heart failure
Meaning of heart failure: A name that frightens more than it explains: the heart has not stopped, it has fallen behind what the body asks of it.
Definition of heart failure
Heart failure is a long-term condition in which the heart cannot pump enough blood to meet the body's needs, or can do so only at raised pressure inside its chambers. Blood backs up behind the struggling side of the heart, so fluid collects in the lungs, the legs or the abdomen. Breathlessness, swelling and fatigue are the usual result.
Does the heart actually stop?
No, and the name is the main source of confusion attached to the condition. Failure here means falling short of a requirement, in the way an engine unable to pull a load is failing while still running. The heart keeps beating, often for many years. What it cannot do is move enough blood forward at a normal filling pressure, so pressure rises behind it and fluid is pushed out of the vessels into the tissues. That fluid is what the older name congestive heart failure describes, and both names refer to the same disorder.
What are the main forms?
| Form | What is wrong | Usual background |
|---|---|---|
| Reduced ejection fraction | The muscle squeezes weakly | Damage from a heart attack, or diseased heart muscle |
| Preserved ejection fraction | The muscle is stiff and fills poorly | Long-standing high blood pressure, aging, obesity, diabetes |
| Left sided | Fluid backs up into the lungs | Breathlessness, cough, waking at night short of air |
| Right sided | Fluid backs up into the body | Swollen ankles, enlarged liver, abdominal fullness |
Ejection fraction is the share of blood in the main pumping chamber that leaves it with each beat, and echocardiography is what measures it. The two halves of that split behave differently enough that treatments studied in one do not transfer automatically to the other, which is why the measurement appears in almost every report.
How does it show itself?
Usually as a slow accumulation rather than a single event. Breathlessness appears first on exertion, then on less exertion, then on lying flat, and some people wake in the night gasping and have to sit upright. Ankles and lower legs swell, and weight climbs over days as fluid is retained rather than as fat is gained. Fatigue is constant and is often the symptom mentioned last, because it is easy to attribute to age. Since these changes creep in, the condition is frequently well established by the time it is recognized.
Also known as
Used in a sentence
Heart failure with preserved ejection fraction was diagnosed following echocardiography.
Good to know
The name describes performance rather than stoppage, and heart failure is not cardiac arrest: a failing heart is still beating, and the fluid that gives congestive heart failure its name comes from pressure building up behind the weaker side.