What is heart failure?

Heart failure (HF) means the heart is not pumping blood as well as it should. It may pump at a different speed, pump blood out with less force, or pump out less blood with each heartbeat. When less blood is flowing out of the heart to the body, muscles and other tissues may not get enough oxygen. The kidneys may not work as well to remove excess fluid in the form of urine. As a result, blood backs up into the blood vessels. The extra fluid seeps into the lungs or other parts of the body. Fluid in the lungs makes it hard to breathe. Fluid seeping into other parts of the body causes swelling. When there is too much fluid in the body, it puts more strain on the heart. Heart failure is one of the most common causes of heart-related illness and death in the U.S.

What can I expect in the hospital?

You may need to stay in the hospital because:

• You are having a lot of trouble breathing
• Your oxygen level is very low
• You have other medical conditions that are making your heart failure symptoms worse
• You need IV medicines that will treat your heart failure symptoms

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring:

• You will be checked often by the hospital staff.
• A cardiac (heart) monitor will be used to keep track of your heart’s rate and rhythm.
• Your blood oxygen level will be monitored by a sensor that is attached to your finger or earlobe.
• Your fluid intake may be monitored closely by keeping track of everything you eat and drink and any IV fluids you receive.
• You may have a small tube (catheter) placed into your bladder through the urethra (the opening from the bladder to the outside of the body) to drain and measure urine from the bladder.

Testing:

Testing may include:

• Blood tests to check for a hormone (brain natriuretic peptide or BNP) that increases when you have heart failure
• Blood, urine, or other tests to monitor how well your heart and other organs are functioning
• A chest X-ray to check if your heart is bigger than normal and to check for extra fluid in your lungs
• An ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat
• Ultrasound (echocardiogram), which uses sound waves and their echoes passed through your body from a small device (called a transducer) that is held against your skin to create pictures of the inside of your heart to look at your heart valves, blood flow, and how well your heart muscle is pumping
• Heart catheterization (coronary angiogram), which is a series of X-rays taken after your healthcare provider places a long, thin, flexible tube (catheter) into a blood vessel in your groin and up to your heart and injects a special dye into your blood vessels to check the flow of blood to the heart muscle and pumping function of the heart
• Nuclear scans, which use a small amount of radioactive material injected into your blood to make detailed pictures of your heart and blood vessels
• Stress test, which is an ECG while you exercise on a treadmill. If you are unable to exercise, you will be given a medicine that increases the work of your heart in order to measure your heart’s response. This test will help your provider decide what treatments and exercise are best for you or may be needed in the future.

Treatment:

The treatment for heart failure depends on your symptoms, how well you respond to treatment, your overall health, and any complications you may have.

• The goals of treatment are to:
  • Decrease how hard your heart is working
  • Get rid of extra water in your body
  • Improve how well your heart pumps blood
  • Treat any problems that make your condition worse
• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow medicine to be given directly into your blood and to give you fluids, if needed.
• You may receive oxygen through a small tube placed under your nose or through a mask placed over your face.
• Your provider may prescribe medicine to:
  • Relax and widen blood vessels and allow blood to flow through them easier
  • Reduce fluid build-up and swelling in the body
  • Help your heart muscle beat stronger and regularly
  • Help reduce blood pressure, slow the heart rate, and reduce the workload of the heart
  • Help prevent blood clots
  • Replace minerals your body loses when taking certain medicines used to treat your condition

What can I do to help?

You will need to tell your healthcare team if you have new or worsening:

• Chest pain or pressure, squeezing, or fullness in the center of your chest that lasts more than a few minutes, or goes away and comes back (may feel like indigestion or heartburn)
• Pain or discomfort in one or both arms or shoulders, or in your back, neck, jaw, or stomach
• Trouble breathing
• Breaking out in a cold sweat for no known reason
• Along with the previous symptoms, feeling very tired, faint, or sick to your stomach
• Feeling like your heart is beating too fast, too slow, or skipping beats
• Dizziness or lightheadedness
• Swelling in your feet, ankles, or legs, or abdominal bloating, or swollen hands or face
• Waking up at night with trouble breathing or having a hard time lying flat in bed because of shortness of breath
• Frequent dry, hacking cough
• Coughing up mucus that is thick or blood-stained
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many factors. The average amount of time to stay in the hospital with heart failure is 4 to 6 days. Your provider will make sure that you are breathing easily, your oxygen levels and other medical conditions are stable, and that you will be able to care for yourself when you go home.