Heart failure is a life-long, common condition when the heart function is reduced by increased pressure inside the heart that progressively damages and weakens the heart muscle, thus the heart can't supply the cells with enough oxygen-rich blood.

The decreased blood flow caused by heart failure results in fatigue and shortness of breath. Everyday activities such as walking, climbing stairs can become very difficult. In this condition, fluids may be retained by the body and lead to edema in several parts of the body, as mainly in the legs, feet, and abdomen.

The doctor uses tests to determine whether the person has heart failure, and the degree of its severity. Many general and specific tests are available, including imaging techniques, blood sampling, and electrical activity measures. Cardiac catheterization and biopsy are another helpful forms of diagnostic tests.

Based on this the patient will undergo the most appropriate treatment that include adhering to healthy life style, taking some medications, and/or undergoing certain medical procedures, which includes using of devices that help heart to work properly. Surgery may also be a choice.

Heart failure is a serious condition, and usually there's no cure. If the condition progressed without caring, it can lead to life threatening conditions, such as arrethmias and thrombosis. However, many people with heart failure have a full, enjoyable life when the condition is managed with appropriate treatment and support.

Heart failure, also known as congestive heart failure (CHF) is a chronic, progressive condition in which the heart muscle is unable to eject enough blood to meet the body's needs. In some cases, the heart can't fill with enough blood. In other cases, the heart can't pump blood to the rest of the body with enough force. Some people have both problems.

How the heart work?

The normal healthy heart is a strong, muscular pump a little larger than a fist. It pushes blood continuously through the circulatory system. The body depends on the heart's pumping action to deliver oxygen- and nutrient-rich blood to the body's cells. When the cells are nourished properly, the body can function normally.

The heart has four chambers, two atria (right, left) and two ventricles (right, left). The right atrium takes in de-oxygenated blood from the rest of the body and pass it to the right ventricle which sends it to the lungs to become oxygenated. Oxygen-rich blood travels from the lungs to the left atrium, then on to the left ventricle, which eventually pumps it to the rest of the body, then the cycle continues.

Heart failure has many classifications based on the criteria used to distinguish between the conditions.

• Based on the side:
  • Right-side heart failure. Occurs if the heart can't pump enough blood to the lungs to pick up oxygen. This may cause fluid to build up in the feet, ankles, legs, liver, abdomen, and the veins in the neck;
  • Left-side heart failure. When the heart is unable to pump enough oxygen-rich blood to the rest of the body. This mainly cause fluid buildup in the lung that mainly well lead to shortness of breath.
• Based on the speed of progression:
  • Chronic heart failure. It is more common and symptoms appear slowly over time and worsen gradually. It happens basically with chronic conditions that damage the heart tissue in progress;
  • Acute heart failure. Develops suddenly and symptoms are initially severe but may only last for a brief time. It either follows a heart attack or emerge from sudden loss of the ability to compensate chronic heart failure.
• Based on functional disruption:
  • Systolic failure: The ventricle, usually the left one, loses its ability to contract normally. The heart can't pump with enough force to push enough blood into circulation;
  • Diastolic failure: The ventricle loses its ability to relax normally due to cardiac muscle stiffness. The heart can't properly fill with blood during the resting period between beats.
• Based on the symptoms and diagnostic tests:
  • A: No objective evidence of cardiovascular disease. No symptoms and or limitation in ordinary physical activity, but the person has risk factors to develop heart failure;
  • B: Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during usual activity. The person feels comfortable at rest;
  • C: Objective evidence of moderately severe cardiovascular disease and marked limitation in activity due to symptoms, even during less-than-ordinary activity. The person is comfortable only at rest;
  • D: Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest. This stage is considered advanced heart failure.

