Heart failure (HF) occurs when the heart cannot pump enough blood to maintain normal circulation throughout the body. The heart keeps pumping, but not as efficiently as a healthy heart. 

Yes. While the term "congestive heart failure" may sound frightening, millions of Americans live with this chronic syndrome. The symptoms and risks associated with heart failure can be managed or reversed with appropriate medications and medical devices. 

• Problems breathing
• Coughing and/or wheezing, especially when lying down
• Swelling in the legs
• Abdominal bloating
• Fatigue, lack of energy
• Problems with concentration or confusion 

Ongoing problems with heart failure can also cause problems with other organ systems, such as the nervous system and the adrenal glands (hormonal system). The syndrome also interferes with the normal functioning of the kidneys. As a result, the body retains more fluid, which can cause swelling of the ankles and legs (edema) and fluid on the lungs (which leads to shortness of breath).

Typically, the heart's loss of pumping action stems from an underlying heart problem. Heart failure can be caused by any conditions or chemicals that injure the heart muscle and/or any condition that interferes with the heart's normal function.

Risk factors that contribute to heart failure include chronic conditions, lifestyle factors, and medicines, such as:

• coronary artery disease
• high blood pressure
• diabetes mellitus
• obesity
• alcohol consumption
• drug abuse
• diet medications and anabolic steroids
• certain types of chemotherapy and radiation to the chest area

If you are living with symptoms and risk factors associated with heart failure, your primary care physician or cardiologist may recommend diagnostic tests. The results will help your care team understand the status of your heart's health and function.

Diagnostic tests include:

• Chest X-Ray
• Electrocardiogram (ECG or EKG)
• Echocardiogram
• Stress Testing
• BNP Testing
• Cardiac Catheterization

No, heart failure is a chronic condition. Lifestyle changes and medical treatment are required to manage the symptoms and recover some heart function. Some patients can go into remission with normal heart function. With the use of today's treatment options, most heart failure patients do not progress to the most severe (and most life-threatening) stage of the syndrome. With an appropriate disease management program, many patients can recover heart function.

Treatment options include prescription medications, medical devices, surgical measures, and lifestyle modifications.

In addition to standard therapy, some patients qualify for clinical trials of emerging treatment options. Researchers and doctors are currently exploring stem cell therapies to restore heart muscle function in some patients.

Most heart failure medications work to re-establish the normal function of the body's hormones and neurologic systems. Several types of medication may help control high blood pressure. Often more than one type is needed to get adequate control and promote recovery. These medications can improve cardiac, neurological, and hormonal functions, which contribute to the quality of life. Many of them can improve survival rates for those living with heart failure.

• Angiotensin-converting enzyme (ACE) inhibitors decrease the pressure inside the blood vessels and reduce the resistance against which the heart pumps. 
• If ACE inhibitors are not tolerated, an angiotensin receptor blocker (ARB) can help reduce the workload on the heart.
• ARNI is a medicine that combines two drugs and has been shown to reduce hospitalizations due to heart failure and improve survival rates.
• Beta-blockers help to control blood pressure and heart rate by blocking the effects of stress hormones. 
• Mineralocorticoid receptor antagonists block the effects of the hormone aldosterone, which causes sodium and water retention.
• SGLT2 antagonist is a new class of medications for diabetes that can benefit heart failure patients with or without diabetes mellitus.
• Vasodilators can reduce the workload on the heart by dilating the blood vessels.
• Diuretics reduce the amount of fluid in the body. 
• Digitalis increases heart strength and helps control rhythm problems.

In some cases, the following medical devices are just as effective as heart transplant surgery in promoting healthy heart function and recovery.

• Biventricular Pacing/Cardiac Resynchronization Therapy (CRT)
  This type of pacemaker paces both ventricles simultaneously to coordinate contractions and improve pumping ability. Some heart failure patients are candidates for this therapy.
   
• Implantable Cardioverter Defibrillator
  This device is similar to a pacemaker, but it senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm.
   
• Ventricular Assist Devices (VADs)
  This mechanical device takes over the pumping function for one or both of the heart's ventricles. A VAD may be necessary when heart failure progresses to the point that medications and other treatments are no longer effective. 
   
• Barostim
  This implantable device is designed to relax the blood vessels, regulate heart rate, and reduce fluid in the body through improved kidney function.
   
• Optimizer
  A device-based therapy delivers cardiac contractility modulation (CCM) for advanced heart failure patients with mildly to moderately reduced left ventricular ejection fractions who are ineligible for CRT.
   
• Mitraclip
  For patients with secondary mitral regurgitation, this procedure attaches a small clip to the mitral valve to help it close more completely and restore normal blood flow through the heart.

Whether you qualify for a heart transplant will depend on a medical evaluation, your response to standard care, and other medical conditions you may have.

Healthy choices can help prevent heart failure and improve your chances of surviving the syndrome. Your choices can significantly support the heart health benefits of medication, surgery, medical devices, and other therapies. Without making the following lifestyle changes, your diet and behaviors can work against the efforts of your cardiologist and health care team.

Exercise, quit or avoid smoking, and consume less alcohol. Eat a heart-healthy diet, which means more fiber and less sugar, red meat, full-fat dairy products, and processed/refined foods. Get enough quality sleep, and reduce your stress level.

With the right treatment program and access to medications, heart failure patients can aim for the following markers of recovery:

• Improved quality of life
• Improved heart function
• Prolonged survival
• Disease remission

At the University of Miami Health System, you have access to experienced and dedicated specialists in advanced heart therapies. Heart transplant surgery is offered at the Miami Transplant Institute at Jackson Memorial Hospital with UHealth physicians. Our Heart Failure Recovery and Therapeutic Innovation Program provides access to leading-edge therapies, including remote monitoring, ventricular assist devices, and electrophysiologic devices for heart failure. UHealth also hosts a variety of clinical trials exploring new medications, stem cell therapy, and innovative medical devices.

We are home to the Elaine and Sydney Sussman Cardiac Catheterization Lab, which provides advanced interventional capabilities and complex procedures for patients with advanced heart failure. As a leading academic medical center, UHealth's options for novel treatments and investigational therapies go beyond what is generally available.

In many cases, the care of patients with advanced heart failure requires various expertise, such as cardiothoracic surgery, interventional cardiology, electrophysiology, cardiac rehabilitation, and medical genetics. UHealth doctors and specialists from diverse departments communicate and collaborate to ensure your provider team is on board with a unified treatment plan. Our providers work together to improve and prolong the lives of patients living with heart failure.