Causes of Heart Failure
As stated, the heart loses some of its blood–pumping ability as a natural consequence of aging. However, a number of other factors can lead to a potentially life–threatening loss of pumping activity.

As a symptom of underlying heart disease, heart failure is closely associated with the major risk factors for coronary heart disease: smoking, high cholesterol levels, hypertension (persistent high blood pressure), diabetes and abnormal blood sugar levels, and obesity. A person can change or eliminate those risk factors and thus lower their risk of developing or aggravating their heart disease and heart failure.

Among prominent risk factors, hypertension (high blood pressure) and diabetes are particularly important. Uncontrolled high blood pressure increases the risk of heart failure by 200 percent, compared with those who do not have hypertension. Moreover, the degree of risk appears directly related to the severity of the high blood pressure.

Persons with diabetes have a three–to–eight–fold greater risk of heart failure than those without diabetes. Women with diabetes having a greater risk of heart failure than men with diabetes. Part of the risk comes from diabetes’ association with other heart failure risk factors, such as high blood pressure, obesity, and high cholesterol levels. However, the disease process in diabetes also damages the heart muscle.

The presence of coronary disease is among the greatest risks for heart failure. Muscle damage and scarring caused by a heart attack greatly increase the risk of heart failure. Cardiac arrhythmias, or irregular heartbeats, also raise heart failure risk. Any disorder that causes abnormal swelling or thickening of the heart sets the stage for heart failure.

In some people, heart failure arises from problems with heart valves, the flap–like structures that help regulate blood flow through the heart. Infections in the heart are another source of increased risk for heart failure.

A single risk factor may be sufficient to cause heart failure, but a combination of factors dramatically increases the risk. Advanced age adds to the potential impact of any heart failure risk.

Finally, genetics contributes to the risk for certain types of heart disease, which in turn may lead to heart failure. However, in most instances, a specific genetic link to heart failure has not been identified.

What are the symptoms?

A number of symptoms are associated with heart failure, but none is specific for the condition. Perhaps the best known symptom is shortness of breath (“Dyspnea”). In heart failure, this may result from excess fluid in the lungs. The breathing difficulties may occur at rest or during exercise. In some cases, congestion may be severe enough to prevent or interrupt sleep.

Fatigue or easy tiring is another common symptom. As the heart’s pumping capacity decreases, muscles and other tissues receive less oxygen and nutrition, which are carried in the blood. Without proper “Fuel”, the body cannot perform as much work, which translates into fatigue.

Fluid accumulation, or edema, may cause swelling of the feet, ankles, legs, and occasionally, the abdomen. Excess fluid retained by the body may result in weight gain, which sometimes occurs fairly quickly.

Persistent coughing is another common sign, especially coughing that regularly produces mucus or pink, blood–tinged sputum. Some people develop raspy breathing or wheezing.

Because heart failure usually develops slowly, the symptoms may not appear until the condition has progressed over years. The heart hides the underlying problem by making adjustments that delay–but do not prevent–the eventual loss in pumping capacity. The heart adjusts, or compensates, in three ways to cope with and hide the effects of heart failure:

• Enlargement (“Dilatation”), which allows more blood into the heart.
• Thickening of muscle fibers (“Hypertrophy”) to strengthen the heart muscle, which allows the heart to contract more forcefully and pump more blood.
• More frequent contraction, which increases circulation.