Heart failure

Your heart is a muscle that works 24/7 to pump oxygenated blood throughout your body. Some conditions can take a toll on the heart muscle, causing it to weaken or stiffen. When this happens, the heart pumps inefficiently. Heart failure exists when the heart can no longer pump enough blood to meet the body’s needs. Conditions that contribute to heart failure include:

• Cancer-related heart disease: Cancer treatment effectively kills cancer cells, but may also damage other cells in the body, including heart cells.
• Cardiac amyloidosis: A disorder that causes abnormal protein deposits (amyloids) in the heart muscle
• Cardiac arrhythmias: Abnormal heart rhythms caused by faulty electrical heart impulses
• Cardiomyopathy: A disease that leads to the heart muscle becoming stiffened, thickened or enlarged
• Congenital heart disease: Heart abnormalities that develop before birth
• Constrictive pericarditis: Chronic inflammation of the membrane that covers the heart, which leads to thickening or scarring that prevents full heart expansion during beating
• Coronary artery disease: A narrowing of the blood vessels that supply the heart with oxygenated blood
• Heart valve disease: A condition that causes one or more of the heart’s four valves to work improperly

There are two types of heart failure, each involving the lower heart chambers (ventricles):

• Left-sided: Left-sided heart failure can be systolic or diastolic. Systolic heart failure happens when the left ventricle can’t contract enough to force blood out. Diastolic heart failure is when the left ventricle can’t relax and fill fully. Both types of left-sided heart failure result in blood backing up into the lungs.
• Right-sided: When the right ventricle doesn’t pump efficiently, fluid can back up into the abdomen, legs or feet.

Heart failure symptoms can range from mild to severe. In the early stages you may experience flu-like symptoms, including:

• Body aches
• Fatigue
• Fever or chills
• Loss of appetite

As heart failure progresses, you may experience more pronounced symptoms, including:

• Belly pain: You may feel bloated or fuller after eating.
• Breathing disturbance: You may have shortness of breath all the time or with exertion. You might also have a cough when lying down.
• Sleep disturbance: You may need to prop yourself up with pillows to prevent coughing.
• Sudden weight gain: You may gain up to 2 pounds overnight.
• Swelling: The fluid backup resulting from improper heart pumping can lead to swelling of the legs, ankles or feet (edema).

Penn’s cardiovascular imaging services offer the most advanced technologies to help your heart failure specialist make an accurate diagnosis. Specialists use a measurement known as ejection fraction to determine how much blood the left ventricle pumps out with each beat. Ejection fraction is measured using:

• Echocardiogram
• MRI

Your cardiologist may use other tests to make a diagnosis, such as:

• Blood tests, to measure markers for diseases that could affect the heart
• Cardiac catheterization, to spot buildup or blockages that might be responsible for your symptoms
• Cardiac CT scans, to detect buildup in heart arteries
• Electrocardiogram, to measure your heart’s electrical activity
• Exercise test (stress test), to measure how your heart responds to physical exertion