Heart failure often develops after other conditions have damaged or weakened the heart muscle. It can also occur if the heart becomes too stiff. The main causes of heart failure are:

• Coronary heart disease (CHD). Considered the most common form of heart disease and the most common cause of heart failure and death. Over time, arteries that supply blood to heart muscle narrow from a buildup of fatty deposits in a process called atherosclerosis. This can cause reduced blood flow to the heart leading to progressive damage, or even sudden one if the condition developed to heart attack.
• Hypertension. High blood pressure cause heart to pump against high force that harshens its function. Over time, the heart muscle may become thicker to compensate for the extra work it must perform. Eventually, the heart muscle may become either too stiff or too weak to effectively pump blood.
• Diabetes. High blood sugar levels can damage and weaken the heart muscle and the blood vessels that supply the heart, leading to heart failure.
• Cardiomyopathy. A damage, thickness and rigidity of the Heart muscle that can have many causes, including several diseases, infections, alcohol abuse and the toxic effect of drugs. Genetic may also play an important role.
• Myocarditis. Myocarditis is an inflammation of the heart muscle. It is most commonly caused by a virus and can lead to left-sided heart failure.
• Congenital heart defects. Abnormalities in the heart chambers or valves cause the healthy parts of the heart to work harder to pump blood, which, in turn, may lead to heart failure.
• Arrhythmias. Abnormal heart rhythms may cause the heart to beat too fast, which creates extra work for it. Over time, the heart may depress, leading to heart failure.
• Heart valve disease. Occurs if one or more of the heart valves doesn’t/don’t work(s) properly to keep blood flowing in the proper direction through the heart. A faulty valve forces the heart to work harder. Over time, this extra work can weaken the heart.
• Rheumatic heart disease (RHD). It is the most common acquired heart disease in children in many developing countries. This chronic disease develops from rheumatic fever that is caused by a preceding group A streptococcal bacterial infection. RHD remains a major cause of heart failure in Africa and Asia.
• Other diseases. Some health problems - such as HIV, hyperthyroidism, hypothyroidism, buildup of iron or protein, and chemotherapy - also may contribute to heart failure.

Having one or more of the causes of the heart failure mentioned above will increase the risk of this condition. Other risk factors include:

• Smoking. Using tobacco can damage the heart by thickening the heart wall and reducing its function. Smoking can also increase the risk of most causes of heart failure.
• Obesity. People who are obese have a higher risk of developing heart failure. The excess weight may put a bothersome job on the heart.
• Sleep apnea. The inability to breathe properly while sleeping results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of them can weaken the heart.
• Certain medications. Some drugs have their side effect on the heart. From these are: nonsteroidal anti-inflammatory drugs (NSAIDs); certain anesthesia, and some diabetes medications, such as thiazolidinedione class.
• Age (65 or older). Aging can weaken the heart muscle. Older people also may have had diseases for many years that led to heart failure. The risk will be doubled every ten years from the age of 65.
• Race. Black people are more likely to have heart failure than other races. They’re also more likely to have symptoms at a younger age, have more hospital visits due to this disease, and die from it.

In case of heart failure, heart muscle weaken and cannot generate the required force to pump the blood. At first, the heart tries to compensate the reduced cardiac output through increasing heart rate, then by developing more cardiac muscle mass and enlarging to contract more strongly, so it pumps more blood. But with time, the muscle fibers become too stiff and unyielding to be of any benefit and the heart begins to beat irregularly.

With an insufficient ability of the heart to pump blood that reach to it, the body starts to retain fluid behind the affected side of the heart. The lungs get congested with fluid with left sided heart failure, while the fluid builds up in the lower extremities and abdomen in the case of right sided failure. The body tries to make up with this by elevating blood pressure to compensate the losing power and by diverting blood away from less important tissues and organs, like the kidneys.

These temporary measures mask the problem of heart failure, but they don't solve it. Heart failure continues and worsens until these substitution processes no longer work. Eventually the heart and body just can't keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a visit to the doctor.

