Heart failure means that your heart muscle doesn't
pump as much blood as your body needs. Failure doesn't mean that your heart
has stopped. It means that your heart is not pumping as well as it
should.
Because your heart cannot pump well, your body tries to
make up for it. To do this:
Your body holds on to salt and water. This increases the
amount of blood in your bloodstream.
Your body has an amazing ability to make up for heart
failure. It may do such a good job that you don't know you have a disease. But
at some point, your heart and body will no longer be able
to keep up. Then fluid starts to build up in your body, and you have symptoms
like feeling weak and out of breath.
This fluid buildup is called
congestion. It's why some doctors call the disease congestive heart failure.
Heart failure usually gets worse over time. But treatment can
slow the disease and help you feel better and live longer.
What causes heart failure?
Anything that damages
your heart or affects how well it pumps can lead to heart failure. Common causes of heart failure are:
Disease of the sac around the heart (pericardial disease), such
as
pericarditis.
A slow, fast, or uneven heart rhythm (arrhythmia).
A heart problem that you were born with (congenital heart defect).
Long-term alcohol abuse, which can damage your heart.
What are the symptoms?
Symptoms of heart failure
start to happen when your heart cannot pump enough blood to the rest of your
body. In the early stages, you may:
Feel tired easily.
Be short of breath when you exert
yourself.
Feel like your heart is pounding or
racing (palpitations).
Feel weak or dizzy.
As heart failure gets worse, fluid starts to build up in
your lungs and other parts of your body. This may cause you to:
Feel short of breath even at
rest.
Have swelling (edema), especially in
your legs, ankles, and feet.
Gain weight. This may happen over just
a day or two, or more slowly.
Cough or wheeze, especially when you
lie down.
Feel bloated or sick to your stomach.
If your symptoms suddenly get worse, you will need
emergency care.
How is heart failure diagnosed?
Your doctor may
diagnose heart failure based on your symptoms and a physical exam. But you will
need tests to find the cause and type of heart failure so that you can get the
right treatment. These tests may include:
Blood tests.
A chest
X-ray.
An
electrocardiogram (EKG or ECG) to check your heart's electrical system.
An
echocardiogram to see the size and shape of your heart
and how well it is pumping.
An echocardiogram can help show if you have heart failure, what type it is, and what
is causing it. Your doctor can also use it to see if your heart failure is
getting worse.
This test can measure how much blood your heart pumps to your body.
This measurement is called the
ejection fraction. If your ejection fraction gets
lower and you are having more symptoms, it means that your
heart failure is getting worse.
How is it treated?
Most people with heart failure need to take several
medicines. Your doctor may prescribe medicines to:
Help keep heart failure from getting worse. These drugs include ACE inhibitors, angiotensin II receptor
blockers (ARBs), beta-blockers, and vasodilators like hydralazine and
a nitrate.
Reduce symptoms so you feel better.
These drugs include diuretics (water pills) and digoxin.
Treat the cause of your heart
failure.
It is very important to take your medicines exactly as
your doctor tells you to. If you don't, your heart failure could get worse.
Pacemaker or defibrillator
You might need to have a pacemaker or a defibrillator (ICD) if you have a
problem with your heart rhythm. A pacemaker can help your heart pump blood better. An ICD can prevent a dangerous heart-rhythm problem.
Care at home
Lifestyle changes are an important part of treatment.
They can help slow down heart failure. They may also help control other
diseases that make heart failure worse, such as high blood pressure, diabetes,
and coronary artery disease.
The best steps you can take are to:
Eat less sodium. Sodium causes your body to hold on to water and may make symptoms worse. Your doctor may also ask you to
limit how much fluid you drink.
Get regular exercise. Your doctor can
tell you what level of exercise is safe for you, how to check your
pulse, and how to know if you are doing too much.
Take rest breaks during the day.
Lose weight if you are overweight. Even
a few pounds can make a difference.
Stop smoking. Smoking damages your
heart and makes exercise harder to do.
Limit alcohol. Ask your doctor how
much, if any, is safe.
