There are a variety of conditions that could lead, or are associated with, heart failure. These conditions include:
Coronary artery disease (CAD). The most common causes of heart failure in the United States, CAD is a chronic disease in which there is a “hardening” of the arteries (atherosclerosis) on the surface of the heart. The term “hardening” refers to a condition that causes the arteries to become so narrowed and stiff that they block the free flow of blood. Severely reduced blood flow to the heart may weaken the heart muscle or cause a heart attack.
Arrhythmia (abnormal heart rhythm). A serious arrhythmia can diminish the effectiveness of the heart’s pumping ability.
Heart attack (myocardial infarction). Following a heart attack, part of the heart muscle is replaced with scar tissue, which prevents the heart from working efficiently. As the weakened heart muscle struggles to pump blood, the muscle fibers of the heart stretch, resulting in enlarged and weakened chambers in the heart remodeling. The AHA estimates that about 22 percent of patients who suffer a heart attack will become disabled with heart failure within six years.
High blood pressure (hypertension). High blood pressure used to be the single most common risk factor for the development of heart failure. Uncontrolled high blood pressure causes the heart muscle to overwork as it pumps blood under high pressure throughout the body. Increases in blood pressure are also associated with a greater incidence of heart attack.
Cardiomyopathy. A type of chronic heart disease in which the heart muscle becomes abnormally enlarged, thickened and/or stiffened. As a result, the heart muscle’s ability to pump blood can become increasingly weakened, leading to heart failure. This condition is seen with viral infections or alcohol abuse, but in many patients, the cause is never found.
Valvular heart disease. Narrowing stenosis or leaking regurgitation of one or more of the heart’s four valves. The resulting blood flow restriction (in stenosis) or overload of blood (in regurgitation) can lead to heart failure. These patients are initially treated with medication, but will often require valve surgery. There may also be an infection in the heart valves (valvular endocarditis). Valvular disease is often a result of aging, but may also be a type of congenital heart disease (present from birth). Less commonly, it results from rheumatic heart disease.
Congenital heart disease. A heart-related problem that is present from birth. It involves one or more defects in the heart (e.g., ventricular septal defect, atrial septal defect), the veins leading to the heart, the arteries leaving the heart or connections among these various parts of the body. Heart failure may develop if the congenital defect creates a blood flow problem (e.g., because of a hole in the heart) or a heart muscle strength problem (e.g., because of a narrowed valve).
Severe lung disease (e.g., pulmonary hypertension). When the right side of the heart cannot generate enough force to pump blood through a diseased pair of lungs, heart failure can result.
Other conditions that are associated with heart failure include:
Obstructive sleep apnea (OSA). A condition commonly found among individuals with heart failure. Muscles in the back of the throat normally work to keep the throat open, but the airway can become blocked if the muscles relax during sleep. When the brain detects a drop in oxygen from not breathing, it quickly sends a signal to the chest muscles and diaphragm to gulp in air. As a result, the sleeper makes a gasping or snorting sound and is awakened. This struggle to breathe and arousal from sleep causes tension in the left ventricle and increases in heart rate, blood pressure, and the body’s demand for oxygen. This increases the risk for developing ischemia, arrhythmia, chronic high blood pressure, pulmonary hypertension and carotid artery disease. Treatment includes continuous positive airflow pressure (CPAP), in which a bedside machine delivers air continuously through a plastic mask over the nose. The predetermined air pressure acts as a splint to keep the airway open, while still allowing the person to exhale. CPAP has shown to be effective in lowering blood pressure and increasing ejection fraction, suggesting that the relief of obstructive sleep apnea can also impact on symptoms of heart failure.
Anemia. Anemia is a deficiency in red blood cells and/or hemoglobin, the iron–rich, oxygen–carrying molecules in red blood cells. Chronic, severe anemia can be a cause of heart failure and can worsen as heart failure progresses. Even mild to moderate anemia is a common finding in patients with heart failure. This is because the heart must work harder in order to circulate a decreased number of red blood cells throughout the body. Studies have shown that correcting anemia can improve heart failure. Patients treated with a combination of intravenous (IV) iron and injections of erythropoietin (a protein that increases red blood cell production) have exhibited an increased ejection fraction, decreased need for diuretics, and improved New York Heart Association (NYHA) class.
Clinical depression. There appears to be a link between clinical depression and overall cardiovascular health. Recent studies have shown that heart failure patients who suffer from depression are more likely to experience an increase in their heart failure symptoms and a decrease in their overall quality of life over time. It is believed that clinical depression may trigger higher levels of stress hormones (e.g., adrenaline), which may help to explain why the hearts of clinically depressed people beat faster, even during sleep. Studies have also shown that people with both heart disease and clinical depression have reduced heart rate variability (the heart’s ability to handle stress).
Diabetes mellitus. Diabetes is a strong risk factor for developing coronary artery disease or heart attack, which may lead to heart failure and also cardiomyopathy. In addition, people with diabetes who also have heart failure should use caution when taking thiazolidinediones (TZDs), a class of drugs for patients with type 2 diabetes. TZDs may increase fluid retention in some people with heart failure. Joint recommendations from the American Heart Association and the American Diabetes Association state that people with moderate to severe (New York Heart Association [NYHA] class III or IV) heart failure should not take TZDs. Patients who are taking medications for diabetes are encouraged to discuss their condition with their physician.
Other conditions that may be associated with heart failure include lupus, rheumatoid arthritis, hyperthyroidism, certain chemotherapy drugs, alcohol abuse and abuse of some types of drugs (primarily amphetamines and cocaine).
The risk of developing heart failure is also increased by the presence of certain risk factors, which include:
Smoking
Obesity (a body mass index [BMI] of 30 or greater)
Lack of exercise
Dietary habits, such as high salt intake
Arrhythmias
Worsening lung disease (emphysema) or pulmonary embolism
Infection
Emotional distress
Certain medications or the failure to take medications properly
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