Paying attention to these subtle symptoms can speed treatment and prevent complications


man suffering illness symptoms

Heart failure is a progressive disease that can severely limit a person’s quality of life, making it especially important to receive an early diagnosis. But symptoms of heart failure are often subtle, and easily mistaken for signs of normal aging and slowing down.

“Heart failure is a chronic condition that develops when the heart muscle is not pumping at full capacity,” explains Robb Kociol, MD, Director of the CardioVascular Institute’s Advanced Heart Failure Program, which was recently awarded a quality achievement award from the American Heart Association. “In many cases, heart failure develops in patients with coronary artery disease, especially if the patient has had a heart attack that has damaged the heart muscle.”

As Kociol describes, in these cases, the damaged heart can no longer pump well enough to keep up with the body’s demands for oxygen-rich blood. “The heart beats faster and grows larger so that it can hold more blood. Ultimately, these attempts to compensate result in further weakening of the heart,” he adds.

If heart failure is detected early, medications can help prevent damage to the heart’s structure and function, improving symptoms and prolonging patients’ lives.

“It’s important to pay attention to the following five symptoms,” says Kociol, also an Assistant Professor of Medicine at Harvard Medical School.

1. Fatigue

“A general feeling of tiredness and loss of appetite may set in when the heart isn’t pumping well,” says Kociol (right). “These symptoms are non-specific and can be related to other conditions, such as a viral illness, but sudden onset of fatigue should be evaluated.”

2. Shortness of Breath

“Being short of breath, particularly during exertion, is often a telltale sign of heart failure,” says Kociol.

Shortness of breath due to heart failure is caused by pulmonary congestion and fluid seeping into the air sacs and tissues of the lungs.

3. Inability to Lie Flat

Needing extra pillows to sleep or awakening suddenly at night having difficulty breathing are symptoms that can point to heart failure.

“Patients often tell me that they have trouble while they are lying flat in bed and suddenly become short of breath,” says Kociol. “Some patients actually sleep upright in a recliner.”

4. Limitation of Routine Activities

Becoming too tired to go about normal daily activities such as shopping, cooking, cleaning, making the bed or taking a walk could point to a problem.

5. Edema or Swelling of the Ankles

When the heart doesn’t have enough pumping power to force used blood back up from the legs and lower extremities, fluid can collect, often in the ankles.

“In patients with heart failure, edema in the legs, abdomen or chest can be the result of weakness on the right side of the heart,” says Kociol. Excess fluid can also lead to weight gain.

Diagnosing Heart Failure

In addition to medical history and a physical examination, doctors use these tests to diagnose heart failure:

Blood Tests

“Your doctor may order a blood test to look for molecular biomarkers that are released by the heart when it is overburdened,” explains Kociol.

One molecule that is a marker of increased stress or pressure on the heart muscle is called B-type natriuretic peptide (BNP). Natriuretic peptides help stimulate the body to eliminate salt and excess fluid.

Imaging Tests

An echocardiogram is a non-invasive test that uses ultrasound to create images of a beating heart.

“If the echocardiogram reveals a lower-than-normal percentage of blood leaving the heart when the left ventricle contracts, there is a possibility of heart muscle damage and heart failure,” says Kociol.

A specific measurement made during an echocardiogram to indicate how well the heart is pumping is called the ejection fraction. A normal, healthy heart usually has an ejection fraction of about 60 percent.

Treating Heart Failure

Although heart failure is a chronic, lasting condition, medications can reduce symptoms and improve patients’ quality of life. Medications that are often used to control heart failure include:

  • Angiotensin-converting enzyme (ACE) inhibitors, which help block hormones that can make heart failure worse
  • Beta blockers, which slow the progression of disease and relax the heart by controlling heart rate and blood pressure, thereby reducing strain on the heart
  • Diuretics or "water pills," which remove excess fluid and salt from the body.

In more severe cases of heart failure, patients may receive an implantable device to restore the heart’s pumping abilities. Treatment options might include:

  • Cardiac resynchronization therapy (CRT): An implantable pacemaker sends timed electrical impulses to the heart’s lower chambers (the ventricles) to help synchronize pumping and improve heart failure symptoms.
  • Left ventricular assist device (LVAD): This implantable mechanical pump can take over the pumping function of the heart’s ventricles, helping the failing heart to pump blood throughout the body.
  • Implantable Cardioverter-Defibrillator (ICD): This device detects life-threatening abnormalities in the rhythm of the heart beat. If a problem is detected, it delivers an electric shock to restore normal rhythm.
  • Orthotopic heart transplant (OHT): The staff of the Advanced Heart Failure program includes board-certified transplant cardiologists. “We perform full comprehensive transplant evaluations at BIDMC and partner with a high-volume transplant center for patient care,” says Kociol.

Learn more about these and other treatment options through BIDMC’s Advanced Heart Failure Program.

  • Make an appointment: call 617-667-8800

Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

July 2017