Ask your doctor if cardiac rehab is right for you. Rehab can give you education and support that help you learn self-care and build new healthy habits, such as exercise and healthy eating.
To stay as healthy as possible, work closely with your
doctor. Have all your tests, and go to all your appointments. It is also
important to:
Talk to your doctor before you take any
new medicine, including nonprescription and prescription drugs, vitamins, and
herbs. Some of them may make your heart failure worse.
Keep track of your symptoms. Weigh yourself at the
same time every day, and write down your weight. Call your doctor if
you have a sudden weight gain, a change in your ability to exercise, or any
sudden change in your symptoms.
What can you expect if you have heart failure?
Medicines and lifestyle changes can slow or even reverse heart failure
for some people. But heart failure often gets worse over time.
Early on, your symptoms may not be too bad. As heart failure
gets worse, you may need to limit your activities.
Treatment can often help reduce symptoms, but it usually doesn't get rid of
them.
Heart failure can also lead to other health problems. These
may include:
Blood clots in your legs (deep vein thrombosis) or lungs (pulmonary embolism).
Your doctor may be able to give you medicine or other
treatment to prevent or treat these problems.
Heart failure can
get worse suddenly. If this happens, you will need emergency care. To prevent
sudden heart failure, you need to avoid things that
can trigger it. These include eating too much salt, missing a dose of your
medicine, and exercising too hard.
Knowing that your health may get worse can be hard. It
is normal to sometimes feel sad or hopeless. But if these feelings last, talk
to your doctor. Antidepressant medicines, counseling, or
both may help you cope.
Health Tools
Health Tools help you make wise health decisions or take action to improve your health.
Decision Points focus on key medical care decisions that are important to many health problems.
Certain triggers,
such as too much sodium or not taking medicines the right way, may
suddenly make heart failure worse. This can sometimes cause deadly
problems such as
pulmonary edema or
cardiogenic shock.
Symptoms
At first you may not have any
symptoms from heart failure. For a while, your heart and body can make up for heart failure. For example, your heart can pump faster and pump more blood with each beat. This is called compensation.
But as your heart has more
trouble pumping enough blood to your body, you will likely have symptoms. These symptoms may get worse or change if your heart failure gets worse.
Symptoms of heart failure
start to happen when your heart can't pump enough blood to the rest of your
body. In the early stages, you may:
Feel tired easily.
Be short of breath when you exert
yourself.
Feel like your heart is pounding or
racing (palpitations).
Feel weak or dizzy.
As heart failure gets worse, fluid starts to build up in
your lungs and other parts of your body. This may cause you to:
Feel short of breath even at
rest.
Have swelling (edema), especially in
your legs, ankles, and feet.
Gain weight. This may happen over just
a day or two, or more slowly.
Cough or wheeze, especially when you
lie down.
Feel bloated or sick to your stomach.
How doctors talk about heart
failure
There is more than one type of heart failure. Each type is based on what problem in the heart is causing it to not pump as much blood as normal.
Heart failure is grouped-or
classified-according to symptoms.
Your treatment is based partly on what class of symptoms you
have.
There's also another way to define heart failure.
It's based on the
stages you might go through as your heart failure gets
worse. Your doctor also may make treatment choices based on your stage of heart
failure.
Symptoms of sudden heart failure
Sometimes your symptoms may get worse very quickly. This is
called sudden heart failure. It causes fluid to build up in your lungs, causing
congestion. (This is why the problem is often called congestive heart
failure.) Symptoms may include:
Severe shortness of breath.
An irregular or fast heartbeat.
Coughing up foamy, pink mucus.
Sudden heart failure is an emergency.
You need care right away.
Your risk for having heart failure is higher if you have certain risk factors. A risk factor is anything that increases your chance of having a particular problem.
Heart failure
is usually caused by another health problem, often
coronary artery disease or high blood pressure. So anything that
increases your risk for one of those problems also increases your risk for
heart failure.
Risk factors for
coronary artery disease and heart attack include smoking, having high cholesterol or
diabetes, and having a family history of heart
disease.
Risk factors for
high blood pressure include being overweight, being inactive, and having a family history
of high blood pressure.
