INDICATORS THAT YOUR HEART FAILURE CONDITION IS DETERIORATING

Recognizing the Worsening Symptoms of Heart Failure (Congestive Heart Failure) for Improved Life Expectancy and Reduced Risk of Sudden Cardiac Arrest.

If you have been diagnosed with pre-heart failure (stage A or B) or heart failure (stage C or D), it is important to be aware of any signs indicating that your condition may be worsening. Early recognition of these symptoms can help you take prompt action.

Undetected Deterioration of Heart Failure: Act Early, Before It’s Too Late

Heart failure, or the inability of the heart to pump blood effectively around the body, affects around 6.2 million adults in the United States.

As this condition typically begins without symptoms, many adults may have heart failure without even realizing it. Over time, the condition can worsen until symptoms appear or you suffer a heart attack. Once the condition becomes acute or chronic, heart failure can lead to death within a matter of years.

Early Stages of Heart Failure (A and B)

Heart Failure (Stages A and B) – Understanding Pre-Heart Failure. During the initial stages of congestive heart failure (Stages A and B), individuals are considered to be in “pre-heart failure” and may still feel normal. However, if proper measures are not taken, the condition can escalate to chronic heart failure and then advanced heart failure.

The Early Stages of Heart Failure (Stage A)

Stage A refers to individuals who have not been diagnosed with systolic left ventricular dysfunction and do not display any symptoms of heart failure, but are at a high risk of developing the condition. The main risk factors for this stage include:

• Coronary artery disease
• Congenital heart disease
• High blood pressure
• Heart attack
• Diabetes
• Obesity
• Metabolic syndrome
• History of alcohol abuse
• History of smoking tobacco
• History of rheumatic fever
• History of taking cancer drugs, including chemotherapy and radiation
• A family history of heart failure or cardiomyopathy

In case you have any of the mentioned risk factors, it is crucial to adhere to all the dietary and lifestyle recommendations provided by your healthcare provider. Furthermore, getting an echocardiogram can help determine if there has been any progression to stage B. Your healthcare provider may prescribe medications to treat high blood pressure or high cholesterol, recommend starting (or intensifying) your exercise routine, and advise adopting a healthy, low-sodium diet to prevent the onset of high blood pressure and heart failure.

Stage B: Mild Heart Failure

During stage B, patients do not exhibit any symptoms of heart failure. However, an echocardiogram reveals an ejection fraction of 40% or less, leading to a diagnosis of systolic left ventricular dysfunction. While this is not yet classified as heart failure, individuals with stage B heart failure will likely require medication and adopt dietary and lifestyle modifications.

Stages C and D of Heart Failure: Severe and Advanced

During stages C and D, individuals experience a decreased ejection fraction that is typically at 40% or less. The heart’s inability to efficiently pump blood throughout the body may result in the accumulation of fluid in the lungs, as well as other symptoms such as:

• Shortness of breath
• Fatigue
• Leg weakness during exercise
• Swelling in the legs, ankles, and belly
• Weight gain
• Needing to get out of bed to urinate
• Heart palpitations or an irregular heartbeat/abnormal heart rhythms
• A persistent cough
• Bloating or hard stomach
• Nausea, loss of appetite, and/or losing weight

Stage C: Severe Heart Failure

During stage C, symptoms may occur intermittently. Patients may require a biventricular pacemaker to maintain proper cardiac synchronization, or an implantable cardiac defibrillator to reset their heart in the event of sudden cardiac arrest.

Stage D:Severe Heart Failure

Stage D represents the final stage of heart failure. Individuals in this stage usually experience heart failure symptoms with greater frequency, severity, or a greater number of symptoms from the list.

Patients with stage D heart failure may be offered advanced therapies to treat heart failure, including:

• Heart surgery
• A ventricular assist device
• A heart transplant
• Continuous intravenous infusions
• Hospice care
• Experimental therapies

Heart Failure with Preserved Ejection Fraction in Stages C and D

Chronic heart failure with a preserved ejection fraction (HF-pEF) is a condition where the ejection fraction remains normal (at or above 50%), but there is elevated left ventricular filling pressure. People with HF-pEF require treatment for heart failure, but may not need all of the same treatments and medications. The key is to manage any underlying conditions to prevent the condition from worsening.

