Heart Failure: When the Heart Can’t Keep Up

By Sarah Samaan, Rosanne Rust, Cynthia Kleckner

Heart failure is a pretty broad term that, generally speaking, means the heart is unable to keep up with the body’s demands. It can be caused by the following:

  • Weakening of the heart muscle (known as systolic heart failure): This can be the consequence of a heart attack but may also be due to a condition known as cardiomyopathy. In cardiomyopathy, the heart muscle is weakened as a result of one of a variety of conditions including viral illness, heavy alcohol use, chemotherapy, genetic factors, or even (in rare cases) pregnancy.

  • Stiffening of the heart muscle (diastolic heart failure): Diastolic heart failure is often caused by high blood pressure. When caught early enough, it may be reversible with effective blood pressure treatment. Obesity, a sedentary lifestyle, aging, and genetic conditions can also lead to diastolic heart failure.

  • A chronically rapid heart rate: If the heart rate is too fast for the heart muscle to keep up with, and if it persists for a long time (usually weeks or longer), it may fatigue and weaken the heart. Usually we’re talking about heart rates of 120 beats per minute or more.

    Atrial fibrillation that isn’t adequately controlled with medication, an overactive thyroid, and stimulant pills can cause this condition. It usually gets better after the heart rate comes down.

Symptoms of heart failure include shortness of breath, swelling in the legs, inability to breathe normally when lying flat, and waking up at night gasping for air. These symptoms may develop gradually, which means heart failure can easily be mistaken for a respiratory infection.

To diagnose heart failure, your doctor will probably start with an echocardiogram and blood work. If a blocked artery is suspected, a stress test or coronary angiogram (a test to look directly at the heart arteries) may be the next step. Treatment of congestive heart failure depends on the cause but often involves diuretics (water pills) and medication to help strengthen the heart and control the heart rate.