Risk factors for
heart valve disease include older age and an infection of the valves.
The risk of heart failure
rises as a person gets older.
When to Call a Doctor
Call 911 or other emergency services right away if you have:
Sudden
numbness, tingling, weakness, or paralysis in your face, arm, or leg,
especially on only one side of your body.
Sudden vision changes.
Sudden trouble speaking.
Sudden confusion or trouble
understanding simple statements.
Sudden problems with walking or
balance.
A sudden, severe headache that is different from past
headaches.
Call your doctor right away if you have a pacemaker or ICD and think you have an infection near the device. Signs of an infection include:
Changes in the skin around your pacemaker or ICD, such as:
Swelling.
Warmth.
Redness.
Pain.
Fever not caused by the flu or another illness.
Call your doctor soon if you have symptoms of
heart failure, which include:
Being very tired or having weakness that
prevents you from doing your usual activities.
Having breathing problems such as:
Trouble breathing during routine activities
or exercise that did not cause problems before.
Sudden shortness of breath, even if it is mild.
Shortness of breath when you lie down.
Waking up at night with shortness of breath or feeling as though
you are suffocating.
A dry, hacking cough, especially when you lie down.
Sudden weight gain, such as
more than 2 lb (0.9 kg) to 3 lb (1.4 kg) in a day or 5 lb (2.3 kg) in a week. (Your doctor may suggest a different range of weight gain.)
Increased fluid buildup in your body (most often in the
legs).
Call your doctor soon if:
Your heart failure symptoms get worse.
You have a sudden change
in symptoms.
You're having trouble keeping even minor symptoms
under control.
Making lifestyle changes, such as eating less salt and being more active. To learn more, see
Living With Heart Failure.
As part of your ongoing treatment, your doctor will also try to
prevent or treat problems-such as fever,
arrhythmia, and
anemia-that can lead to
sudden heart failure. Treatment may include:
Getting vaccines. Your doctor may want you to get vaccines against
pneumonia and
flu. These vaccines can keep you from getting
infections that could put you in the hospital.
Checking your weight. Your doctor will probably give you
guidelines for watching fluid buildup and tell you how much weight gain is too
much.
Getting devices to fix heart rhythm problems. In some cases, your doctor may recommend a
biventricular pacemaker that can help your heart pump blood better. This is also called cardiac resynchronization therapy (CRT). Or you may
have an
implantable cardioverter-defibrillator (ICD) to stop a deadly rhythm. Some people get a pacemaker that is combined with an
ICD.
Oxygen treatment. Your doctor may recommend
oxygen therapy to reduce your
shortness of breath and increase your ability to exercise.
You might take part in a disease management program. These programs include a broad range of services, such as education, home health care, visiting nurses, and rehabilitation.
A very small number of people may have other treatments, including:
Surgery to replace or repair a valve in your heart.
Cardiac rehabilitation, a supervised program that uses exercise, education, and support to help people live well with heart failure. For more
information, see the topic
Cardiac Rehabilitation.
Sometimes
heart failure can be fixed if another problem can be corrected, such as
by treating hyperthyroidism.
Palliative care
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life-not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness. You can also have it if treatment to cure your illness no longer seems like a good choice.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
Heart failure tends to get worse over time. So you
need to decide what kind of care you want at the end of your
life.
It can be hard to have talks with your
doctor and family about the end of your life. But making these decisions now
may bring you and your family peace of mind. Your family won't have to wonder
what you want. And you can spend your time focusing on your
relationships.
You will need to decide if you want
life-support measures if your health gets very bad. An
advance directive is a legal document that
tells doctors how to care for you at the end of your life.
This care includes electronic devices that are used for heart failure, such as pacemakers. You also can say where you want to have care. And you can name
someone who can make sure your wishes are followed.
The
best way to prevent
heart failure is to have a heart-healthy lifestyle and control existing health problems like high blood pressure and diabetes.
To reduce your risk:
Don't smoke. If you
smoke, quit. Avoid
secondhand smoke too.
