What Women Need to Know About Heart Failure

Have you heard of heart failure? It’s not a heart attack. But they’re both forms of heart disease.

A heart attack is when blood flow to the heart is suddenly reduced or blocked. Heart failure happens when the heart doesn’t pump blood as well as it should. And it affects almost 3 million women a year.

Understanding this condition can help you know if you’re at risk — and what you can do about it.

The dangers of heart failure

Heart failure, which usually happens over time as the heart muscles become weaker, can lead to many serious problems, including:

• Kidney damage
• Liver damage
• Irregular heartbeat
• Sudden heart attack
• Malnutrition
• Breathing problems

The causes of heart failure

Anything that damages the heart or makes it work too hard may lead to heart failure.

This includes health conditions like:

• Clogged blood vessels (coronary artery disease)
• Infection in the heart muscle (endocarditis)
• Past heart attack (myocardial infarction)
• Heart problems you’re born with (congenital heart defects)
• High blood pressure (hypertension)
• Type 2 diabetes
• Metabolic syndrome
• Kidney disease
• Low red blood cell count (severe anemia)
• Overactive or underactive thyroid (hyperthyroidism or hypothyroidism)
• Heartbeat that is too fast, too slow or irregular (arrhythmia or dysrhythmia)
• Certain viruses, like the herpes virus or influenza

Lifestyle factors may also increase your risk of heart failure. Some of them are:

• Smoking
• Not getting enough exercise
• Obesity 
• Eating foods high in fat and cholesterol

In women — particularly women who are postmenopausal — the most common causes of heart failure include:

• High blood pressure
• Heart valve disease
• Diabetes
• Coronary artery disease

Types of heart failure

Heart failure is grouped into three main categories.

Left-sided heart failure happens when the left side of the heart has to work harder to pump the same amount of blood. There are two kinds of left-sided heart failure:

• Systolic failure (also called heart failure with reduced ejection fraction, or HFrEF), when the left lower chamber (ventricle) can’t tighten normally
• Diastolic failure (also called heart failure with preserved ejection fraction, or HFpEF), when the left lower chamber (ventricle) can’t relax like it should

Right-sided heart failure usually happens due to left-sided failure. When the left side of the heart can’t pump enough blood, pressure buildup can damage the right side.

Congestive heart failure happens when the blood returning to the heart through your veins backs up, causing fluid to collect. This may lead to swelling (edema) throughout the body, including in the lungs (pulmonary edema). This can make it hard to breathe.

Congestive heart failure can also keep the kidneys from getting rid of sodium and water, which may make swelling even worse.

Signs and symptoms of heart failure

For some people, heart failure symptoms come on slowly. For others, they may be sudden.

Symptoms of heart failure can include:

• Shortness of breath
• Feeling tired or weak
• Fast or irregular heartbeat
• Swelling (edema) in the ankles, legs and feet
• Swelling in the belly
• Wheezing
• Cough that won’t go away
• Upset stomach/loss of appetite/nausea
• Memory loss, feeling disoriented, confusion
• Sudden weight gain or loss

If you experience any of these symptoms, be sure to check them out with a healthcare provider (HCP).

Diagnosing heart failure

Heart failure is diagnosed using a combination of tools. First, an HCP will ask about your medical history, including any health issues or lifestyle choices that might increase your risk of heart failure.

Your HCP will also ask how you’ve been feeling. (It’s a good idea to bring a list of symptoms when seeing an HCP about your heart, along with a list of your medications.)

Next, your HCP will give you a physical exam and decide which tests to order. (They may also send you to a cardiologist, a doctor who focuses on the heart.)

Some tests used to diagnose heart failure are:

• Blood tests to check for certain molecules that go up during heart failure

• Echocardiography (echo) to measure how much blood is pumped out of your left ventricle (ejection fraction)

• Other imaging tests such as a chest X-ray, CT scan or MRI to see how well your heart is working

• Electrocardiogram (EKG or ECG) to test your heart’s electrical activity

• Stress test to see how your heart handles exercise

Treating heart failure

Treatment of heart failure depends on what’s causing it and how serious it is. Heart failure can’t be cured, so the goal of treatment is to reduce symptoms and improve quality of life.

Thankfully, the list of medicines used to treat heart failure is long. Medications can include:

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), which widen blood vessels to lower the heart’s workload

• Angiotensin-receptor neprilysin inhibitors (ARNIs), which is the combination of two blood pressure medicines and can be used to widen blood vessels, reduce blood pressure and lessen strain on the heart

• Beta blockers, which keep the heart from beating too fast or hard

• Diuretics (water pills), which help the body to get rid of extra fluid
• Sodium-glucose cotransporter-2 (SGLT2) inhibitors, which help lower blood sugar and are often used as one of the first treatments in heart failure

• Aldosterone antagonists (also called potassium-sparing diuretics), which are water pills that help lower high blood pressure and improve heart function in people with heart failure

People with heart failure often need more than one medication.

Devices that may be helpful for people with heart failure include:

• Cardiac Resynchronization Therapy Defibrillator (CRT-D) – a device that sends signals to the lower chambers of the heart to help synchronize your left and right ventricles
• Ventricular assist device (VAD), a device that helps the heart pump blood and is most often placed in the lower left chamber

Surgery isn’t always necessary to manage the condition. However, there may be cases where certain surgeries, such as surgery to clear blocked arteries, fix a heart valve defect or reroute blood flow to the heart, may be needed. A heart transplant may be required for people who can’t be helped by other treatments.

Living with heart failure

Changing your lifestyle may also help keep heart failure symptoms in check. It’s a way that you can be proactive about your treatment, and little tweaks can make a big difference. Lifestyle changes can include:

• Maintaining a healthy weight

• Keeping your blood sugar in check if you have diabetes
• Setting aside time for rest, relaxation and stress management

• Strengthening your heart with physical activity

• Eating heart-healthy foods like vegetables and whole grains

• Quitting smoking
• Avoiding or limiting alcohol intake
• Protecting yourself from flu, pneumonia and Covid with vaccines

A healthcare provider also may suggest cardiac rehab, which includes exercise counseling and training, heart-healthy living education, and counseling to manage stress.

Together with your HCP, you can figure out a treatment plan that will allow you to live your best life with heart failure.

This educational resource was created with support from Novartis.