Most of heart failure manifestation result of either fluid buildup in the body or insufficient blood supply to the body cells. The main signs and symptoms for these:

• Shortness of breath (dyspnea) during usual physical effort, or even when lying down in the advanced condition;
• Fatigue, which may be with habitual activity of daily living;
• swelling in body tissues, such as in legs, ankles, feet and abdomen;
• Rapid or irregular heartbeat that are noticeable by the patient (palpitation);
• Persistent cough or wheezing with white or pink blood-tinged phlegm;
• Weight gain from fluid retention;
• Lack of appetite and nausea, which may lead to weight loss and muscle wasting.
• Confusion, impaired thinking, or loss of memory and concentration.

By themselves, any one manifestation of heart failure may not be cause for alarm. But if the person has more than one, he has to report them to a healthcare professional and ask for an evaluation of the heart. These symptoms tend to get worse as the condition progress.

Investigation of heart failure starts with assessing symptoms. If the physical exam – that includes listening to heart, lung sounds and measuring blood pressure - showed that the heart function could be affected, the doctor may order to undergo certain tests to check for heart failure, as the following:

• Blood tests: A sample of venous blood will be taken and analyzed for levels of important substances, such as sodium, potassium, albumin and creatinine. Abnormal levels may indicate strain on organs such as the kidneys and liver which may results from heart failure. Another test will check the level of a chemical in the blood called (NT-proBNP) or simply (BNP) that usually rises with heart failure.
• Imaging tests. X-ray images help to see the condition of the heart the lungs. The heart may appear enlarged in the case of heart failure and fluid buildup may be visible in your lungs. In same context, Cardiac computerized tomography (CT) scan or magnetic resonance imaging (MRI) may be used to show whether parts of the heart are damaged and help diagnose heart problems.
• Electrocardiogram (ECG). This painless test records the electrical activity of the heart through electrodes attached to the skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps the doctor diagnose heart rhythm problems, thickness of left ventricle and damage to the heart from current or previous heart attack that may be underlying heart failure.
• Echocardiography. Simply called "echo", a test uses sound waves to create a moving picture of the heart to show the size, shape of the heart and how well the heart chambers and valves work. Echo also can identify areas of poor blood flow to the heart, regions of heart muscle that aren't contracting normally, and heart muscle damage caused by lack of blood flow.
• Doppler Ultrasound. A Doppler ultrasound uses sound waves to measure the speed and direction of blood flow. This test often is done with echo to give a more complete picture of blood flow to the heart and lungs. Doctors often use Doppler ultrasound to help diagnose right-side heart failure.
• Stress test. Measures how the heart and the blood vessels respond to exertion. The person may walk on a treadmill or pedal a stationary bike while attached to an ECG machine, or he may receive an intravenous drug that stimulates the heart similar to exercise. A stress echocardiogram may be used to see images of heart while exercising. The test help to assess whether the blood flow is reduced in the arteries that supply heart and can help determine the kind and level of exercise appropriate for the person.
• Cardiac Catheterization. A long, thin, flexible tube called a catheter is put into a blood vessel in the arm, groin, or neck and threaded to the heart. This allows the doctor to look inside coronary arteries. The doctor can also check the pressure and blood flow in the heart chambers and collect blood samples.
• Coronary Angiography. During cardiac catheterization procedure, a dye that can be seen on x ray is injected into the bloodstream through the tip of the catheter. The image allows the physician to see the flow of blood to heart muscle and shows how well the heart is pumping.
• Nuclear Heart Scan. For this test, a form of radioactive substance is injected into the blood that back through veins to the heart and releases energy. This radioactivity can be seen with a special camera outside the body. It can show how blood is flowing through the heart and how much blood is reaching heart muscle. A positron emission tomography (PET) scan is a common type of these scans.
• Myocardial biopsy. Here, the doctor inserts a small, flexible biopsy cord into a vein in the neck or groin that leads to the heart, then small pieces of the heart muscle are taken. This test may be performed to diagnose certain types of heart muscle diseases that cause heart failure.

