Heart failure occurs when the heart is unable to pump sufficient blood to meet the body's needs. Advanced heart failure can be treated through various methods, including medications, electrical or valvular device implantations, a left ventricular assist device (LVAD) to aid circulation, or by transplanting a healthy heart to replace the existing unhealthy one.
Failure isn’t final
Since our first heart transplant in 1985, we've been at the forefront of offering people in need of a new heart a fresh beat on life.
It’s important to know that heart failure looks different for each person because there are factors — such as underlying conditions like coronary artery disease, diabetes, high blood pressure or obesity — that can weaken the heart over time. That’s why it’s so important to keep a close pulse on your heart health.
You can trust that your personalized treatment path will place your health and well-being at the heart of it all.
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Conditions
Nearly 1 in 4 adults in the United States will develop heart failure during their lifetime. While lifestyle factors like obesity can also lead to heart failure, certain conditions can weaken the heart, too. For example:
Cardiac amyloidosis
Cardiac sarcoidosis
Coronary heart disease
Diabetes
Dilated cardiomyopathy
Heart attack
Hypertension
Hypertrophic cardiomyopathy (HCM)
Sleep apnea
Valvular heart disease
Heart failure symptoms
Heart failure symptoms vary based on your underlying condition and stage of heart failure. Common symptoms include:
- Fatigue and weakness
- Shortness of breath with activity or when lying down
- Struggling with exercise
- Rapid weight gain
- Swelling in the legs and/or abdomen
- Loss of appetite or nausea
- Confusion or difficulty concentrating
- Persistent cough or wheezing
- Arrhythmia (rapid or irregular heartbeat)
Types of heart failure
While there are many causes of heart failure, there are 2 primary categories. Knowing which type you have helps us create the most effective care plan for you.
- Heart Failure with Reduced Ejection Fraction (HFrEF) happens when the heart's main pumping chamber, the left ventricle, doesn't pump blood well. In this condition, the ejection fraction (EF), which measures how much blood the heart pumps out with each beat, is 40% or less. This means the heart is too weak to pump blood effectively throughout the body.
- Heart Failure with Preserved Ejection Fraction (HFpEF) happens when the heart is stiff and has trouble relaxing, even though its pumping function (ejection fraction) is normal.
Stages of heart failure
Heart failure is a chronic condition that becomes more serious over time.
The process of understanding the extent of your heart failure is called staging, and it helps us design the most effective care plan for you. There are 4 stages of heart failure:
- Stage A: When a person is at high risk for heart failure, and doesn’t have structural heart disease or obvious symptoms
- Stage B: When a person has a heart disease, but isn’t experiencing obvious symptoms
- Stage C: When a person has a heart disease, and is experiencing heart failure symptoms
- Stage D: Also known as advanced heart failure, a person with Stage D heart failure is not tolerating or not responding well to standard medications, and may be offered advanced treatments or surgeries
Caring for your heart
Living well with heart failure
Having heart failure is tough, but people can still live full lives if they follow some simple rules. Eating healthy foods, keeping track of how you feel and doing exercises recommended by doctors can help improve your overall health and emotional well-being.
Testing
Everyone’s journey to better heart health starts with a thorough evaluation. Your doctor and cardiologist will use the latest techniques and technology to better understand your heart’s condition:
- Blood testing
- Echocardiogram (an ultrasound for the heart)
- CT scan of the chest
- Cardiac stress test
- MRI of the heart
- Left heart catheterization
- Right heart catheterization
Cath lab
A catheterization laboratory, also known as a cath lab, is a facility with specialized equipment designed specifically for evaluating serious heart and blood vessel conditions. Your doctor may send you to the cath lab for tests like:
- A coronary angiography, also known as a left heart catheterization, to examine the coronary arteries (blood vessels to the heart).
- A right heart catheterization, also known as a Swan-Ganz catheter, is where a small tube called a catheter is inserted into the heart to measure pressures and flows.
Treatments
Treatments for early-stage and end-stage heart failure look a little different. We can help get a grasp on early-stage heart failure with simple lifestyle changes and medications. Treating end-stage heart failure is more involved, and may call for installing a device in your chest to aid your heart, or a heart transplant.
For early-stage heart failure
For people living with Stage A or Stage B heart failure, our top priority is getting you on the path to better health before symptoms begin to show. For many people, that starts with making heart-healthy lifestyle choices, like exercising more, managing your weight and having less salt in your diet.
Stopping smoking and cutting back on alcohol use does your heart a big favor, too, but that’s not always easy to do on your own. There are resources and support available to help, and we’re always here to listen if you need to talk.
Your doctor may also prescribe medication — like beta-blockers or diuretics — to slow or stop the progression of heart failure. You can learn more about heart failure medications with our guide, "How to Take Your Heart Failure Medicines."
For end-stage heart failure
For people living with Stage C or Stage D heart failure, also known as advanced or end-stage heart failure, we focus on:
- Managing symptoms
- Preventing further complications
- Helping you enjoy a comfortable quality of life
We always prefer to start with minimally invasive treatments, such as lifestyle changes and medications, for heart failure. However, if these strategies are not sufficient, we will consider more advanced options like mechanical circulatory support or a heart transplant.
Ventricular assist devices (VAD)
People with advanced heart failure may require a mechanical device to help their hearts pump enough blood. This approach is called mechanical circulatory support, and it uses a group of ventricular assist devices (VADs) to help the heart pump blood.
A VAD is a mechanical pump that’s surgically implanted into the chest when a person’s heart function is severely impaired. VADs are powered by an electricity source (batteries or AC power) from outside the body. Most often, VADs are implanted in the left ventricle (LVAD), which is the main pumping chamber of the heart.
Heart transplant
A cardiac transplant is a type of cardiac surgery that involves replacing a failed heart with a healthy one. It’s a serious procedure that often involves time spent on a waitlist and a long recovery time.
Hearing that you need a transplant is never easy, but we have resources and support available to help you process the news and stay strong. And undergoing a heart transplant at Tufts Medicine means you're in very safe hands. In fact, we're among the leading health systems in the country for the number of transplant surgeries performed each year. So, when you're in need of a second chance at heart health, know that your care matters to us.
Who qualifies for a heart transplant or an LVAD?
Deciding to move forward with a heart transplant or an LVAD is a big decision between you, your doctor and anyone else in your support corner. You may be eligible for a heart transplant or LVAD if:
- You have a heart condition that severely limits your heart's ability to pump blood.
- Your body can handle the stress of a major surgery and post-transplant treatments.
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