Congestive Heart Failure

Congestive Heart Failure
Overview
Congestive heart failure is a condition in which your heart can't pump enough oxygen-rich blood to meet your body's needs. When your heart doesn't pump efficiently, blood may back up into your lungs and other tissues.
The severity of congestive heart failure depends on how much pumping capacity your heart has lost. As they age, most people lose some pumping capacity. However, in congestive heart failure, your heart has very little pumping capacity. Congestive heart failure often results from damage caused by a heart attack, high blood pressure, diabetes or other conditions.
Why choose Mayo Clinic
The doctors and researchers at Mayo Clinic actively develop new ways to diagnose and treat people who have heart failure. Each year, Mayo Clinic doctors trained in heart care (cardiologists) evaluate and treat thousands of people who have congestive heart failure.
Cardiologists and other specialists staff heart failure clinics at each Mayo Clinic location. The staff works together as a team to diagnose and treat all forms of congestive heart failure. The Advanced Heart Failure Clinic at Mayo Clinic in Minnesota is a facility devoted specifically to surgical advanced heart failure treatment.
Mayo Clinic in Rochester, Minn., is ranked among the Best Hospitals for Heart & Heart Surgery by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals for Heart & Heart Surgery.

Research
As a major heart failure research center, Mayo Clinic focuses on the detection and diagnosis of heart failure in its earliest stages. Mayo Clinic researchers study investigational and new treatments for people who have congestive heart failure. Mayo Clinic is part of the National Institutes of Health Heart Failure Clinical Research Network.
You may have the opportunity to participate in clinical trials of experimental therapies not available at all medical centers. Learn more about cardiovascular research at the research website.
Mayo Clinic publications
See a list of publications by Mayo Clinic doctors on congestive heart failure on PubMed, a service of the National Library of Medicine.
Investigational treatment studies
Mayo Clinic investigators are studying several potential therapies for congestive heart failure, including:
• Percutaneous heart valve repair. Leaky heart valves can cause or worsen heart failure by overworking your heart. Mayo Clinic researchers are studying devices implanted under the skin without surgery to reduce or prevent heart valve leakage.
• New surgical approaches. Mayo Clinic surgeons are studying new left ventricular assist devices, surgical and nonsurgical valve repair and replacement and heart muscle surgeries.
• Artificial heart. An all-mechanical artificial heart exists for special situations and is available as an investigational procedure. More commonly, surgeons use a device that replaces the function of one side of your heart (left ventricular assist device) or both sides (biventricular assist devices).
• New drugs. Mayo Clinic researchers are testing new drugs that may help people who have heart failure. Researchers developed these drugs by modifying the heart's defense system, the natriuretic peptide system, to create drugs that may enhance heart and kidney function
Diagnosis
Mayo Clinic heart disease doctors with special training in heart failure (heart failure cardiologists) work with other specialists to evaluate and treat people who have heart failure. The team has training in many areas, including noninvasive studies which use radioactive dyes to show heart structure and function (nuclear cardiology), heart rhythm disorders (electrophysiology), echocardiography, radiologic heart imaging and cardiac catheterization.
To diagnose heart failure, your heart failure cardiologist discusses your medical history and risk factors, performs a thorough physical examination and may also recommend other tests, including:
• Blood tests. Blood tests may indicate other diseases that affect your heart. A blood test for congestive heart failure checks for levels of a hormone called B-type natriuretic peptide (BNP). Your heart secretes BNP in high levels when overworked. A large amount of BNP in the blood may suggest congestive heart failure.
• Chest X-ray. An X-ray image shows the size and shape of your lungs and heart. In congestive heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. An X-ray can also be used to diagnose other conditions.
