Heart failure is diagnosed when the heart loses pumping power, usually causing widespread swelling, shortness of breath, and fatigue. Mark Herpel, 49, describes the feeling as "having your head held under a pool, but you can't get to the surface so you begin to panic." The National Heart, Blood, and Lung Institute categorizes the two types of heart failure as follows.
- Systolic: This occurs when the heart's ability to contract decreases. The heart cannot pump with enough force to push a sufficient amount of blood into the circulation. Blood coming into the heart from the lungs may back up and cause fluid to leak into the lungs, a condition known as pulmonary congestion.
- Diastolic: This occurs when the heart has a problem relaxing. It cannot properly fill with blood because the muscle has become stiff, losing its ability to relax. This form may lead to fluid accumulation, especially in the feet, ankles, and legs. Some patients may have lung congestion.
The body shuts down
Ron Gordon, 52, of Avondale, Ga., knew his poor eating habits and lack of exercise weren't good for his heart, but he never expected to be diagnosed with heart failure. He went to the doctor complaining that he felt his body was choking him to death. "It turns out my whole body was shutting down" he says, adding that his cardiologist told him his heart was pumping at 3% capacity (healthy hearts beat at about 50%). "Later I found that even my thinking was affected because my heart rate was so low."
Major factors that may increase the risk of developing heart failure include the following.
A previous heart attack or a serious infection can also usher in heart failure. New evidence suggests insulin resistance may also be a cause. And the chemotherapy agent doxorubicin has been linked to higher than normal rates of heart failure.
“I could not catch my breath”
Herpel didn't think any of those risks factors applied to him in 2006, when he became extremely fatigued, felt fluid gurgling in his lungs, and started gasping. His doctors thought these were symptoms of pneumonia, so they prescribed powerful antibiotics and sent him on his way.
After five weeks of suffering he staggered to the emergency room, barely able to breathe or walk because his heart was too weak to pump blood through his kidneys, which led to fluid buildup in his abdomen. The diagnosis of heart failure and the suggestion by his doctor that he might need a heart transplant shook his world.
Neither Herpel nor Gordon ended up needing a heart transplant. Following their scares, both radically changed their diets, nearly eliminating sodium, which leads to fluid buildup that can exacerbate heart failure. They have also become avid walkers.
Like many patients who've had heart failure, Herpel also takes medication, including an ACE-inhibitor and beta-blocker to keep his heart contracting, a diuretic to reduce fluid buildup, and an expectorant to keep his lungs clear. He also keeps nitroglycerin tabs handy to alleviate chest pain.
But his prognosis still spooks him, especially when he starts to feel somewhat normal again. "The worst thing is when I can't breathe well, but I don't recognize it," Herpel says. "I may be taking small shallow breaths all afternoon or for several hours before I recognize that I'm not getting enough oxygen and take a pill. The doctors don't tell you to watch out for that!"