Depending on the heart attack’s severity (the
extent of damage to the heart), a person may
return to regular activities within a few weeks or
require several months to recuperate. Most people
benefit from a structured CARDIAC REHABILITATION
program.
Risk Factors and Preventive MeasuresThe primary risk factors for heart attack are CORO-
NARY ARTERY DISEASE(CAD) and hypertension. Many
people are unaware that they have either one, so
heart attack becomes the first recognition that
these conditions exist. Regular ROUTINE MEDICAL
EXAMINATION, including tests to measure cholesterol
blood levels and blood pressure, help detect these
conditions in their early stages, when therapeutic
intervention can thwart their progression to life-
threatening events such as heart attack and
STROKE. Key preventive measures include daily
physical exercise, nutritious eating habits, WEIGHT
LOSS AND WEIGHT MANAGEMENT, SMOKING CESSATION,
and management of conditions such as hyperten-
sion and DIABETES.
See also CARDIOVASCULAR DISEASE PREVENTION;
LIFESTYLE AND CARDIOVASCULAR HEALTH; MEDICATIONS
TO TREAT CARDIOVASCULAR DISEASE; PHYSICAL EXERCISE
AND CARDIOVASCULAR HEALTH; ROUTINE MEDICAL EXAMI-
NATION.
heart failure The inability of the HEARTto ade-
quately pump BLOOD. Heart failure may affect the
right heart (pulmonary circulation), left heart
(body circulation), or total heart. Heart failure,
occasionally called by its antiquated name dropsy,
is a consequence of longstanding CARDIOVASCULAR
DISEASE(CVD) that has damaged the structure of the
heart. About 5 million Americans live with heart
failure.
CONDITIONS THAT CAN CAUSE HEART FAILUREATHEROSCLEROSIS CARDIOMYOPATHY
certain arrhythmias CONGENITAL HEART DISEASE
CORONARY ARTERY DISEASE(CAD) HEART ATTACK
HYPERTENSION(highBLOOD PRESSURE) long-term ALCOHOLabuse
PRIMARY PULMONARY HYPERTENSION VALVULAR HEART DISEASE
Symptoms and Diagnostic Path
The key symptoms of heart failure are shortness of
breath (DYSPNEA) and fluid retention (edema).
Because symptoms come on gradually as the heart
failure progresses, many people are unaware of
them until they notice fatigue, weakness with
exertion, rapid or unexplained weight gain, and
frequent URINATION. Right heart failure tends to
produce peripheral edema (swelling of the lower
legs, ankles, and feet). Left heart failure tends to
produce central edema (fluid accumulation in the
LUNGS), also known as congestive heart failure.
Progressive heart failure generally affects the total
heart, though right or left failure may be domi-
nant. The diagnostic path typically includes chest
X-RAY, which shows fluid accumulation in the
lungs and enlargement of the heart, as well as
ELECTROCARDIOGRAM(ECG) to assess the heart’s elec-
trical activity. Heart failure often causes ARRHYTH-
MIA.ECHOCARDIOGRAMshows the heart’s function
and size.Treatment Options and Outlook
Treatment targets any causative cardiovascular
conditions, such as CORONARY ARTERY DISEASE(CAD)
and HYPERTENSION. Surgery may correct valve dys-
functions or previously undetected congenital
abnormalities such as septal defect. Medications
can effectively manage heart failure for many
years, allowing people to work and enjoy recre-
ational activities. However, as heart failure pro-
gresses, it imposes greater restrictions on physical
activity. People who have end-stage heart failure
may benefit from a ventricular assist device
(VAD), a mechanical pump implanted in the chest
cavity that aids the heart in pumping blood. This
allows the heart to rest and sometimes to recuper-
ate. The VAD also can serve as a bridge to HEART
TRANSPLANTATION, another treatment option for
end-stage heart failure.Risk Factors and Preventive Measures
Underlying cardiovascular conditions are the most
important risk factors for heart failure, particularly
those that are undiagnosed or poorly managed
(notably hypertension and CAD). Lifestyle meas-
ures to prevent cardiovascular disease, such as
daily physical exercise and not smoking, reduce
the likelihood of heart failure as well. CARDIAC
REHABILITATIONfollowing heart attack can restore
heart function to the extent possible. Other pre-
ventive measures include careful management of58 The Cardiovascular System