Heart failure affects about 5 million Americans. Roughly 550,000 people are diagnosed with heart failure each year. It is the leading cause of hospitalization in people older than 65.

Heart failure does not mean the heart has stopped working. Rather, it means that the heart's pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart respond by stretching to hold more blood to pump through the body or by becoming more stiff and thickened. This helps to keep the blood moving for a short while, but in time, the heart muscle walls weaken and are unable to pump as strongly. As a result, the kidneys respond by causing the body to retain fluid (water) and sodium. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested, and congestive heart failure is the term used to describe the condition.

Heart failure is caused by many conditions that damage the heart muscle, including:

●Coronary artery disease. Coronary artery disease (CAD), a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.

●Heart attack. A heart attack may occur when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle and damaging it. All or part of the heart muscle becomes cut off from its supply of oxygen. A heart attack can damage the heart muscle, resulting in a scarred area that does not function properly.

●Cardiomyopathy. Damage to the heart muscle. Causes include artery or blood flow problems, infections, and alcohol and drug abuse.

●Conditions that overwork the heart. Conditions including high blood pressure, heart valve disease, thyroid disease, kidney disease, diabetes, or heart defects present at birth can all cause heart failure. In addition, heart failure can occur when several diseases or conditions are present at once.

Systolic dysfunction (or systolic heart failure) occurs when the heart muscle doesn't contract with enough force, so there is less oxygen-rich blood that is pumped throughout the body.

Diastolic dysfunction (or diastolic heart failure) occurs when the heart contracts normally, but the ventricle — the main pumping chamber — does not relax properly, reducing the amount of blood that can enter the heart and raising blood pressure in the lungs.

A test called the ejection fraction (EF) is used measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. The ejection fraction is a measure of the percentage of blood that your heart pumps out with each beat. Your doctor can discuss which condition you have.

In patients with systolic heart failure, the ejection fraction is less than 40%. Imaging studies such as an echocardiogram (heart ultrasound) show the heart is enlarged and pumps out less than a normal amount of blood with each beat.

In contrast, patients with diastolic heart failure usually have a normal ejection fraction, normal heart pumping capability, but an echocardiogram shows that the heart does not fill up with blood properly during the heart relaxation phase that occurs between beats.

In 2001, the American Heart Association (AHA) and American College of Cardiology (ACC) developed the “Stages of Heart Failure.” These stages, which were updated in 2005, will help you understand that heart failure is often a progressive condition and can worsen over time. They will also help you understand why a new medication was added to your treatment plan and may help you understand why lifestyle changes and other treatments are needed.

The stages classified by the AHA and ACC are different than the New York Heart Association (NYHA) clinical classifications of heart failure that rank patients as class I-II-III-IV, according to the degree of symptoms or functional limits. Ask your doctor what stage of heart failure you are in.

Check the table below to see if your therapy matches what the AHA and ACC recommend. Note that you cannot go backward in stage, only forward.

The table below outlines a basic plan of care that may or may not apply to you, based on the cause of your heart failure and your special needs. Ask your doctor to explain therapies that are listed if you do not understand why you are or are not receiving them.

You may not have any heart failure symptoms, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. Heart failure symptoms are related to the changes that occur to your heart and body, and the severity depends on how weak your heart is. The symptoms can include:

●Congested lungs. A weak heart causes fluid to back up in the lungs. This can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.

●Fluid and water retention. A weak heart pumps less blood to your kidneys and causes fluid and water retention, resulting in swollen ankles, legs, and abdomen (called edema) and weight gain. This can also cause an increased need to urinate during the night as your body attempts to get rid of this excess fluid. Bloating in your stomach may cause a loss of appetite or nausea.

●Dizziness, fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.

●Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a fast or irregular heartbeat.

If you have heart failure, you may have one or all of these symptoms or you may have none of them. In addition, your symptoms may not be related to how weak your heart is; you may have many symptoms but your heart function may be only mildly weakened. Or you may have a more severely damaged heart but have few symptoms.

To diagnose heart failure, your doctor will first ask you questions about your symptoms and medical history. Your doctor will want to know:

●If you have any other health conditions such as diabetes, kidney disease, angina, high blood pressure, or other heart problems.

●If you smoke.

●If you drink alcohol and how much you drink.

What medications are you taking.

Your doctor will also perform a complete physical exam. Your doctor will look for signs of heart failure as well as any other illnesses that may have caused your heart to weaken.

Your doctor may also order tests to determine the cause and severity of your heart failure. These include:

●Blood tests. Blood tests are used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia. Anemia is a blood disorder that occurs when there is not enough hemoglobin (the substance in red blood cells that enables the blood to transport oxygen through the body) in a person's blood.

●B-type natriuretic peptide (BNP) blood test . BNP is a substance secreted from the heart in response to changes in pressure that occur when heart failure develops and worsens. The level of BNP in the blood increases when heart failure symptoms worsen, and decreases when the heart failure condition is stable. The BNP level in a person with heart failure — even someone whose condition is stable — is higher than in a person with normal heart function.

