Dear Dr. Gott: We have a friend who says she has heart failure and edema. We would like to know what this is, as we have never heard of it before.

Reply: Heart failure means that the heart cannot pump adequate blood to meet the body's needs. It generally develops slowly after one or more conditions have damaged or weakened the heart. Some of the more common causes of heart failure are coronary-artery disease, heart attack, hypertension, myocarditis (inflammation of the heart muscle) often caused by a virus, arrhythmias, faulty heart valves, cardiomyopathy and severe anaemia. Still other contributing diseases include diabetes, emphysema, hyper-or-hypothyroidism and hemochromatosis. While many of the conditions that lead to heart failure cannot be reversed, the failure itself can often be treated successfully.

Signs and symptoms include shortness of breath, rapid or irregular heartbeat, a decreasing ability to exercise, fatigue, weakness, edema (swelling) of the lower extremities, chest pain if the failure is caused by a heart attack and increased abdominal girth (ascites).

In order for a physician to make a proper diagnosis, he or she will likely perform a physical exam that includes, in part, checking blood pressure. The stethoscope that is used to check blood pressure will also be used to listen to your lungs for any signs of congestion and to detect abnormal heart sounds suggestive of failure. Beyond that, an electrocardiogram (EKG), chest X-ray, echocardiogram and blood testing might be included. More sophisticated testing, if necessary, includes a stress test, angiogram, and MRI or CT scanning.

As an initial step, medication is commonly prescribed for treatment. Depending on the symptoms, more than one drug might be taken for optimal control. Angiotensin-converting enzyme (ACE) inhibitors dilate blood vessels and lower blood pressure. They improve the quality of blood flow and lower the heart's workload. Unfortunately, some drugs in this category can produce what is known as an ACE inhibitor cough. For those people unable to deal with the side effect, there are alternative angiotensin II receptor blockers. Then there is digoxin to increase the strength of contractions of the heart muscle, beta blockers to decrease the heart rate and blood pressure simultaneously, diuretics that reduce or prevent fluid retention and more. If surgery is recommended, appropriate specialists have the capability of performing coronary bypass, installing implantable defibrillators, pacemakers, left-ventricular assist devices and, finally, heart transplant. Experimental procedures include cardiac wrap, where a failing heart is wrapped in a mesh bag to prevent a weak heart from further enlargement; removal of scar tissue in the ventricular muscle caused by a myocardial infarction; and applying inflatable pressure cuffs on the calves, thighs and buttocks with the intent of increasing the flow of blood back to the heart muscle. There is a great deal a person can do to prevent heart failure from worsening. The process begins by restricting salt intake, discontinuing smoking, avoiding saturated and transfats in the diet, exercising and reducing stress.