These two types of heart failure have different symptoms and treatments.
There’s a lot of misunderstanding around what it means to have heart failure, a chronic condition that affects nearly six million Americans, according to the American Heart Association (AHA).
Clyde Yancy, MD, chief of the division of cardiology-medicine at Northwestern University’s Feinberg School of Medicine and associate director of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital in Chicago, would like to help clear things up. He’s worked hard to come up with simple language to define heart failure because, he says, he’s continually surprised at how inadequate his profession has been in conveying a correct definition.
Many people think heart failure means your heart stops beating, but that’s not the case.
“What ‘heart failure’ describes is any condition in which the heart is not working properly. A working heart means a person is able to exercise, their organs can function normally, and they can think clearly,” Dr. Yancy says. When the heart isn’t working efficiently enough to carry out these functions, that’s called heart failure. Signs of the condition may include:
Shortness of breath during activity or while lying down
Persistent coughing or wheezing
Fatigue
Confused or impaired thinking
Swelling in the ankles, feet, legs, or abdomen
If you experience any of these symptoms, it’s important to see your doctor, who can order an echocardiogram (a diagnostic ultrasound) to take pictures of your heart. “That’s so your doctor can figure out why your heart isn’t working properly,” says Yancy.
There are two primarily possibilities: “Either your heart isn’t squeezing [or contracting] very well because it’s too weak, or it doesn’t relax very well because it’s too stiff. This is important information for your doctor to know, because next steps depend on which type of problem your heart is having,” explains Yancy. The first type is called systolic heart failure, and the second is diastolic heart failure.
Systolic Heart Failure: Your Heart Isn’t Contracting Properly
The job of the pumping heart is to send oxygen-rich blood to every part of the body. If the heart muscle is weakened or damaged — from hypertension (high blood pressure), for instance — it may not be able to contract with enough force to circulate oxygenated and nutrient-filled blood.
“The way a doctor measures this is by looking at how much blood is ejected, or squeezed out, every time the heart contracts, or gets smaller,” says Yancy. “It turns out that a normal heart empties about one-half to three-fourths of the blood it’s holding at any given time, with every heartbeat. If tests show that the heart is squeezing out much less than 50 percent, that’s called heart failure with reduced ejection fraction, or systolic heart failure.”
Diastolic Heart Failure: Your Heart Isn’t Relaxing the Way It Should
As part of the pumping cycle, after each contraction, your heart muscle relaxes to allow the heart to fill with blood. If your heart loses its ability to relax normally between beats because the muscle has become stiff, it can’t fill with enough blood to circulate out to the body.
When the heart can’t properly fill with blood during its resting period, it’s called diastolic heart failure (or heart failure with preserved ejection fraction). This can happen when the heart muscle “bulks up” or thickens from being overworked — as a result of coronary artery disease or hypertension, for instance. So if tests show that your heart is contracting normally but you’re experiencing heart failure symptoms, your condition may be caused by heart muscle that’s stiff and unable to properly relax.
Heart Failure Treatment Depends on the Cause
Though both types of heart failure indicate that the heart isn’t able to do its job, the treatment plans for each are different.
For systolic heart failure, Yancy says, “there’s a suite of medicines — and in some cases medical devices [such as an implantable cardiac defibrillator] — that are proven to be effective. When those medicines are taken correctly, a patient’s condition almost always improves.”
If a doctor suspects you may have diastolic heart failure, they will probably don a detective hat and start to explore, looking for other conditions that may be causing your symptoms. These include high blood pressure, diabetes, kidney disease, coronary artery disease, or atrial fibrillation, a heart rhythm disorder. “Those diseases taken together are probably responsible for 85 to 90 percent of [diastolic] heart failure, when the heart muscle is still beating adequately but nevertheless the heart isn’t working properly,” says Yancy.
“Then it’s a matter of evaluating the hypertension, searching for the coronary disease, treating the atrial fibrillation, controlling diabetes, addressing the kidney function, and managing the obesity,” he says. “It’s more about evaluation and strategies rather than a list of drugs” to help alleviate the heart failure that results from one of these conditions.
It Takes More Than Medication to Manage Heart Failure
No matter which type of heart failure you’re diagnosed with, your doctor will probably recommend the same lifestyle changes to ease symptoms and improve your prognosis:
Regular low-intensity aerobic exercise to strengthen the heart
A heart-healthy diet
Cutting back on salt (sodium)
Limiting your alcohol consumption
Because major lifestyle adjustments can be daunting, says Zubin Eapen, MD, associate professor of medicine at Duke University and director of the Duke Heart Failure Same-Day Access Clinic in Durham, North Carolina, it’s a good idea to ask your physician if you qualify for a cardiac rehab program, which usually includes supervised exercise, diet counseling, and help with issues such as quitting smoking and managing medications. “I think we’ve found that insurance will now cover it,” Dr. Eapen says. But check with your insurance provider to be sure.
The bottom line, says Yancy, is that the outcomes of heart failure in today’s world are dramatically better than they used to be. Yes, it can be a very serious condition, but it is eminently treatable.”