Heart failure does not actually mean that your heart has failed or stopped beating. It means that your heart, which is a muscle that pumps blood to all parts of your body, is not working as well as it should be. As your heart's pumping action lessens, blood may back up in your lungs, liver, or legs. This can cause shortness of breath, leg swelling (called edema), and other problems. In addition, organs in your body may not get the oxygen and nutrients they need, reducing their ability to function properly.

You may experience one or more of the following if your heart is failing:

• Swollen feet, ankles, and possibly abdomen
• Weight gain
• Shortness of breath and cough
• Racing or skipping heart beat (palpitations)
• Indigestion, nausea and vomiting, and loss of appetite
• Difficulty sleeping
• Fatigue, weakness, and exercise intolerance
• Lightheadedness
• Diminished concentration and level of alertness
• Changes in urination like needing to urinate at night (nocturia). If you have decreased urine production (oliguria), this is often a sign that your kidneys are failing.

The more advanced your heart failure, the more likely you are to have symptoms. Doctors use different grading or staging systems to classify your heart failure in terms of its severity.

The most common causes of heart failure are high blood pressure and coronary artery disease. Other causes of heart failure include:

• Valvular abnormalities (valves separate the chambers of the heart)
• Congenital heart disease (heart defects with which one may be born)
• Cardiomyopathy (weakening of the heart muscle, which may be from infection, nutritional deficiencies, or many other possible causes)
• Lung disease
• Heart tumor

You are at risk for developing heart failure if you:

• Have had a heart attack or have heart disease of any kind.
• Have high blood pressure or diabetes.
• Are obese.
• Abuse alcohol, smoke cigarettes, or use cocaine.

Your doctor can usually diagnose heart failure based on the history and your physical exam. He or she will focus attention on examination of your heart and lungs, checking for enlargement of the former and fluid in the latter. Other signs of heart failure that the doctor will look for include distended neck veins, swelling in your legs or abodmen, and tenderness of the liver. A chest xray can help to see if there is fluid on your lungs or enlargment of your heart - two factors that often go along with CHF.

After the initial diagnosis, your health care provider will focus on identifying the cause and precipitating factors for CHF. This is especially important if the underlying cause is treatable. Procedures include blood tests, chest xray, electrocardiograms (EKG), and an echocardiogram - ultrasound of your heart - to test heart function by observing and measuring how well the heart muscle pumps.

Carefully monitoring yourself and helping to manage your condition makes a big difference in keeping CHF under control and feeling good. To do this, track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that the pump function of your heart is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.

Other important measures include:

• Take your medications as directed. Carry a list of medications with you wherever you go.
• Limit salt and sodium intake.
• Don't smoke.
• Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan based on your degree of heart failure and how well you do on tests that check the strength and function of your heart. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.
• Lose weight if you are overweight.
• Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.

Tips to lower your salt and sodium intake

• Look for foods that are labeled "low-sodium," "sodium-free," "no salt added," or "unsalted." Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels.
• Don't cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).
• Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese.
• Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.
• Use oil and vinegar, rather than bottled dressings, on salads.
• Eat fresh fruit or sorbet when having dessert.

• Vasodilators—open up blood vessels; cornerstone of treatment; for example, angiotensin-converting enzyme (ACE) inhibitors; side effects include kidney failure, cough, low blood pressure
• Diuretics—main types of diuretics include thiazide, loop diuretics, and potassium-sparing diuretics; help rid your body of fluid and sodium
• Digitalis glycosides—increase the ability of the heart muscle to contract properly; prevent heart rhythm disturbances

Carnitine

L-carnitine supplements may reduce your chances of developing heart failure after a heart attack and improve exercise capacity if you already have CHF. Carnitine is a nutrient that helps the body convert fatty acids into energy. This energy, in turn, is used primarily for muscular activities throughout the body.

Coenzyme Q-10 (CoQ10)

Levels of CoQ10 are low in people with CHF. Several research studies suggest that CoQ10 supplements can help reduce swelling in the legs, enhance breathing by reducing fluid in the lungs, and increase exercise capacity in people with CHF. Not all studies agree, however. As a result, some experts conclude that CoQ10 supplements do not contribute any benefit beyond the effects of standard treatment for CHF. More conclusive research will help resolve the debate. In the meantime, talk to your doctor about whether this supplement would be good as well as safe for you.

Creatine

In a few studies of people with congestive heart failure, those who took creatine (in addition to standard medical care) had significant improvement in symptoms and exercise capacity compared to those who received placebo. Creatine is a naturally occurring amino acid (protein building block) found mainly in muscles. Fifty percent of creatine in our bodies is ingested through the foods we eat while the other 50% is made in the liver, kidney, and pancreas. Creatine supplements have gained much popularity in recent years, particularly among body builders and competitive athletes.

Magnesium

Magnesium is essential to heart health. This mineral is particularly important for maintaining a normal heart rhythm and is often used by physicians to treat irregular heartbeat (arrythmia). People with CHF are often at particular risk for developing an arrhythmia. For this reason, your doctor may determine that magnesium should be a part of the treatment of CHF.

