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.
Signs and Symptoms
You may experience one or more of the following if your heart is
Swollen feet, ankles, and possibly abdomen
Shortness of breath and cough
Racing or skipping heart beat (palpitations)
Indigestion, nausea and vomiting, and loss of appetite
Fatigue, weakness, and exercise intolerance
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)
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.
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
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
Other important measures include:
Take your medications as directed. Carry a list of medications with
you wherever you go.
Limit salt and sodium intake.
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
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,
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
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
Nutrition and Dietary Supplements
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
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.
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 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.
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, 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 (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
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
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.
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications;
Brady JA, Rock CL, Horneffer MR. Thiamin status, diuretic medications, and
the management of congestive heart failure. J Am Diet Assoc.
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
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;
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.
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.
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.
Mashour NH, Lin GI, Frishman WH. Herbal medicine for the treatment of
cardiovascular disease. Arch Intern Med.
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.
Miller AL. Botanical influences on cardiovascular disease. Altern Med Review.
Morelli V, Zoorob RJ. Alternative therapies: Part II. Congestive heart
failure and hypercholesterolemia. [Review]. Am Fam Physician.
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.
Sarter B. Coenzyme Q10 and cardiovascular disease: a review. J Cardiovasc
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
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
Zenuk C, Healey J, Donnelly J, Vaillancourt R, Almalki Y, Smith S. Thiamine
deficiency in congestive heart failure patients receiving long term furosemide
Review Date: April 2004
Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Newton, Ma., and
Senior Medical Editor, A.D.A.M., Inc.; Peter Hinderberger, MD, PhD, Ruscombe
Mansion Community Health Center, Baltimore, MD; Richard A. Lippin, MD,
President, The Lippin Group, Southampton,
The publisher does not accept any responsibility for the accuracy of
the information or the consequences arising from the application, use, or misuse
of any of the information contained herein, including any injury and/or damage
to any person or property as a matter of product liability, negligence, or
otherwise. No warranty, expressed or implied, is made in regard to the contents
of this material. No claims or endorsements are made for any drugs or compounds
currently marketed or in investigative use. This material is not intended as a
guide to self-medication. The reader is advised to discuss the information
provided here with a doctor, pharmacist, nurse, or other authorized healthcare
practitioner and to check product information (including package inserts)
regarding dosage, precautions, warnings, interactions, and contraindications
before administering any drug, herb, or supplement discussed