By Tanner Lambson 

Roughly one in four adults will develop heart failure at some point in their life, and that lifetime risk has been climbing in recent years. 

Even though it is common, heart failure remains widely misunderstood. Once thought of as a single, terminal diagnosis, heart failure is actually an umbrella term for several distinct chronic diseases that in many cases can be managed with medication and lifestyle changes. 

“A common misconception is that heart failure is a life-ending diagnosis with few treatment options,” said Hamang Patel, M.D., a cardiologist at VCU Health Pauley Heart Center who also collaborates with Hume-Lee Transplant Center’s heart transplant team. “Heart failure once had a 50% five-year mortality rate. Today, five-year survival is closer to 90%.” 

Hamang Patel, M.D., a cardiologist at VCU Health Pauley Heart Center. (Enterprise Marketing and Communications)

One of the main goals of Pauley Heart Center’s advanced heart failure team is to help patients understand their heart condition and work with them to develop individualized treatment plans to improve their quality of life. To get a clearer picture of what heart failure is, we spoke with Patel about common questions patients have after getting diagnosed. 

What is heart failure? 

Heart failure is a chronic condition that makes it difficult for the heart’s muscle to pump and ‘keep up’ with the body’s demand for blood. The three main ways heart failure presents are:  

• Hypertrophy: A larger-than-normal size heart 
• Fibrosis: The buildup of scar tissue in the heart muscle 
• Dilation: Stretching of the heart muscle  

Any combination of these changes can make it harder for the heart to function properly compared to a normal, healthy heart. 

What are some of the signs and symptoms of heart failure? 

There are several types of heart failure, and each type has different signs and symptoms. The three main types are named based on which side of the heart is affected. The heart's lower chambers, called ventricles, do most of the work of pumping blood throughout the body. 

• Left-sided heart failure affects the left ventricle. It typically causes shortness of breath and fatigue that affects daily activities. 
• Right-sided heart failure affects the right ventricle, and it tends to cause swelling of the limbs and abdomen, and poor appetite. 
• Biventricular heart failure affects both ventricles, so it can cause the effects of both left- and right-sided heart failure, like swelling or fatigue. 

Another form of the condition is called “heart failure with preserved ejection fraction” (HFpEF), which more commonly affects women. With this type of heart failure, the heart is still capable of pumping out a “normal” amount of blood, but the muscle is stiffened, doesn’t relax and cannot fill with blood adequately between beats. HFpEF is linked to diabetes, hypertension and aging, and tends to cause swelling, severe fatigue and difficulty lying down flat. 

What symptoms do patients commonly mistake as heart failure? Are there symptoms that patients dismiss that are actually warning signs for heart failure? 

The symptom most often mistaken for heart failure is leg swelling at the end of the day— it sends a lot of patients to the clinic after an online search, but it’s actually one of the less likely heart failure indicators, especially without accompanying weight gain.  

On the flip side, a few red flags deserve more attention than they usually get: 

• Waking up short of breath a few hours after falling asleep. 
• Rapid weight gain: gaining three to five pounds a week, sustained over two or three weeks, isn’t physiologically normal and is often a sign of heart failure. 
• New wheezing in an older adult; roughly a third of heart failure patients wheeze as a symptom. wheeze as a symptom. 

Who is most at risk of heart failure? How do lifestyle choices or genetics play a role in heart failure risk?

Up to a third of people with heart failure have a genetic component to their disease. But genetics isn’t destiny. Those with a family history of heart failure can still lower their risk by maintaining a healthy body weight, controlling blood pressure and staying active.  

Heart failure is usually caused by overlapping medical conditions and lifestyle choices that develop into a more significant problem affecting the heart. Reducing risk factors like hypertension, diabetes, obesity and coronary artery disease meaningfully lowers your chances of developing heart failure. 

A newer tool called the PREVENT score can help estimate a person's risk of developing heart disease or heart failure. Patients can use the online calculator, but the results should be reviewed with a healthcare provider. 

How is heart failure typically diagnosed?  

For most patients, diagnosis is done through a blood test and echocardiogram. The blood test checks for a marker called proBNP, a hormone the heart releases when it’s under stress. The echocardiogram, a sonogram of your heart, shows the heart’s true function and size.  

How is heart failure treated, and can it be cured?  

While there is no definitive cure for heart failure, more than 95% of heart failure patients’ symptoms can be well-controlled through medication management, simple assistive devices like the pacemaker or newer, more complex devices like the left ventricular assist device (LVAD), which helps move blood through the heart. 

For a small number of patients who don’t respond to medication or devices, heart transplant is a last-resort option. 

With proper care and treatments, a majority of heart failure patients can go into remission, which means that the signs and symptoms of heart failure temporarily or permanently disappear. 

If I am worried about my heart, when should I see a cardiologist?  

When in doubt, tell a cardiologist about all of your symptoms and how long you’ve been having them. So many patients chalk up fatigue, minor weight gain or mild swelling to “just getting older,” but that might not be the case. Knowing the timeline of your symptoms also makes it much easier for your provider to sort out what is going on.  

If you are concerned about any heart symptoms, schedule an appointment with us today. As the top-ranked hospital for heart care in Virginia, our team sees patients at ten clinic locations across Central Virginia.

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