Heart Failure is a common and serious condition resulting from a critical decline in cardiac output.  The heart is a pump, the arteries are pipes, and the body is a dynamic field that requires constant irrigation for proper functioning.  As long as the heart pumps enough blood to perfuse the entire body, all the body parts perform properly.  But when, due to myriad causes, the heart is unable to pump enough blood to supply the body’s energy needs, our organs go hungry and their functions fail in proportion to their hunger—much like a fading flashlight caused by a failing battery.

         Although there are many diseases that result in heart failure, the common mechanisms by which these diseases cause a critical decline in cardiac output are basically six:

         1) Heart valves that start to leak or become narrowed from conditions such as—congenital abnormalities, rheumatic fever, valve infections, abnormal calcifications, cartilage degenerations, and valve inflammations— reduce the heart’s efficiency and decrease the amount of blood it can pump to the body.

         2) Certain heart muscle diseases—cardiomyopathies—weaken the heart muscle and reduce the amount of blood it can pump in proportion to the muscle fatigue they cause.

         3) Narrowing or obstruction of the coronary arteries—which nourish and feed the heart muscle—reduce the heart muscle’s ability to pump in proportion to the damage caused by heart attacks or to the malnutrition caused by a decline in the blood supply to the heart muscle itself.

         4) Abnormal thickenings of the heart muscle—which impinge on the heart chambers and reduce the amount of blood that can flow into them—cause a decline in cardiac output proportionate to the decline in cardiac filling.

         5) Uncontrolled high blood pressure—which causes the heart muscle to enlarge and become redundant—reduces cardiac output in proportion to the magnitude and duration of the hypertension.

         6) Lungs damaged by smoking, asthma, or other diseases can obstruct the flow of blood going through them—which strains the right ventricle and diminishes the amount of blood it is able to pump through such lungs to the left ventricle—thus causing a decline in cardiac output in spite of a normal set of heart valves and left ventricular muscle.

         Once the reduced cardiac output reaches a critical level, symptoms begin to appear.  This critical reduction varies with each individual and depends on the individual’s energy requirements.  Thus an athlete will notice his symptoms long before a bed-confined elderly person.  Regardless of cause, the primary symptoms are two, shortness of breath and fatigue.  Both symptoms increase with physical activity and diminish with rest and both get worse with worsening of the heart failure.  On the other hand, the fatigue that diminishes with activity cannot be due to heart failure nor is the fatigue that is not linked to shortness of breath upon exertion.

         Before symptoms appear, meaning before the diminished cardiac output reaches critical levels, the heart failure is considered sub-clinical and is only detectable with special tests such as echocardiograms.  Such situations mainly arise from defective heart valves and are treated surgically before symptoms develop because waiting until symptoms occur may damage the heart muscle irreversibly.

         Hence, suspecting heart failure—in the presence of unexplained fatigue and shortness of breath—is critical because early recognition may enhance recovery while late recognition may render the condition irreversible.  Swelling, which may also be a sign of heart failure, is all too common and may be caused by too many other conditions.  Thus, if the swelling is not associated with the two cardinal symptoms of fatigue and shortness of breath, it is usually explainable by other diagnoses.

         Treatment of heart failure depends on its causes.  When the cause is reversible and the recognition of the heart failure does not come inappropriately late, the prognosis is usually good.  Prompt replacement of defective heart valves or bypassing of blocked coronary arteries may totally reverse the shortness of breath and fatigue.  On the other hand, primary heart muscle diseases or bad lungs or heart muscles severely damaged by heart attacks usually carry bad prognoses.