• Coronary catheterization (angiogram). In this test the doctor inserts a thin, flexible tube (catheter) into a blood vessel in your groin or elbow and guides the catheter to your heart. The doctor injects a dye into the arteries in your heart, making the arteries visible under X-ray. This test identifies narrowed arteries to your heart (coronary artery disease), which can cause congestive heart failure. The test also helps to show the strength of your heart's main pumping chamber (left ventricle) and the health of your heart valves.
• Echocardiogram. An echocardiogram uses sound waves to produce a detailed video image of your heart's size, structure and function. These images can help doctors determine your heart's pumping capacity and distinguish between forms of heart failure. This test also measures the percentage of blood pumping out of the heart's main pumping chamber (ejection fraction).
• Electrocardiogram (ECG). In this test, your doctor places sensor patches with wires attached (electrodes) on your skin to measure the electrical impulses given off by your heart. This test can reveal heart rhythm disorders and damage to your heart from a heart attack.
• Magnetic resonance imaging (MRI). An MRI uses magnetic fields and radio waves to create detailed images of your heart.
• Myocardial biopsy. In this test, your doctor inserts a small flexible biopsy cord into a vein in your neck or groin, and small pieces of the heart muscle are taken. This test is performed to diagnose certain types of heart muscle diseases that cause heart failure.
• Right heart catheterization. In this test, your doctor inserts a thin, flexible tube (catheter) into a blood vessel (vein) in your neck or groin and guides the catheter to the heart to measure pressures within the heart chambers. This helps guide treatment in heart failure.
• Stress tests. In a stress test or exercise test, you exercise on a treadmill or stationary bicycle, or take a drug to simulate heart activity during exercise, while an electrocardiogram (ECG) monitors your heart. The exercise test helps your doctor judge your therapy's effectiveness and plan the timing of more advanced treatments. Different types of stress tests measure the heart's response to exercise in different ways and are used in different situations. Mayo Clinic is one of the few centers in the world that measures the relaxation response of the heart to exercise, a test used to diagnose diastolic heart failure.
• Radionuclide ventriculography or Multiple-gated Acquisition Scanning (MUGA). In this nuclear medicine test, the doctor injects a small amount of radioactive dye into your vein and special cameras show how much blood your heart can pump with each beat.
Results of these tests help doctors determine the cause of your symptoms and develop a treatment plan. Doctors classify heart failure based on a scale of I to IV. In Class I heart failure, the mildest form, you can perform everyday activities and not feel winded or fatigued. In Class IV, the most severe, you have shortness of breath even when you are at rest.
Treatment
At Mayo Clinic, doctors trained in heart care (cardiologists) and cardiologists with advanced training in heart failure (heart failure cardiologists) treat people who have congestive heart failure. Mayo Clinic cardiac surgeons have extensive experience in all types of surgery to treat heart failure and other heart diseases. Surgeons perform minimally-invasive heart surgery, implant ventricular assist devices (VADs) and perform heart transplants.
Congestive heart failure treatment can significantly improve your symptoms and help your weakened heart work as efficiently as possible. Doctors treat some people by correcting the underlying cause of the condition, such as controlling a fast heart rhythm, opening blocked arteries or repairing or replacing diseased valves. Heart failure specialists also treat conditions that may aggravate your underlying heart problems, such as sleep apnea, thyroid problems, anemia and other blood abnormalities.
Congestive heart failure treatment at Mayo Clinic may include surgery, medical devices, medications and lifestyle changes.
• Surgery
o Heart valve repair or replacement. Cardiologists may recommend heart valve repair or replacement surgery to treat an underlying condition that led to congestive heart failure. Heart valve surgery may relieve your symptoms and improve your quality of life.
o Coronary bypass surgery. Cardiologists may recommend coronary bypass surgery to treat your congestive heart failure if your disease results from severely narrowed coronary arteries.
o Heart transplant. Some people who have severe congestive heart failure may need a heart transplant.
o Myectomy. In a myectomy, the surgeon removes part of the overgrown septal muscle in your heart to decrease the blockage that occurs in hypertrophic cardiomyopathy. Surgeons may perform myectomy when medication no longer relieves your symptoms.
• Medical devices

