Understanding Heart Failure in the Elderly


When a person has heart failure (HF), it means that their heart is unable to pump enough blood throughout their body. Heart failure usually develops over time. As the heart weakens, it either cannot fill with enough blood, pump with enough force or both. While this cardiovascular condition sounds scary, heart failure does not imply that the heart has stopped working or is about to stop working.

Types of Heart Failure

There are a few different types of HF and each has its own unique symptoms, depending on which areas of the organ are affected. In normal hearts, blood vessels called veins bring oxygen-poor blood from the body to the right side of the heart. It is then pumped through the pulmonary artery to the lungs, where it becomes re-oxygenated. From there, the blood returns to the left side of the heart and is pumped through a large artery called the aorta that distributes it throughout the body.

Heart failure is a chronic, progressive condition, meaning it is persistent and worsens over time. Cardiac conditions like heart attack and high blood pressure, as well as conditions like diabetes and kidney disease can cause cumulative damage to the heart. At first, the organ finds ways to compensate, but over time these methods of keeping up with an increasing workload cause more damage to the heart muscles. The heart’s chambers may compensate by stretching to pump more strongly, which causes the walls to thin, or they may thicken as the muscles of the heart build up to provide more force.

Left-Sided Heart Failure

In most cases, HF affects the left side of the heart, causing a deficit in oxygen-rich blood sent to the rest of the body. The left ventricle is the largest chamber of the heart and provides most of the power for pumping blood around the cardiovascular system. Two things can happen to the left ventricle to cause it to pump less effectively. When the chamber walls stretch out and thin, they eventually lose their ability to contract and pump blood. This is called systolic heart failure. When the walls thicken, the chambers become inflexible and shrink, preventing the heart from filling with enough blood. This is called diastolic heart failure.

Right-Sided Heart Failure

When HF affects the right side, the heart cannot pump enough blood to the lungs, where it picks up oxygen. Weakness on the right side usually develops due to left-sided heart failure. When both pumping mechanisms of the heart are compromised, unoxygenated blood tends to back up throughout the body, causing swelling in the extremities and abdomen.

Congestive Heart Failure

While the terms heart failure and congestive heart failure (CHF) are often used interchangeably, there is a difference between these two conditions. When the heart is weakened significantly, blood and fluid can back up and collect not only in the feet, ankles and legs but also in the lungs. Excess fluid “congests” tissues and can put dangerous amounts of pressure on vital organs. This problematic fluid build-up is called edema. In addition to inhibiting proper blood flow, CHF can interfere with the kidneys’ ability to balance water and sodium in the body.

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Heart Failure Risk Factors

A recent report published by the American Heart Association estimates that 6.2 million American adults have heart failure, and that number is growing as the U.S. population continues to age. Heart failure is most common in African Americans, individuals with a family history of HF, and those who are 65 and older. It is the number one reason older people are hospitalized.

Unhealthy lifestyle factors (e.g., smoking, poor diet, excess alcohol consumption, physical inactivity) and certain medical conditions like diabetes, high blood pressure, chronic kidney disease and obesity are also associated with an elevated risk for HF.

Symptoms of Heart Failure

The most common symptoms of HF include:

  • Shortness of breath or difficulty breathing
  • Chronic coughing and/or wheezing
  • Fatigue
  • Light-headedness
  • Swelling, especially of the feet, ankles and legs
  • Nausea
  • Loss of appetite
  • Elevated heart rate
  • Confusion or disorientation
  • Unexplained weight gain

If someone is experiencing more than one of these symptoms, it is crucial to make a doctor’s appointment for evaluation. Tracking symptoms is also important for helping those who have already been diagnosed manage their condition, which can significantly impact their overall quality of life.

Heart failure symptoms in elderly individuals are often confused with normal age-related changes and may be difficult to differentiate from symptoms of other health conditions. Fatigue and shortness of breath are commonly the first indicators of early HF. However, research suggests that “atypical symptoms, such as confusion, memory deficit, sleepiness, episodes of delirium, irritability, syncopal states [fainting], fatigue, anorexia, and reduced level of activity, gradually become common manifestations of HF in the elderly, especially after age 80.”

How to Prevent Heart Failure and Manage Symptoms

Chronic heart failure is usually caused by other diseases or conditions that damage the heart muscle, such as coronary artery disease, diabetes and high blood pressure. However, acute HF can come on suddenly due to a heart attack, infection or pulmonary embolism (blood clot in the lung). Taking steps to maintain a healthy cardiovascular system will significantly minimize the risk of developing heart failure.

Maintaining desirable cholesterol levels and blood pressure is crucial for heart health. Clogged arteries can contribute to high blood pressure, causing the heart to work harder and raising the risk of HF.

Read: High Blood Pressure: Guidelines and Treatments for Seniors

Diabetes, obesity, smoking cigarettes and excess alcohol consumption all have negative impacts on heart health. Lifestyle changes, such as eating a healthy diet and exercising regularly, can be beneficial at any age. However, starting these healthy habits early on is vital because the damage caused by heart disease can be permanent. Be sure to discuss diet and/or exercise changes with a physician before beginning a new regimen.

For more information on treatments for heart failure, how it progresses and tips on managing symptoms of this condition, read Caring for a Loved One with Heart Failure.

Source: Heart Failure (https://www.nhlbi.nih.gov/health-topics/heart-failure)

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