Results of the tests may help doctors determine the cause and severity of heart failure. This help the doctor to develop a compatible and effective program to treat heart failure and/or the underlying causes. This can prevent fast progression, help relieve symptoms and regain the ability to do activity of daily living.

• Lifestyle changes: Modifying the way that person lives can often help relieve signs and symptoms of heart failure and cool the condition worsening. These changes may be among the most important and beneficial things could be made. The patient may have to:
  • Eating healthy foods, such as fruits vegetables, and fish in order to improve cardiovascular health and fighting excess Wight. Food that are rich in cholesterol or trans-fat should be limited.
  • Restricting sodium intake, as too much sodium contributes to water retention, which strains the heart and causes shortness of breath and swollen legs, ankles and feet.
  • Quitting smoking and limiting alcohol intake, whereas both of them can lead to abnormal heart rhythm and worsen the condition.
  • Restricting fluid intake. When the body is retaining fluid, as often happens with heart failure, the person should ask the healthcare provider about how much liquid to drink every day.
  • Being active. Having heart failure is not an excuse for inactivity. The patient will benefit from some Moderate aerobic exercises that help keep the body healthy and conditioned. This should be after talking to the doctor.
  • Sleeping well. Patients with heart failure may face insomnia as dyspnea worsens when lying down and the recurrent need to urinate. Propping up the head with pillows and consulting the doctor to take diuretics earlier in the day may be helpful.

These healthy choices are recommended to be taken under the supervision of the doctor and nutritionist in order to precisely determine patient’s needs and limitations that correlate to his condition.

• Medications: Several drugs may be used to deal with heart failure and the correspondent symptoms. The following medications are commonly used:
  • Angiotensin-converting enzyme (ACE) inhibitors. These drugs will dilate blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril, lisinopril and captopril.
  • Angiotensin II receptor blockers. Have many of the same benefits as the previous group and likewise may be used as alternative for people who can't tolerate ACE inhibitors. Examples include losartan and valsartan.
  • Beta blockers. Beta blockers slow heart rate and lower blood pressure to decrease heart workload. They also reduce the risk of some arrhythmia and lessen the chance of sudden death. Examples: carvedilol, metoprolol and bisoprolol.
  • Diuretics. They help reduce fluid buildup in the lungs and swelling in the feet and ankles, thus reduce pressure on the heart and ease edema and dyspnea. Losing potassium is the main side effect of certain diuretics, such as furosemide. Aldosterone antagonists, like spironolactone, can spare potassium while removing excess sodium and water.
  • Digoxin. This drug Increases the strength of heart muscle contractions and therefore the increase the cardiac output. It also tends to slow the heartbeat, as so it may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation.

The doctor may prescribe other drugs to help gain control over health conditions that affect heart function. These could include cholesterol lowering medication and blood thinners. The patient has to take all medications regularly, as doctor prescribes without changing or skipping doses unless guided by the doctor.