Eat heart-healthy foods. Eat fruits, vegetables, fish, lean meats, and whole grains. Choose foods that are low in saturated fat and avoid trans fat. Limit sodium, alcohol, and sugar.
Get regular exercise. Try to do activities that raise your heart rate. Aim
for at least 2½ hours of
moderate exercise a week.footnote 1
Stay at a healthy weight. Lose weight if you need to.
Manage other health problems that can raise your risk of heart disease and heart failure. These include high blood pressure, high cholesterol, and diabetes. You can use heart-healthy lifestyle changes along with medicines to manage these conditions.
Living With Heart Failure
You can feel better when you have heart failure by taking your medicines as directed, having a healthy lifestyle, and avoiding things that make heart failure worse. Know what things you can do every day to stay healthy, what symptoms to watch for, and when to call a doctor.
Ask your doctor if cardiac rehab is right for you. Rehab can give you education and support that help you learn self-care and build new healthy habits, such as exercise and healthy eating.
Try to avoid medicines that can make your heart failure worse.
Before taking any new medicine, ask your doctor or a pharmacist if it's safe to take it with your heart failure medicines.
Limit sodium. Your doctor might recommend that you limit sodium to less than 2,000 mg a day. Limiting sodium can help you feel better and prevent sudden heart failure. Fluid may build up in your lungs-making it harder for you to breathe-and in your feet, ankles, legs, and belly.
Exercise regularly. If
you aren't already active, your doctor may want you to start
exercising. Do not start exercising until you have talked with your doctor to make an exercise program that is safe for you. You could do it in a cardiac rehabilitation program or on your own.
Check your
weight at the same time every day. Checking your weight helps you keep track of your symptoms. Sudden weight gain may mean that fluid is building up in your body because your heart failure is getting worse.
Try to lose weight if
you are overweight. Eating a heart-healthy diet and exercising regularly
will help you lose weight. Even
a few pounds can make a difference.
Don't smoke. If you smoke, try to quit. Smoking increases your
risk for heart disease and makes it harder to exercise.
Avoid
secondhand smoke too.
Limit alcohol. Moderate drinking is no more than 2 drinks a day for
men and 1 drink a day for women.
Limit your fluids if your doctor tells you to. Limiting fluid can help relieve swelling. Limiting fluid helps your body get rid of extra water and sodium.
"I was having a lot of trouble getting enough sleep. I
was snoring so bad that my wife was sleeping in another room. I'd wake up 7
times a night. Sometimes I'd wake up gasping for breath. The next day I'd be so
tired that I'd fall asleep while doing my woodworking in the garage. And I was
really fuzzy-headed. I couldn't remember anything.
"I thought it
might be my heart failure. So I decided to talk to my doctor about it, and he
suggested a sleep study. I found out that I have sleep apnea. I haven't been
getting enough oxygen because of it. He put me on a CPAP machine at night. I've
used it for the past 4 months.
"It took a little time to get used
to sleeping with a mask. But I'm sleeping much better. Now if I wake up, it's
only once, and I go right back to sleep. I feel so much better during the
day."-Pete
This story is based on information gathered from many people living with heart failure.
Many people with heart failure have trouble
sleeping. Your doctor may be able to find out what is causing your
sleep problems and help you get a good night's
sleep.
Most people with heart failure can
still have an active and safe sex life. Talk with your doctor if you have concerns about having sex.
Unfortunately, sexual problems are common. Your
interest may drop, or you may have shortness of breath or other symptoms that
limit your ability to have sex. Men may have erection
problems.
Talk to your doctor. You can get
help for erection problems or other sexual troubles.
Get help for depression and anxiety if you have them. Heart failure can be hard on your
emotions. Many people with heart failure feel
depressed or anxious. For more information on how to feel better, see
Coping With Your Feelings.
It can be rewarding to help a loved one with heart failure. But
it's also a lot of work. And it can be hard emotionally.
If you are taking care of a loved one, make sure that you also take
care of yourself. This can mean taking breaks by getting help from family or
friends. You also may be able to use respite care. These services provide
someone who will stay with your loved one while you get out of the house for a
few hours.