Ventricular assist device
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o Ventricular assist device (VAD). When your weakened heart needs help pumping blood, surgeons may implant a VAD into your abdomen and attach it to your heart. These mechanical heart pumps can be used either as a "bridge" to heart transplant or as permanent therapy for people who aren't candidates for a transplant. Mayo Clinic offers VADs to many people who may have no other options.

Cardiac resynchronization therapy device
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o Cardiac resynchronization therapy (CRT) device (biventricular cardiac pacemaker). A cardiac resynchronization therapy device (biventricular cardiac heart pacemaker) sends specifically timed electrical impulses to your heart's lower chambers. CRTs are suitable for people who have moderate to severe congestive heart failure and abnormal electrical conduction in the heart.
o Internal cardiac defibrillator (ICD). Doctors implant ICDs under the skin to monitor and treat fast or abnormal heart rhythms (arrhythmias), which occur in some people who have heart failure. The ICD sends electrical signals to your heart if it detects a high or abnormal rhythm to shock your heart into beating more slowly and pumping more effectively.
• Medications. Doctors usually treat people who have congestive heart failure with medications proven to relieve symptoms and increase survival in people who have heart failure. Your doctor may also prescribe medications to lower blood pressure, improve circulation and prevent blocked arteries or blood thinners to prevent blood clots.
Several types of drugs may help treat your heart failure if you have reduced blood flow pumping out of your heart's main pumping chamber (left ventricle).
• Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors lower blood pressure, improve blood flow and decrease your heart's workload.
• Angiotensin II (A-II) receptor blockers. These drugs provide several benefits of ACE inhibitors without the potential side effect of a persistent cough.
• Beta blockers. Beta blockers slow the heart rate, lower blood pressure and lessen the risk of some abnormal heart rhythms.
• Digoxin. Also known as digitalis, digoxin increases the strength of heart contractions and tends to slow your heartbeat.
• Diuretics. Diuretics prevent fluid from collecting in your body and decrease fluid in your lungs, making breathing easier.
• Nesiritide. Nesiritide, which is given through a vein (intravenously), is a synthetic version of B-type natriuretic peptide (BNP), a hormone that occurs naturally in your body.
• Aldosterone antagonists. These medications may help your heart work better, reverse scarring of the heart and help prolong your life if you have severe congestive heart failure.
• Inotropes. These are intravenous medications used in severe heart failure patients to improve heart pumping function and maintain blood pressure.
Sometimes congestive heart failure becomes severe enough to require hospitalization and monitoring for a few days. While you're in the hospital, you may take medications that quickly help your heart pump better and relieve your symptoms. You may also receive supplemental oxygen. People who have severe congestive heart failure that doesn't improve with treatment may need supplemental oxygen on a long-term basis.
• Lifestyle changes. Lifestyle changes often can relieve symptoms of congestive heart failure and prevent your disease from worsening. Some changes you can make include:
o Avoiding or limiting alcohol to one drink two or three times a week
o Avoiding or limiting caffeine
o Eating a low-fat, low-sodium diet
o Exercising by yourself or in a structured cardiac rehabilitation program
o Maintaining a healthy weight or losing weight if you're overweight
Appointments
Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals, or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.
Clinical Trials
Below is a list of Congestive Heart Failure clinical trials from the clinical trials database at Mayo Clinic.
Mayo's clinical trials include experimental treatments, often unavailable elsewhere, which frequently lead to improved patient care for people worldwide. Patients should ask their doctor at Mayo about clinical trials appropriate for their situation.
Genetic Basis of Left Ventricular Recovery in Congestive Heart Failure
Research suggests that many cases of cardiomyopathy are caused initially by a virus, which then causes the body's immune system to attack the heart. This is an inflammatory
reaction which leads to heart damage. In some patients with this disorder, the heart will recover significantly over the first year, while others will be left with a chronically weak heart. The purpose of this research study is to determine if persons who present with the recent onset of primary cardiomyopathy have a better chance of recovery if they have certain genes and for a stronger inflammatory reaction.
Read more
Heart Failure and Control Trial Investigating Outcomes of Exercise Training
Mayo Clinic's Cardiovascular Research Program is conducting a research study involving patients who have congestive heart failure. This study is being done to determine if a long-term exercise program affects illness and survival.

Read more
Renal Optimization Strategies Evaluation in Acute Heart Failure
Acute heart failure (AHF) is the most common cause of hospital admission in patients over age 65, accounting for 1,000,000 admissions, over 6 million hospital days, and $12 billion in costs annually. The prognosis of patients admitted with AHF is dismal, with a 20-30% readmission rate and a 20-30% mortality rate within six months after admission. Recent studies have established the prognostic importance of renal function in patients with heart failure. In patients who are hospitalized with decompensated congestive heart failure, worsening renal function is also associated with worse outcome, Various studies have estimated that 25-30% of patients hospitalized for decompensated CHF have worsening of renal function leading to prolonged hospitalization, increased morbidity and mortality. Although there are no FDA approved renal adjuvant therapies for AHF, several novel adjuvant therapies for use in AHF are being investigated in randomized clinical trials. Additionally, there are currently available strategies, with the potential for improving renal function in AHF such as low dose dopamine and low dose nesiritide. However, these strategies have not been investigated. Participation in this study will last 6 months. All potential participants will undergo initial screening, which wil include a medical history, physical exam, blood draws, measurements of fluid intake and output, and questionnaires. The same evaluations and procedures will be repeated at various points during the study. Eligible participants will be randomly assigned to receive low dose nesiritide or placebo with optimal diuretic dosing or low dose dopamine or placebo with optimal diuretic dosing. Follow-up assessments will occur at Baseline, 24 hours, 48 hours, 72 hours, day 7 or discharge, day 60 and 6 months. Follow-up assessments will include medical history, physical exam, blood draws, measurements of fluid intake and output, questionnaires and questions about medications and changes in health.
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TOPCAT
Subjects with heart failure are asked to volunteer in this study. The purpose for this study is to see if adding a drug called spironolactone to the current treatment for heart failure is able to safely improve heart failure. The study aims to examine the safely and effectiveness of spironolactone compared with placebo, which is an inactive drug that serves as pretend treatment (with no active drug in it), in the treatment of adults with heart failure and a certain level of heart contraction. Spironolactone is approved by the Food and Drug Administration (FDA) for the treatment of congestive heart failure. However, this study uses a lower starting dosage of spironolactone that is not approved by the FDA and compares it to placebo to test if the drug has a real effect.
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We are testing the safety and effectiveness of sildenafil (Viagra) to placebo (a pill containing no medication) in patients with diastolic heart failure.
The purpose of this study is to compare the safety and effectiveness of sildenafil (Viagra) to a placebo (a pill containing no medication) in patients with diastolic heart failure to see if it will improve your ability to exercise and your quality of life. You will be asked to take this study medication for 6 months