• Medical Procedures and Surgery: As heart failure worsens, lifestyle changes and medications may not Suffices to control the condition. In these cases, medical intervention may offer a solution, such as:
  • Implantable cardioverter-defibrillator (ICD). A device similar to a pacemaker, implanted under chest skin with wires leading through the veins into the heart. ICD well help maintaining heart beats within normal rate and rhythm. It could also prevent sudden deaths by pacing or shocking the heart muscle in cases of severe arrhythmia and cardiac arrest.
  • Cardiac Resynchronization Therapy (CRT). Also known as biventricular pacing, in which a special pacemaker is used to make the ventricles contract more like normal and in synchrony. This therapy can improve heart function, reduce hospitalization risk, and improve survival. The device is often combined with an ICD.
  • Valve repair or replacement. If a defected or damaged heart valve is the cause, then a surgery to repair or substitute it is mainly the first step in treating this problem. The treated or implanted valve will regulate the blood flow inside the heart to improve or resolve the condition.
  • Coronary bypass surgery. If severely, multiple blocked arteries are contributing to heart failure, then the doctor may recommend coronary artery bypass graft (CABG). In this open-heart surgery, blood vessels from the leg, arm or chest override a blocked artery in the heart to allow blood to flow more freely.
  • Heart transplant. Some people have such severe heart failure that surgery or medications don't help. They may need to have their diseased heart replaced with a healthy one form a donor. Heart transplants can dramatically improve the survival and quality of life of some people with severe heart failure. However, candidates often have to wait a long time before a suitable donor heart is found.
  • Ventricular assist device (VAD). A mechanical pump device that is surgically implanted into the abdomen or the chest and attached to a weakened heart to help it pump blood to the rest of the body. VAD is mainly used with heart transplant candidates to keep them alive while they waited for a donor heart. It is also being used with end-stage heart failure patients when heart transplantation is not an option.
• Monitoring of the condition: The patient must constantly be awake to his condition in order to notice any worsening of heart problem. The main approaches in this case:
  • Tracking weight. Weight gain from day to day could mean that fluids are building up in the body. For more accurate and expressive readings, weight should be measured on the same scale and at the same time every day.  Conversely, unintentional weight loss in a specific period may suggest worsening of the condition.
  • Controlling chronic illnesses. Having hypertension or other life-long diseases should enhance the patient to take more care and comment to the recommended program to manage these conditions and reduce their impact on the heart.
  • Avoiding respiratory infections. Infectious respiratory diseases, such as, flu and pneumonia, will worsen the symptoms and adds more load to the heart. Getting available flu and pneumonia vaccines will decrease the risk of having these diseases.

• Arrhythmias. Irregular heartbeats may represent either a cause or a consequence of heart failure. From these unsynchronized problems: atrial fibrillation; ventricular tachycardia, ventricular fibrillation, bradyarrhythmias, and Left bundle-branch block. These conditions may cause palpitation and may increase the risk of stroke and cardiac arrest.
• Heart valve conditions, particularly mitral regurgitation. The valves of the heart may not function properly if it is enlarged or if the pressure in the heart is very high due to heart failure. This can progress to more serious condition, such as atrial fibrillation.
• Cardiac cachexia. An unintentional rapid weight loss (at least 7.5% of normal weight within 6 months) caused mainly by heart disease that lead to back up of fluid into the liver and intestines, causing them to swell, which may eventually decrease appetite and nutrient absorption. Cardiac cachexia is an important indicator of a worsening heart failure condition. It can require supplemental nutrition and may be life-threatening if left untreated.
• Liver damage. Heart failure can lead to a buildup of fluid that puts too much pressure on the liver. This may lead to scarring of this organ, which makes it more difficult to function properly.
• Kidney damage. Heart failure can reduce the blood flow to the kidneys, which can destroy the fictional units inside the kidneys. If left untreated for a long time, this can progress to kidney failure.
• Leg venous stasis. Affected by slow blood flow in the leg veins related to heart failure, the skin thickens and looks shiny or scaly. This can increase the risk of inflammation and ulcer formation in the skin.
• Thrombosis. Congestive heart failure predisposes to stroke and thromboembolism. This may be caused by low cardiac output, regional wall motion abnormalities, and associated atrial fibrillation.
• Premature death. In some cases (Roughly 5%), the condition may progress to an advanced, life threatening stage, when conventional heart therapies and symptom management strategies no longer work. Cardiac transplantation is last way to deal with this case. If that is not available, the Palliative care - aimed at improving quality of life and giving support - may help coexist with this situation with the least losses possible.