Heart failure
brings big changes to your life. You may struggle with sadness and worry. You
may wonder if you'll still be able to enjoy your life. Coping with your
feelings and seeking help when you need it can help you live better with heart
failure.
Depression and anxiety
Heart failure can be hard on your
emotions. You may feel
depressed that you can't do some of the things you
used to do. You may worry about your future. And symptoms of heart failure,
such as shortness of breath, can make this
anxiety worse.
These feelings are common.
Talk to your doctor if you have
symptoms of depression or are worried a lot.
Depression and anxiety can be treated with counseling and medicine.
You also can help yourself feel better by
changing your "self-talk." Those are the things you tell yourself about how
you're coping. Negative thoughts can make you feel bad. Changing the way you
think can change the way you feel.
The challenges of living with heart
failure can increase your stress. And stress can make living with heart failure
even harder. Stress also can disturb your sleep and make depression and anxiety
worse. Explore ways to relax and manage stress to help your body, mind, and
spirit.
Emotional support from friends and family can help you cope with the struggles
of heart failure. You might want to think about joining a heart failure support
group. Ask your doctor about the types of support that are available where you
live.
Cardiac rehab programs can offer support for you and your family. Ask your doctor if rehab is right for you.
Meeting other people with the same
problems can help you know you're not alone. If you're shy or aren't a joiner,
you can look at an online support group. Even though people online aren't
talking face-to-face, they're sharing their feelings and creating a
community.
Medications
You probably will need to take
several medicines to treat
heart failure, even if you don't
have symptoms yet.
Medicines don't cure heart failure. But
they can help your heart work better and improve symptoms.
Slow the rate at which your heart failure
gets worse.
Reduce the chance of other problems from heart failure,
such as
stroke.
Reduce hospital
stays.
Help you live as long as possible.
It's very important to take your medicines
exactly as your doctor says. If you don't, your heart
failure may get worse or you may get sudden heart failure.
The medicines you take
will depend on the type of heart failure you have. The most commonly used
medicines are listed below.
Medicines for pumping problems (heart failure with reduced ejection fraction, or systolic heart failure)
ACE inhibitors (angiotensin-converting enzyme inhibitors)
relax and widen blood vessels. This
makes it easier for blood to flow.
Aldosterone receptor antagonists, a type of diuretic, make the kidneys get rid of extra
fluid.
ARBs (angiotensin II receptor
blockers) make it easier for blood to flow through the
vessels.
ARNI (angiotensin receptor neprilysin inhibitor) medicine makes it easier for blood to flow through the
vessels. ARNI medicine may be used instead of an ACE inhibitor or an ARB.
Beta-blockers slow the heart rate. They also may help the heart fill with blood more completely.
Digoxin helps the heart pump more blood with each beat.
Diuretics help relieve symptoms like swelling in the legs.
Hydralazine taken with a nitrate widens blood vessels. This medicine can lower blood pressure and reduce the workload on the
heart.
Ivabradine slows the heart rate. This medicine may help prevent some people from being hospitalized for heart failure.
Medicines for filling problems (heart failure with preserved ejection fraction, or diastolic heart failure)
Heart transplant to replace a failing heart. This is not common.
Other Treatment
Pacemakers
Cardiac resynchronization therapy (CRT) uses a biventricular pacemaker, which makes the
heart's lower chambers (ventricles) pump together. This can help your heart pump blood better.
This type of pacemaker
can help you feel better so you can be more active. It also can help keep you
out of the hospital and help you live longer.
If you get a pacemaker, you have to be careful
not to get too close to some devices with strong magnetic or electrical fields.
These include
MRI machines (unless your pacemaker is safe for an MRI), battery-powered cordless power tools,
and CB or ham radios. But most everyday appliances are safe.
A pacemaker may be used alone or along
with an implantable cardioverter-defibrillator (ICD) for heart
failure.
Implantable defibrillators (ICDs)
Implantable cardioverter-defibrillators (ICDs) can
prevent sudden death from an abnormal heart rhythm and may help you live
longer. An ICD checks the heart for very fast
and deadly heart rhythms. If the heart goes into one of these
rhythms, the ICD shocks it to stop the deadly rhythm and
returns the heart to a normal rhythm.
