Heart - Cardiology & Cardiovascular Surgery

What is Heart Failure?

At Mount Sinai Heart, we see many patients who have experienced heart failure. Heart failure is when your heart is too weak to properly pump and circulate blood throughout your body. The heart's main function is to pump blood and oxygen throughout our body. To do so, it uses two small upper chambers (atria) and two large lower chambers (ventricles).

There are a number of risk factors for heart failure, including but not limited to:

Stages of Heart Failure

Heart failure is categorized in several ways, all of which add important pieces of information of the challenge of diagnosis and treatment. The American College of Cardiology/American Heart Association practice guidelines outline the following stages of heart failure:

  • Stage A: You have no symptoms but have risk factors for heart failure.
  • Stage B: You have no symptoms, but have structural heart disease.
  • Stage C: You have both symptoms of heart failure and structural heart disease.
  • Stage D: You have symptoms of advanced heart failure as well as end-stage disease.

We also follow The New York Heart Association Functional Classification System which describes symptomatic stages of heart failure based on level of capable daily physical activity:

  • I: You have no symptoms either at rest or with exertion.
  • II: You display symptoms with mild exertion.
  • III: You experience symptoms with less than normal exertion.
  • IV: You have symptoms when you are at rest.

Types of Heart Failure

Heart failure results when your heart fails to pump enough blood to meet your body’s needs. Your heart can ‘fail’ in several ways; and the type of heart failure you experience may influence the treatment plan. Types of heart failure include systolic, diastolic, acute, chronic, right side, and left side heart failure.

Systolic vs. Diastolic Heart Failure 

In about half of all heart failure cases, the heart becomes too weak to pump with the force necessary to move blood throughout the body. We call this systolic heart failure. In the other half of heart failure cases, the heart becomes stiff and cannot stretch to fill with the required volume – this is known as diastolic heart failure. The symptoms (shortness of breath, inability to exercise, ankle swelling, and breathing that is labored when you are lying flat but is fine when you sit upright) may be identical, but the treatments are often different.

Acute Vs. Chronic Heart Failure

Acute heart failure develops suddenly and the symptoms are severe but improve rapidly. Symptoms include:

  • Severe shortness of breath, especially while walking or bending over
  • Rapid heartbeat and palpitations, which may cause the heart to stop
  • Unexpected fluid retention
  • Rapid weight gain and swelling
  • Swift and severe chest pain

Chronic heart failure, which is more common than acute heart failure, occurs when symptoms appear slowly and get worse. The symptoms are:

  • Coughing
  • Fatigue
  • Shortness of breath, especially while walking or bending over to put on shoes
  • Trouble walking long-distances
  • Fluid retention
  • Swelling in the feet, ankles, and legs
  • Irregular heartbeat

Right Side Vs. Left Side Heart Failure

Right side heart failure occurs when the right side of the heart is weakened or damaged, and the right ventricle cannot pump enough blood to the lungs to get new oxygen to send to the left side of the heart. Blood tends to pool on the right side of the heart. Symptoms of right-side heart failure may include:

  • Swelling in the feet, ankles and legs
  • Distended abdomen or bloating
  • Fatigue
  • Shortness of breath, especially while walking or bending over
  • Irregular heartbeat

Left side heart failure is when the left side of the heart is weakened or damaged and the left ventricle cannot pump enough blood to the body and major organs. The blood gets backed up and pools on the left side of the lungs. Symptoms may include:

  • Shortness of breath, especially while walking or bending over
  • Fatigue
  • Dizziness, lightheadedness
  • Irregular heartbeat

You can also experience symptoms suggesting both right and left side heart failure. Should you have any of these signs and symptoms, you should contact your doctor.

Diagnosing Heart Failure

Heart failure is a complex condition that may be challenging to diagnose. But it is important to do so. Early diagnosis of heart failure can reduce the damage to your heart and other organs.

Our doctors at Mount Sinai Heart can make an initial diagnosis based on your medical history and a thorough physical examination. But to determine precisely what type of heart failure you are experiencing, its stage and severity, we usually perform various types of imaging tests. These tests include the following:

  • Echocardiography uses high frequency sound waves (ultrasound) to assess the heart's function, particularly to learn how well its chambers and valves are working. In addition to standard echocardiography, we also use transesophageal echocardiography, which provides an even closer view of some structures of the heart.
  • Cardiopulmonary Stress Tests are non-invasive evaluations that assess how your heart, lungs, and muscles respond to exercise. By putting a patient on a bicycle or a treadmill, doctors use cardiopulmonary stress tests to measure how much oxygen your heart uses during exercise. This can help your doctor assess your stage of heart failure and guide your personalized treatment plan.
  • Chest X-Ray can help doctors identify any structural abnormalities in your heart and lungs that may be linked to heart failure. Chest X-rays show conditions such as an enlarged heart or excess fluid retention in your lungs.
  • Computed Tomography Imaging provides highly detailed images of your heart. This procedure allows doctors to obtain accurate cardiac images rapidly with the advanced, fast, low-dose radiation computed tomography scanners at Mount Sinai.
  • Computed Magnetic Resonance Imaging (CMR) enables us to detect and identify conditions like heart failure and monitor the effects of various drug therapies. Computed Magnetic resonance imaging also lets us classify medications that hold the most promise for preventing future clinical cardiac events.
  • Positron Emission Tomography is a sophisticated, noninvasive method of studying the heart. The procedure uses tracer drugs that emit particles called positrons. Like X-rays, positrons are visible using an imaging device called a gamma camera. Positron emission tomography scans provide unique information about the metabolic functioning of the heart and other organs.
  • Cardiac Catheterization is a minimally invasive procedure performed in a cardiac catheterization laboratory to explore the inside of your heart and its vessels for any malfunction and defects. Also, during a cardiac catheterization we can perform an angiogram to test for coronary artery disease in the vessels of the heart.
  • Electrophysiology Studies (EPS) help us test for dangerous arrhythmias or irregular heartbeats that may be contributing to heart failure. EPS studies aim to pinpoint what part of the heart is causing an arrhythmia.
  • Multiple-Gated Acquisition (MUGA) Scans are nuclear medicine tests that can assess and measure how well your heart is beating. Multiple-gated acquisition scans also takes picture of your heart during its heartbeat cycles to assess your heart's function.