Omega-3 Fatty Acids

Omega-3 fatty acids, particularly in the form of dietary fish, may help reduce the risk of irregular heart rhythms from CHF. Omega-3 fatty acids may also improve certain factors, like high blood pressure, that increase your chances of developing CHF.

Selenium

Low blood levels of selenium may contribute to heart failure. It is not known, however, whether selenium supplementation can help treat CHF or not.

Vitamin B1 (Thiamine)

Thiamine may be related to heart failure in several ways. First, low levels of thiamine can contribute to the development of congestive heart failure (CHF). On the flip side, people with severe heart failure can lose a significant amount of weight including muscle mass (called wasting or cachexia) and become deficient in many nutrients including thiamine. In addition, diuretics, which are frequently prescribed for CHF, can deplete thiamine levels.

For those with low levels of this vitamin, taking a thiamine supplement may be very important for treating CHF. Talk to your doctor about measuring your level of vitamin B1 and determining if you should take thiamine. In the meantime, eating a balanced diet, including vitamin B1, and avoiding things that deplete this nutrient, such as high amounts of sugar and alcohol, seems prudent for anyone with CHF or its risk factors.

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine.

Berberine

Berberine, an active ingredient of goldenseal, can dilate blood vessels. Therefore, it may prove useful in the treatment of certain causes of both irregular heartbeat and heart failure. Although more studies are needed, research to date does suggest that berberine, when added to standard treatment of CHF, may improve heart function and exercise capacity as well as reduce shortness of breath, fatigue, and irregular heartbeats. Talk to your doctor about whether it is safe and appropriate for you to take berberine in addition to your usual care.

Hawthorn

Hawthorn (Crataegus species), a member of the rose family, was recognized by physicians in the early 1800s for its ability to treat disorders related to circulation and respiration (breathing). Considered a "cardiotonic" herb, the flowers and berries of the hawthorn plant have been used in traditional medicine to treat irregular heartbeat, high blood pressure, chest pain, atherosclerosis, and congestive heart failure.

Modern day studies suggest that Hawthorn berry extract improves heart function and exercise capacity in those with CHF. Participants in research trials also report significantly improved symptoms (like reduced shortness of breath and fatigue). Hawthorn extract may even prove to be as effective as low doses of ACE inhibitors (a leading class of heart medication) in improving symptoms of congestive heart failure. Talk to your doctor about using standardized hawthorn berry extracts in addition to the usual treatment of your CHF.

Acupuncture can reduce the response to mental stress in people with heart failure. In theory, this control of one's reaction to stress might translate into reduced blood pressure and heart rate which would, if this proves to be true, decrease the work load on your heart.

Prognosis and Complications

Heart failure is a serious disorder that carries a reduced life expectancy. It is generally a chronic illness, but many forms of heart failure can be controlled with correction of the underlying disorder, lifestyle change, and medication.

Potential complications include:

Pulmonary edema (significant fluid accumulation in the lungs)

Total failure of the heart to function (circulatory collapse or shock)

Arrhythmias (irregular heart rhythm) including fatal arrhythmias

Side effects of medications including muscle cramps, cough, gastrointestinal upset (such as nausea, heartburn, or diarrhea), low blood pressure, light-headedness, or even fainting.

Al-Hasso. Coenzyme Q10: a review. Hosp Pharm. 2001;36(1):51-66.

Andrews R, Greenhaff P, Curtis S, Perry A, Cowley AJ. The effect of dietary creatine supplementation on skeletal muscle metabolism in congestive heart failure. Eur Heart J. 1998;19(4):617-622.

Arsenian, MA. Carnitine and its derivatives in cardiovascular disease. Progr Cardiovasc Dis. 1997;40:3:265-286.

Baggio E, Gandini R, Plancher AC, Passeri M, Carmosino G. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure. CoQ10 Drug Surveillance Investigators. Mol Aspects Med. 1994;15(Suppl):s287-294.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:120,142-144,162-163,171-172,197.

Brady JA, Rock CL, Horneffer MR. Thiamin status, diuretic medications, and the management of congestive heart failure. J Am Diet Assoc. 1995;95:541-544.

Churbasik S. Evidence of the effectiveness of hawthorn extract. Am J Med. 2003;115(7):585; author reply 585-586.

Degenring FH, Suter A, Weber M, Saller R. A randomized double blind placebo controlled clinical trial of standardized extract of fresh Crataegus berries (Crataegisan) in the treatment of patients with congestive heart failure NYHA II.

Eaton LJ, Kinkade S. Hawthorn extract improves chronic heart failure. J Fam Pract. 2003;52(10):753-753.

Evangeliou A, Vlassopoulos D. Carnitine metabolism and deficit - when supplementation is necessary? Curr Pharm Biotechnol. 2003;4(3):211-219.

Ferraro S, Codella C, Palumbo F. Hemodynamic effects of creatine phosphate in patients with congestive heart failure: a double-blind comparison trial versus placebo. Clin Cardiol. 1996;19(9):699-703.

