Lown Cardiovascular Research Foundation

Harvard Heart Letter | June 2008

Don’t delay when heart failure threatens

Ignoring the warning signs of worsening heart failure can get you into big trouble.

When the “Check Engine” light starts flashing on the dashboard and a grinding sound emanates from under the hood, most people heed the warnings and head for a mechanic. People living with heart failure often get warnings like these from their bodies. Many ignore the signs that their condition is about to flare up, sometimes for days, before calling a doctor or heading to the hospital (see “Warning signs of worsening heart failure”).

Waiting it out isn’t a good idea. The symptoms don’t usually fade away by themselves, and they can spiral out of control into what doctors call acute or decompensated heart failure. This usually requires hospitalization and often intensive care. Rapidly worsening heart failure can put a tremendous strain on the heart, lungs, kidneys, and other organs.

Heeding the warning signs, and taking action, can nip this in the bud.

Dangerous delays

Doctors, nurses, public health experts, and even the Harvard Heart Letter make a big deal about the importance of getting to the hospital as fast as possible if you suspect you are having a heart attack. Worsening heart failure isn’t accorded the same sort of urgency, though it should be.

In an effort to get a handle on how people respond to heart failure warning signs, researchers looked at the medical records of all 2,587 people hospitalized for acute heart failure in any of the 11 hospitals of greater Worcester, Mass., in a single year. What first struck them was how few of the records contained information on when the heart failure symptoms had begun. This is in stark contrast to medical records of heart attack victims, which religiously note the time of symptom onset.

People who experienced acute symptoms — serious shortness of breath, swelling of the ankles or feet, a gain of 5 pounds in a week — waited an average of 13 hours before seeking medical help, the investigators reported in the March 2008 American Journal of Medicine. Those with less severe or more vague symptoms waited nearly 10 days before calling a doctor or going to the hospital.

There are many reasons why people with heart failure hold off on calling their doctors or coming to the emergency department, says Dr. Joel Gore, professor of cardiovascular medicine at the University of Massachusetts Medical School and an author of the study. Many have learned to live with their symptoms and don’t recognize when they are getting out of hand. Some are afraid of what they’ll learn. Others worry about crying wolf.

Warning signs

Heart failure is something of a trickster. Long periods of stability can be punctuated by flare-ups, seemingly from out of the blue, that can push symptoms out of control. Unlike a car, the body doesn’t have warning lights or alarms to alert you that the heart is having greater-than-usual trouble pumping enough blood to meet the body’s needs. That’s why you need to watch it like a hawk and heed the subtle signs. There aren’t any hard-and-fast rules about when to call your doctor. “You know your body best,” advises Dr. Gore. “If you have a feeling that something isn’t right, it probably isn’t. When in doubt, check it out.”

Trying to prevent flare-ups is just as important as acting on them. If you have heart failure, here are some strategies that can keep it under control and keep you out of the hospital:

• Take your medications, even when you are feeling fine.

• Stick with your diet.

• Go easy on the salt.

• Drink the right amount of fluid.

• Weigh yourself every day.

• Have your potassium checked.

• Exercise regularly.

• Relax and reduce stress.

• Guard against the flu and pneumonia with vaccinations and frequent hand washing.

• Be alert for signs of a flare-up.