If you get an ICD, you have to be careful not
to get too close to some devices with strong magnetic or electrical fields.
These include
MRI machines (unless your ICD is safe for an MRI), battery-powered cordless power tools,
and CB or ham radios. But most everyday appliances are safe.
An ICD may be used alone or along
with a pacemaker for heart failure.
Ventricular assist devices (VADs)
Ventricular assist devices (VADs), also known as heart
pumps, may be placed into the chest to help the heart pump
more blood.
VADs can keep people alive until
a donor heart is available for transplant. In some cases, VADs may also be used
as an alternative to heart transplant for long-term treatment. VADs are used in people who have severe heart failure.
Talk
to your doctor before you take any over-the-counter medicine or
supplement. They are used along with medical treatments for heart failure, not instead of treatment.
You may hear
about supplements, vitamins, or hormones that might improve heart failure
symptoms.
Fish oil (omega-3 fatty acid) supplements have been shown to help some heart failure patients. In some studies, fish oil supplements, taken along with other heart failure medicines, helped people stay out of the hospital and live longer.footnote 2
No other supplement, vitamin, or hormone has been shown definitely to relieve heart
failure or help you live longer.
Examples include coenzyme Q10 and hawthorn.
Only some of the studies of coenzyme Q10 showed that it helps heart
failure symptoms.footnote 3
Hawthorn is an herb that is sometimes used in Europe and Asia
to try to increase blood flow to the heart.
U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
Siscovick DS, et al. (2017). Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: A science advisory from the American Heart Association. Circulation, 135(15): e867-e884. DOI: 10.1161/CIR.0000000000000482. Accessed April 10, 2017.
Coenzyme Q10 (2006). Medical Letter on Drugs and Therapeutics, 48(1229): 19-20.
Other Works Consulted
Allen LA, et al. (2012). Decision making in advanced heart failure: A scientific statement from the American Heart Association. Circulation, 125(15): 1928-1952.
Drugs for treatment of chronic heart failure (2009). Treatment Guidelines From The Medical Letter, 7(83): 53-56.
Levine GN, et al. (2012). Sexual activity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 125(8): 1058-1072.
McKelvie R (2011). Heart failure, search date August 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Riegel B, et al. (2009). State of the science. Promoting self-care in patients with heart failure. A scientific statement from the American Heart Association. Circulation, 120(12): 1141-1163.
Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458-2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.
Somers VK, et al. (2008). Sleep apnea and cardiovascular disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing in collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation, 118(10): 1080-1111.
Whelton PK, et al. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults.
Journal of the American College of Cardiology, published online November 13, 2017. DOI: 10.1016/j.jacc.2017.11.006.
Accessed November 20, 2017.
Yancy CW, et al. (2013). 2013 ACCF/AHA Guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16): e147-e239.
Yancy CW, et al. (2016). 2016 ACC/AHA/HFSA Focused update on new pharmacological therapy for heart failure: An update of the 2013 ACCF/AHA guideline for the management of heart failure. Circulation, published online May 20, 2016. DOI: 10.1161/CIR.0000000000000435. Accessed June 10, 2016.
Yancy CW, et al. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Circulation, published online April 28, 2017. DOI: 10.1161/CIR.0000000000000509. Accessed April 28, 2017.
Credits
ByHealthwise Staff Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology E. Gregory Thompson, MD - Internal Medicine Martin J. Gabica, MD - Family Medicine Elizabeth T. Russo, MD - Internal Medicine Adam Husney, MD - Family Medicine Kathleen Romito, MD - Family Medicine Specialist Medical ReviewerStephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
Siscovick DS, et al. (2017). Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: A science advisory from the American Heart Association. Circulation, 135(15): e867-e884. DOI: 10.1161/CIR.0000000000000482. Accessed April 10, 2017.
Coenzyme Q10 (2006). Medical Letter on Drugs and Therapeutics, 48(1229): 19-20.
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