Adhering to healthy habits will help to protect the heart from damage and reduce the chance of having heart failure, especially for whom at risk. Warding off this condition require changing the way we used to live into a new, healthy life style. Preventive measures of heart failure include:

• Eating healthy foods: A lot of foods are good for the heart and the body. Monounsaturated and polyunsaturated fatty acids actually help lower blood cholesterol levels. Examples of these foods are avocado, nuts, seeds, tofu, salmon, tuna, and some oils (olive, canola, peanut, safflower and sesame). High fiber foods also play an important role in heart health. They include fruits, legumes, vegetables and whole grains.
• Avoiding bad foods. Some foods are considered unhealthy. Heart patients are advised to limit their intake of red meat, Palm and coconut oils, sugary foods and beverages, salt, alcohol and trans-fat, which is found in products made with hydrogenated oils and fats, that could be found at stick margarine, baked goods and coffee creamers.
• Maintaining a Healthy Weight: having normal body weight is important for overall health and could lower the risk for heart failure. This can be achieved by following a heart-healthy eating plan and keeping physically active. A general goal to aim for is a BMI of less than 25 and a waist circumference that is less than 35 inches for women or less than 40 inches for men.
• Physical Activity: Regular exercising can lower many heart failure risk factors, including LDL cholesterol, high blood pressure, and excess weight. Physical activity also can lower the risk for diabetes and raise HDL cholesterol level. Talking with the doctor before starting a new exercise plan is preferred. The general target is 30 minutes of moderate-intensity aerobic physical activity, such as brisk walking, most days of the week.
• Get away from smoking: Smoking is a major risk factor for developing heart disease, thus quitting or avoiding that bad habit provide a good chance to protect from many cardiac myopathies. The good news is that the potential effects of tobacco on the myocardium might be reversible after smoking cessation, as a new study at university of California, loss angles, has suggested recently.
• Stress Management. Learning how to relax and cope with problems can improve emotional and physical health. Meditation, Physical activity and deep breathing are of these helpful techniques that also boosts cardiovascular health, in contrast to bad ways to cope with stress - such as drinking, smoking, or overeating – that damage the heart.

For most people, heart failure is a long-term condition that can't be cured. It will usually continue to get worse slowly over time. Heart failure can severely limit the activity level and is often eventually fatal. However, early and correct treatment can help keep the symptoms under control, possibly for many years and the patient can perform the activity of daily living. Researchers continue to study new ways to treat heart failure and its complications.

Acute heart failure may only last for short period and improve rapidly if intervention starts quickly. Early diagnosis and treatment can help people who have heart failure (acute, or chronic) live longer, more active lives. The outlook for the future will depend on how well the heart muscle is functioning, the symptoms, and the response to and following of treatment plan. Early recognizing of symptoms and seeking medical care could prevent premature deaths.

Heart failure accounts for 1-4% of all hospital admissions, with an average of stay for 5-10 days for each. 24% of these patients are re-hospitalized for heart failure within the 30-day post discharge period. 17-45% of patient admitted to hospital with heart failure die within 1 year of admitting and the majority die within 5 years. These facts mentioned by national health services (NSH), UK. and Global heart failure awareness program.

However, survival rates have improved recently in many parts of the world in parallel with modern therapies and patient management systems. But the outlook of the condition remains poor and the survival rates are worse than those for bowel, breast, or prostate cancer. This is because the condition arises from different underlying problems that complicate the situation.

Heart failure is a very common condition. According NHS, there are an estimated 26 million people with HF worldwide. The condition risk increases steeply with age, particularly among those aged 65 years or more. The incidence of heart failure duplicates with each decade after this age. In economically developed countries, up to one in five is expected to develop heart failure at some point of his life. However, as developing countries undergo socio-economic development, the epidemiology of heart failure becomes increasingly similar to that of Western Europe and North America.

The incidence rate of heart failure is higher in men, but the overall prevalence is similar in both sexes, since women survive longer after the onset of the condition. Women tend to be older when diagnosed with heart failure and more often have diastolic dysfunction than men. Different attitudes toward heart failure are between men and women. Physical and social restrictions affecting daily life activities are experienced as most bothersome for men, whereas restrictions affecting the possibility to support family and friends are most difficult to accept for women.