RPM for Heart Failure
Between 6 and 7 million Americans are living with heart failure.
A serious condition characterized by the inability to pump enough blood. Most often, it is caused by another medical condition that damages your heart. This might include coronary heart disease, high blood pressure, cardiomyopathy, heart inflammation, or an irregular heartbeat. But acute heart failure may be caused by injury or infection.
Heart failure can be acute or slowly develop over time. It can affect just one side of the heart or both sides at once. If it is just on one side, it can create different symptoms and have different causes.
Heart failure might not cause symptoms right away; however, severe heart failure can require long stints in the hospital, as well as invasive medical procedures or surgeries. Patients with heart failure require routine check-ups with their doctors to monitor their heart function.
Heart failure has no cure. But accurate, proactive, long-term treatment is paramount. In order to understand how best to treat the condition, it is essential to understand how the heart works. The right side of your heart pumps oxygen-low blood from your body to your lungs. The left side of your heart pumps oxygen-rich blood to the rest of your body. This explains why heart failure behaves differently when it is just one side of the heart.
What Is Left-Sided Heart Failure?
The most common kind of heart failure, left-sided heart failure is often caused by another medical condition and chronic in nature.
There are two types of left-sided heart failure: reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Men are more likely to experience the first, women the second.
With HFrEF, the left side of your heart can’t pump enough blood to the rest of your body. This might be due to coronary heart disease or a heart attack preventing your heart muscle from getting enough oxygen. Other causes of this type of heart failure include faulty heart valves, an irregular heartbeat, or genetic heart diseases.
With HFpEF, the left side of your heart is too stiff to relax between heartbeats. It is working too hard and yet can’t fill up with enough blood. Your muscle thickens to adapt, making it stiffer. High blood pressure or conditions that stiffen the chambers of the heart (such as obesity and diabetes) can cause this type of left-side heart failure.
What Is Right-Sided Heart Failure?
In right-sided heart failure, your heart can’t pump enough blood to your lungs to pick up oxygen. Blood builds up and creates pressure in the blood vessels that do travel to your lungs. The result is pulmonary hypertension. Over time, it creates untenable strain on your heart.
Though it is rarer overall, right-sided heart failure is often caused by left-sided heart failure. That’s because left-sided heart failure can cause blood to build up on the left side of your heart.
In some cases, right-side heart failure is an isolated incident; for example, if someone has a congenital heart defect or condition that damages the right side of the heart (such as an abnormal heart valve). The same is true for conditions that damage the lungs, such as chronic obstructive pulmonary disease (COPD).
What Are Risk Factors for Heart Failure?
Below is a list of common risk factors. Please note that your risk of heart failure goes up if you have more than one of these factors.
- Age. After 65, your risk of heart failure increases. Your heart physically weakens as you age. Additionally, you are more likely to have other health conditions.
- Genetics. A family history of heart failure is likely to predicate individual heart failure. Certain gene mutations can also raise your risk by weakening your heart tissue.
- Lifestyle. Many lifestyle choices and habits can factor into heart failure, including an unhealthy diet, smoking, using illegal drugs, and lack of physical activity.
- Medical Conditions. Any blood vessel condition, serious lung disease, or infection (including HIV or SARS-CoV-2, aka COVID-19) can increase your risk of heart failure. Long-term health conditions such as high blood pressure, diabetes, sleep apnea, obesity, chronic kidney disease, anemia, or thyroid disease also raise your risk. Cancer treatments such as radiation and chemotherapy can raise your risk. Atrial fibrillation can raise your risk.
- Race. African-Americans are more susceptible to heart failure, and starting at a younger age. Their experience might also be more severe.
- Sex. Men are likely to develop heart failure starting at a younger age than women, but women are likely to have worse symptoms. Women may experience preserved ejection fraction (HFpEF), meaning the heart does not fill with enough blood, while men are more likely to have heart failure with reduced ejection fraction (HFrEF).
What Are the Symptoms of Heart Failure?
Mild heart failure may be hard to detect; for example, you might not be aware anything is wrong until you are undergoing excessive physical exertion. In that case, you might only notice shortness of breath. However, symptoms usually worsen and become easier to detect as your heart grows weaker. Eventually, you might notice strain when you are simply strolling across the room. Additionally, symptoms can depend on whether you have left-sided or right-sided heart failure. Some individuals have symptoms for both.
Those with left-sided heart failure may experience:
- Weakness
- Trouble breathing
- Cough
- Fatigue
- Blue or gray color to lips and fingertips
- Difficulty concentrating
- Inability to sleep lying flat
- Disorientation
Those with right-sided heart failure may experience:
- Nausea
- Weight gain
- Abdominal pain
- Loss of appetite
- Swelling in your ankles, feet, legs, or abdomen
- Protruding veins in your neck
- Needing to pee often
Eventually, severe heart failure will lead to serious complications, which might include:
- Pulmonary hypertension
- Kidney or liver damage
- Fluid buildup in or around your lungs
- Malnutrition
- Other heart conditions (irregular heartbeat, leaking heart valves, sudden cardiac arrest)
What Are Treatments for Heart Failure?
A healthier lifestyle is one of the key components of a cardiac rehabilitation plan. Your doctor may recommend one or more of the following treatment options:
- Reduce salt intake.
- Target a healthy weight that relieves some heart strain.
- Pursue regular physical activity.
- Quit smoking. For free help quitting smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
- Limit alcohol intake.
- Manage contributing risk factors like high blood pressure and anemia.
- Manage stress to improve your mental and physical health.
- Pursue better sleep. This may include treating sleep disorders such as sleep apnea.
Your doctor may prescribe medicine to treat your heart failure on a case-by-case basis.
For example, with right-sided heart failure, your doctor may prescribe medicines to remove extra salt and fluid from your body, as well as medicines to relax your blood vessels.
With a left-side heart failure, reduced ejection fraction, your medicines will likely be diuretics and prescriptions to treat blood pressure as needed.
However, you might also be given:
- Medicine to remove extra sodium and fluid from your body, including aldosterone antagonists (such as spironolactone). These decrease the amount of blood that the heart must pump. Side effects of aldosterone antagonists can include kidney disease and high potassium levels.
- Medicine to relax your blood vessels; this will make it easier for your heart to pump blood. Examples include angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Possible side effects include low blood pressure, cough, and reduced kidney function.
- Medicines to slow your heart rate, such as beta blockers and ivabradine. These make it easier for your heart to pump blood and prevent long-term heart failure from worsening. Possible side effects include a slow or irregular heart rate, high blood pressure, and fuzzy vision or seeing bright halos.
- Two medicines that treat diabetes are being studied for their potential to treat heart failure: sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide (GLP) agonists.
- Digoxin can make your heart beat stronger and pump more blood. However, it’s mostly used to treat serious heart failure if other options fail. Side effects may include digestive problems, disorientation, and vision issues.
If your heart failure worsens after pursuing those treatments, you may need a medical device:
- A biventricular pacemaker (or cardiac resynchronization therapy) can help both sides of your heart contract at the same time.
- A mechanical heart pump (a ventricular assist device or a total artificial heart) can be used as a long-term treatment or as-needed until surgery is available.
- An implantable cardioverter defibrillator (ICD) checks your heart rate and can help prevent sudden cardiac arrest using electrical pulses to correct irregular heart rhythms.
Heart surgery is a way to repair a congenital heart defect or similar damage; however, if your heart failure is life-threatening, and other treatments have not worked, you may need a heart transplant.
For people with preserved ejection fraction, there are no currently approved devices or procedures to improve symptoms.
