Chest x-rays can also show fluid or congestion in the lungs
During an ECG, electrodes are placed on the chest and detect the electric signals in the heart
This can indicate prior heart attacks, and abnormal heartbeats (like atrial fibrillation)
They can also be used to detect whether the left ventricle is thickened/enlarged
Symptoms from heart-failure can vary from person-to-person; no two people will have identical symptoms. Below is a list of some the most common
symptoms for heart failure. Heart failure symptoms can wax and wane over time. Use this as a guide to heart failure symptoms, but also seek out
professional help and guidance.
Severity of Heart Failure Symptoms:
There are different degrees (known as classes) of severity of heart failure as defined by the New York Heart Association:
Difference between Class of Heart Failure & Grade of Ventricle
One common source of confusion for patients and family members is the symptom NYHA class of heart failure and the grade of left ventricular
function. These are independent measures of the severity of heart failure and may not necessarily correlate with each other.
The grade of LV (left ventricle) function refers to the actual physiological performance of the left ventricle which can often, but not
always correlate to the degree of symptoms. LV function is measured by ejection fraction, which measures the percentage of blood in the
left ventricle that is pumped out. In other words, if 60% of the blood in the left ventricle is pumped out as the heart beats and 40%
remains in the left ventricle, the ejection fraction would be 60%.
LV function can be graded, with Grade I referring to healthy ventricular function (with an ejection fraction ≥55%) and a Grade IV
referring to severely reduced ventricular function (with an ejection fraction ≤30%). As mentioned before, someone may have a severely
weakened and impaired Grade IV ventricle with minimal symptoms (NYHA Class I or II). Likewise, a patient may have a relatively healthy LV
function but still experience NYHA Class III or IV symptoms.
Types of Heart Failure
Heart failure can affect either side of the heart:
The left side of the heart is responsible for pumping blood to the body that came from the lungs. During left sided heart
failure, the heart muscle can’t pump blood sufficiently to the body, leaving fluid backed up in the lungs. This can cause a
shortness of breath and fluid buildup. Because the left heart is not pumping blood effectively enough to the rest of the body
including the brain, left-sided heart failure can cause fatigue and dizziness, and sometimes confusion.
The right side of the heart is responsible for pumping blood to the lungs that came from the body. Right sided heart failure is sometimes
caused by left-sided heart failure because the backed up blood in the lungs forces the right side of the heart to pump harder than it
normally would to compensate. This additional stress can result in damage and weakness (or failure) or the right side of the heart.
Blood can therefore become backed up in the body, resulting in swelling of blood in the legs and ankles, abdomen and GI tract.
Wondering why the image is reversed? This is because our reference frame is from an outside point of reference, looking in.
There are two major types of heart failure which are very different and thus require different treatment:
HFpEF (Diastolic) Heart Failure
HFreF (Systolic) Heart Failure
HFreF (Systolic) Heart Failure (also known as Heart Failure with Reduced Ejection Fraction) is when the heart muscle loses the
ability to pump with enough muscle power or force. This type of heart failure is more common and occurs when the heart muscle is
weak, thin and enlarged.
HFpEF (Diastolic) Heart Failure (also known as Heart Failure with Preserved Ejection Fraction) is when the heart muscle contracts
normally and can still be strong enough to force blood out of the ventricle normally. However, due to stiffness and thicker walls,
the left ventricle loses the ability to relax normally during the resting period between each heartbeat. This means that less blood
is able to fill the heart, leading to less blood being pumped out to organs in the body
Note: Ejection Fraction is a measure of the percentage of blood in the ventricles that the heart pumps out. In Systolic heart failure,
the ventricle is typically filled up with blood, but due to muscle weakness it is unable to pump out all of the blood.