Field ML. Creatine supplementation in congestive heart failure. Cardiovasc Res. 1996;31(1):174-176.

Fong HH, Bauman JL. Hawthorn. J Cardiovasc Nurs. 2002;16(4):1-8.

Fugh-Berman A. Herbs and dietary supplements in the prevention and treatment of cardiovascular disease. Prev Cardiology. 2000;3:24-32.

Gavagan T. Cardiovascular disease. Primary Care. 2002;29(2):323-338, vi.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:779-781,932-923,1101-1103,1175-1176,1185-1187,1219-1221.

Holubarsch CJ, Colucci WS, Meinertz T, Gaus W, Tendera M. Survival and prognosis: investigation of Crataegus extract WS 1442 in congestive heart failure (SPICE)--rationale, study design and study protocol. Eur J Heart Fail. 2000;2(4):431-437.

Ince C, Schulman SP, Quigley JF, et al. Usefulness of magnesium sulfate in stabilizing cardiac repolarization in heart failure secondary to ischemic cardiomyopathy. Am J Cardiol. 2001;88(3):224-229.

Kendler BS. Recent nutritional approaches to the prevention and therapy of cardiovasular disease. Prog Cardiovasc Nurs. 1997;12(3):3-23.

Khatta M, Alexander BS, Krichten CM, Fisher ML, Freudenberger R, Robinson SW et al. The effect of conenzyme Q10 in patients with congestive heart failure. Ann Int Med. 2000;132(8):636-640.

Koh SG, Brenner DA, Korzick DH, Tickerhoof MM, Apstein CS, Sauper KW. Exercise intolerance during post-MI heart failure in rats: prevention with supplemental dietary propionyl-L-carnitine. Cardiovas Drugs Ther. 2003;17(1):7-14.

Lau CW, Yao XQ, Chen ZY, Ko WH, Huang Y. Cardiovascular actions of berberine. [review]. Cardiovasc Drug Rev. 2001;19(3):234-244.

Leslie D, Gheorghiade M. Is there a role for thiamine supplementation in the management of heart failure? Am Heart J. 1996;131:1248-1250.

Mashour NH, Lin GI, Frishman WH. Herbal medicine for the treatment of cardiovascular disease. Arch Intern Med. 1998;158:2225-2234.

McCarty MF. Fish oil and other nutritional adjuvants for treatment of congestive heart failure. Med Hypotheses. 1996;46(4):400-406.

Mendoza CE, Rodriquez F, Rosenberg DG. Reversal of refractory congestive heart failure after thiamine supplementation: a report of a case and review of literature. J Cardiovas Pharmacol Ther. 2003;8(4):313-316.

Middlekauff HR, Hui K, Yu JL, et. al. Acupuncture inhibits sympathetic activation during mental stress in advanced heart failure patients. J Card Fail. 2002;8(6):399-406.

Miller AL. Botanical influences on cardiovascular disease. Altern Med Review. 1998;3(6):422-431.

Morelli V, Zoorob RJ. Alternative therapies: Part II. Congestive heart failure and hypercholesterolemia. [Review]. Am Fam Physician. 2000;62(6):1325-1330.

Overvad K, Diamant B, Holm L, Holmer G, Mortensen SA, Stender S. Review coenzyme Q10 in health and disease. Eur J Clin Nut. 1999;53:764-770.

Pauly DF, Pepine CJ. The role of carnitine in myocardial dysfunction. Am J Kidney Dis. 2003;41(4 Suppl 4):S35-43.

Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med. 2003;114(8):665-674.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:231-235.
Rigelsky JM, Sweet BV. Hawthorn: pharmacology and therapeutic uses. Am J Health Syst Pharm. 2002;59(5):417-422.

Sarter B. Coenzyme Q10 and cardiovascular disease: a review. J Cardiovasc Nurs. 2002;16(4):9-20.

Schmidt U, Kuhn U, Ploch M, Hubner WD. Efficacy of the hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomedicine. 1994;1:17-24.

Singh RB, Niaz MA, Agarwal P, Beegum R, Rastogi SS, Sachan DS. A randomised, double-blind, placebo-controlled trial of L-carnitine in suspected acute myocardial infaction. Postgrad Med. 1996;72:45-50.

Sole MJ, Jeejeebhoy KN. Conditioned nutritional requirements: therapeutic relevance to heart failure. Herz. 2002;27(2):174-178.

Tauchert M. Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure. Am Heart J. 2002;143(5):910-915.

Washington University School of Medicine, Department of Medicine. Washington Manual of Medical Therapeautics. 29th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1998.

Witte KK, Clark AL, Cleland JG. Chronic heart failure and micronutrients. J Am Coll Cardiol. [Review]. 2001;37(7):1765-1774.

Zeng XH, Zeng XJ, Li YY. Efficacy and safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 2003;92(2):173-176.

Zenuk C, Healey J, Donnelly J, Vaillancourt R, Almalki Y, Smith S. Thiamine deficiency in congestive heart failure patients receiving long term furosemide therapy.