●Chest X-ray. Chest X-ray shows the size of your heart and whether there is fluid build-up around the heart and lungs.

●Echocardiogram. This test (often called an “echo”) shows a graphic outline of the heart's movement. During an echo, a wand is placed on the surface of your chest. This wand sends ultrasound waves that provide pictures of the heart's valves and chambers so the pumping action of the heart can be studied. Echo is often combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart's valves.

●Ejection fraction (EF). A normal EF is generally between 55% and 75%, which means that over half of the blood volume is pumped out of the heart with each beat. Heart failure may occur as the result of a low EF (called systolic heart failure), or from another cause, such as a valve disorder or from diastolic dysfunction. People with diastolic dysfunction can have a normal EF.

●Electrocardiogram (EKG or ECG). ECG records the electrical impulses traveling through the heart. During the test, small, flat, sticky patches called electrodes are placed on your chest. The electrodes are attached to an electrocardiograph monitor (ECG) that charts your heart's electrical activity on graph paper. Your doctor will also be interested in determining your ejection fraction, or EF. This is a measurement of how much blood is pumped out of the heart with each heartbeat.

●Stress test. The patient's heart is “stressed” by walking on a treadmill or by medications that increase the pumping of the heart. It helps determine if someone may have clogged heart arteries.

●Cardiac catheterization. This is an invasive test which measures whether you have clogged heart arteries (coronary artery disease).

●CT coronary angiogram. This is a noninvasive test which uses X-ray and intravenous contrast dye to determine whether you have coronary artery disease.

●Cardiac MRI. This less commonly used test helps your doctor understand whether you have abnormalities of the heart muscle itself or of the tissues surrounding the heart (pericardium).

Today there are more options available to treat heart failure than ever before. Regular medications and lifestyle changes coupled with careful monitoring is the first line of treatment. As the condition progresses, centers specializing in the treatment of heart failure can offer more advanced treatment options, such as surgery.

Taking your heart failure medications as prescribed is one of the most important things you can do to manage your condition. The more you know about your medications and how they work, the easier it will be for you to stay on track.

Common types of drugs used to treat heart failure include:

●Angiotensin II receptor blockers (ARBs)

●Beta-blockers

●Digoxin

●Diuretics

●Blood vessel dilators

●Potassium or magnesium

●Aldactone Inhibitors

●Calcium channel blockers

●Heart pump medication

Surgery is aimed at stopping further damage to the heart and improving the heart's function. Procedures used include:

The most common surgery for heart failure is bypass surgery to route blood around a blocked heart artery.

The LVAD helps your heart pump blood throughout your body. It allows you to be mobile, sometimes returning home to await a heart transplant.

As heart failure progresses, the heart valves that normally help direct the flow of blood through the heart to the rest of the body may no longer completely close, allowing blood to “leak” backward. The valves can be repaired or replaced.

When a heart attack occurs in the left ventricle (left lower pumping chamber of the heart), a scar forms. The scarred area is thin and can bulge out with each beat (an aneurysm). A heart surgeon can remove the dead area of heart tissue or the aneurysm.

A heart transplant is considered when heart failure is so severe that it does not respond to all other therapies.

ankle ['æŋk(ə)l] n.踝关节

aldosterone [æl'dɒstərəʊn] n.醛固酮

angina [æn'dʒainə] n.心绞痛

cardiomyopathy [,kɑːdiəʊmai'ɒpəθi] n.心肌病

cholesterol [kə'lestərɒl] n.胆固醇

diuretic [,daijʊ(ə)'retik] n.利尿剂；adj.利尿的

edema [i'diːmə] n.水肿

hemoglobin [,hiːməʊ'gləʊbin] n.血红蛋白

hospice ['hɒspis] n.养老院

pacemaker ['peismeikə] n.起搏器

palliative ['pæliətiv] adj.缓和的，姑息性的

alcohol and drug abuse 酒精及药物滥用

angiotensin converting enzyme inhibitor (ACE inhibitor) 血管紧张素转换酶抑制剂

angiotensin II receptor blocker (ARB) 血管紧张素Ⅱ受体阻断剂

blood vessel dilators 血管扩张剂

B-type natriuretic peptide (BNP) B型钠尿肽

calcium channel blockers 钙通道阻滞剂

congested lungs 肺充血

congestive heart failure 充血性心力衰竭

coronary artery disease (CAD) 冠心病

CT coronary angiogram 冠脉CT造影

diastolic dysfunction 舒张功能不全

ejection fraction (EF) 射血分数

heart attack 心脏病发作

heartfailure 心衰

heart valve surgery 心脏瓣膜手术

implantable cardiac defibrillator (ICD) 植入式心脏除颤器

left ventricular assist device (LVAD) 左心室辅助装置

left ventricular dysfunction 左心室功能不全

retain fluid (water) and sodium 水钠潴留

rheumatic fever 风湿热

systolic dysfunction 舒张功能不全

systolic heart failure 收缩性心衰