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; and More frequent contraction, which increases circulation. By making these adjustments, or compensating, the heart can temporarily make up for losses in pumping ability, sometimes for years. However, compensation has its limits. Eventually, the heart cannot offset the lost ability to pump blood, and the signs of heart failure appear.

Diagnosis
In many cases, physicians diagnose heart failure during a physical examination. Readily identifiable signs are shortness of breath, fatigue, and swollen ankles and feet. The physician also will check for the presence of risk factors, such as hypertension, obesity, and a history of heart problems. Using a stethoscope, the physician can listen to a patient breathe and identify the sounds of lung congestion. The stethoscope also picks up the abnormal heart sounds indicative of heart failure.

If neither the symptoms nor the patient's history point to a clear-cut diagnosis, the physician may recommend any of a variety of laboratory tests, including, initially, an electrocardiogram, which uses recording devices placed on the chest to evaluate the electrical activity of a patient's heartbeat.

Echocardiography is another means of evaluating heart function from outside the body. Sound waves bounced off the heart are recorded and translated into images. The pictures can reveal abnormal heart size, shape, and movement. Echocardiography also can be used to calculate a patient's ejection fraction, a measure of the amount of blood pumped out when the heart contracts.

Another possible test is the chest x-ray, which also determines the heart's size and shape, as well as the presence of congestion in the lungs.

Tests help rule out other possible causes of a patient's symptoms. The symptoms of heart failure can result when the heart is made to work too hard, instead of from damaged muscle. Conditions that overload the heart occur rarely and include severe anemia and thyrotoxicosis (a disease resulting from an overactive thyroid gland).

Treatment
Heart failure caused by an excessive workload is curable by treating the primary disease, such as anemia or thyrotoxicosis. Also curable are forms caused by anatomical problems, such as a heart valve defect. These defects can be surgically corrected.

However, for the common forms of heart failure--those due to damaged heart muscle--no known cure exists. But treatment for these forms may be quite successful. The treatment seeks to improve patients' quality of life and length of survival through lifestyle change and drug therapy.

Patients can minimize the effects of heart failure by controlling the risk factors for heart disease. Obvious steps include quitting smoking, losing weight if necessary, abstaining from alcohol, and making dietary changes to reduce the amount of salt and fat consumed. Regular, modest exercise is also helpful for many patients, though the amount and intensity should be carefully monitored by a physician.

But, even with lifestyle changes, most heart failure patients must take medication. Many patients receive two or more drugs.

Several types of drugs have proven useful in the treatment of heart failure:

. Diuretics help reduce the amount of fluid in the body and are useful for patients with fluid retention and hypertension. 
. Digitalis increases the force of the heart's contractions, helping to improve circulation. 
. Results of recent studies have placed more emphasis on the use of drugs known as angiotensin converting enzyme (ACE) inhibitors. 

Several large studies have indicated that ACE inhibitors improve survival among heart failure patients and may slow, or perhaps even prevent, the loss of heart pumping activity. Originally developed as a treatment for hypertension, ACE inhibitors help heart failure patients by, among other things, decreasing the pressure inside blood vessels. As a result, the heart does not have to work as hard to pump blood through the vessels. 

Patients who cannot take ACE inhibitors may get a nitrate and/or a drug called hydralazine, each of which helps relax tension in blood vessels to improve blood flow.
Common Heart Failure Medications Listed below are some of the medications prescribed for heart failure. Not all medications are suitable for all patients, and more than one drug may be needed. 

Also, the list provides the full range of possible side effects for these drugs. Not all patients will develop these side effects. If you suspect that you are having a side effect, alert your physician. 

ACE inhibitors
These prevent the production of a chemical that causes blood vessels to narrow. As a result, blood pressure drops and the heart does not have to work as hard to pump blood. Side effects may include coughing, skin rashes, fluid retention, excess potassium in the bloodstream, kidney problems, and an altered or lost sense of taste. 

Digitalis
Increases the force of the heart's contractions. It also slows certain fast heart rhythms. As a result, the heart beats less frequently but more effectively, and more blood is pumped into the arteries. Side effects may include nausea, vomiting, loss of appetite, diarrhea, confusion, and new heartbeat irregularities. 

Diuretics
These decrease the body's retention of salt and so of water. Diuretics are commonly prescribed to reduce high blood pressure. Diuretics come in many types, with different periods of effectiveness.Side effects may include loss of too much potassium, weakness, muscle cramps, joint pains, and impotence. 

Hydralazine
This drug widens blood vessels, easing blood flow. Side effects may include headaches, rapid heartbeat, and joint pain. 

Nitrates
This drug is used mostly for chest pain, but may also help diminish heart failure symptoms. It is a smooth-muscle relaxer and widens blood vessels. It acts to lower primarily systolic blood pressure. Side effects may include headaches. 

Sometimes, heart failure is life-threatening. Usually, this happens when drug therapy and lifestyle changes fail to control its symptoms. In such cases, a heart transplant may be the only treatment option. However, candidates for transplantation often have to wait months or even years before a suitable donor heart is found. Recent studies indicate that some transplant candidates improve during this waiting period through drug treatment and other therapy, and can be removed from the transplant list.

Transplant candidates who do not improve sometimes need mechanical pumps, which are attached to the heart. Called left ventricular assist devices (LVADs), the machines take over part or virtually all of the heart's blood-pumping activity. However, current LVADs are not permanent solutions for heart failure but are considered bridges to transplantation.

An experimental surgical procedure for severe heart failure is available at a few U.S. medical centers. The procedure, called cardiomyoplasty, involves detaching one end of a muscle in the back, wrapping it around the heart, and then suturing the muscle to the heart. An implanted electric stimulator causes the back muscle to contract, pumping blood from the heart.