Worsening Signs of Heart Failure

If you are in pre-heart failure or have a heart failure diagnosis, diagnostic tests and symptomatic changes may indicate that the condition is getting worse.

Diagnostic Tests for Medical Evaluation

Medical evaluation tests are employed to assess the presence and severity of heart failure, as well as its underlying cause. If you display symptoms of heart failure or if your existing symptoms intensify, your healthcare provider may recommend any of the following tests:

• Echocardiogram
• Electrocardiogram (ECG or EKG)
• Magnetic resonance imaging (MRI)
• Multigated Acquisition Scan (MUGA scan)
• Chest X-ray
• Blood test
• NT-pro B-type Natriuretic Peptide (BNP) blood test
• Cardiac catheterization
• Stress test

Emerging or Aggravating Symptoms

The emergence of any heart failure symptoms is generally an indication that pre-heart failure (stage A or B) has progressed to a heart failure diagnosis (stage C or D). Individuals who possess any risk factors, left ventricular dysfunction or left-sided heart failure should undergo heart failure testing as soon as any symptoms surface.

For those who already have a heart failure diagnosis, your condition may be worsening if:

• You develop symptoms of heart failure that you didn’t previously have.
• Your existing symptoms of heart failure are getting worse or occur more frequently.
• You experience a rapid weight gain of 5 pounds or 2.3 kilograms over a few days.

Managing Worsening Heart Failure: Steps to Take

If a new symptom develops or an existing one worsens, it’s crucial to promptly inform your doctor. This can help you receive testing, identify factors contributing to the decline, and make necessary adjustments to your medications or lifestyle.

Many of the symptoms of heart failure could be symptoms of something else, which is why it’s so important to have tests performed if you present with any of the symptoms of heart failure.

Severe Symptoms That Require Immediate Medical Attention

Call 9-1-1 in the United States or go to the emergency room immediately if you experience any of the following symptoms:

• Chest pain
• Severe weakness
• Fainting
• Sudden shortness of breath
• Irregular or rapid heartbeat together with chest pain, fainting, or shortness of breath
• Coughing up foamy mucus, either white or pink

These symptoms may require urgent treatment, such as intravenous medications, surgery, or defibrillation with an automated external defibrillator if you experience sudden cardiac arrest. Seeking immediate medical attention will help stabilize your condition, determine the cause of your symptoms, and allow for appropriate treatment.

Identifying Deterioration of Heart Failure Symptoms in Another Person

If you want to assist someone who may have heart failure, it’s possible to identify heart failure symptoms in others and direct them to seek medical attention.

The emergency symptoms listed above (chest pain, shortness of breath, fainting, coughing up foamy mucus) are the most telltale signs of a medical emergency due to heart failure. If you notice any of these symptoms in someone who is conscious, remain with them, keep them calm, and call 9-1-1. It’s also wise to have a high-quality AED, like the Philips HeartStart FRx or ZOLL AED Plus Plus, nearby in case of cardiac arrest. You may never have to use it, but it’s better to be prepared.

If you witness someone suddenly collapse and stop breathing normally, immediately call 9-1-1, send someone to get an automated external defibrillator, and begin performing chest compressions. The person may be experiencing sudden cardiac arrest and chest compressions can help maintain the circulation of oxygen-rich blood until emergency medical services arrive.

Prevention is the Best Medicine

Although pre-heart failure cannot be reversed, you can take steps to prevent or slow its progression. These include obtaining an early diagnosis, adopting a healthy lifestyle and diet, maintaining a healthy weight, and adhering to medication regimens.

If you have a friend or loved one with pre-heart failure or heart failure, you can offer support by encouraging them to follow their doctor’s recommendations for diet, exercise, and medication, as well as exercising together.

Taking a CPR and AED training course can help to reduce mortality from heart failure and cardiac arrest. In an emergency situation, knowing how to perform CPR and use an AED can be crucial in saving someone’s life. It’s always better to be prepared, as you never know when someone around you might need your help.