Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Heart Failure


The heart is a muscle that functions much like other muscles in your body. It contracts and relaxes to pump blood continuously to every part of the body. 

Heart failure means that the heart does not pump normally or does not pump enough. It does not mean that your heart has stopped working or is about to stop working. 

With heart failure, either the heart is pumping less blood than your body needs (low output); or it is pumping with raised pressure so that fluid backs up (fluid congestion). 

Backed-up fluid can accumulate in your lungs, ankles, abdomen, or elsewhere in your body. Some people with heart failure have fluid congestion and low output. 

Your heart has 4 separate chambers that pump blood: two atria and two ventricles. The chambers are separated by muscular walls. The heart also has valves that connect to major blood vessels.

The right side of your heart receives blood and pumps it to your lungs, where the blood gains oxygen and eliminates carbon dioxide. The left side of your heart receives the oxygen-rich blood and pumps it to the rest of your body.


There are 2 main categories of heart failure.

Heart failure with reduced ejection fraction (HFrEF).

The heart’s main pumping chamber is called the left ventricle. HFrEF develops when the left ventricle is too large and does not contract as often as it should. This means that the amount of blood squeezed out with each heartbeat is too low. We call this a reduced ejection fraction. 

A normal ejection fraction is between 50 and 65 percent. You have HFrEF if your ejection fraction is below 40 percent. We sometimes call this systolic heart failure.

Heart failure with preserved ejection fraction (HFpEF).

Heart failure can also occur when heart contractions and the ejection fraction are normal. HFpEF develops if the left ventricle does not relax properly. This may be caused by a stiff ventricle muscle. When this happens, the heart does not get enough blood. 

Fluid can also back up in other parts of the body. We sometimes call this diastolic heart failure or a “stiff” heart.


Symptoms of heart failure include:

  • Difficulty breathing or shortness of breath. This may happen while you are resting, exercising, or lying flat. It occurs because fluid is backing up into the lungs.
  • Weight gain. This can be caused by fluid retention. Weigh yourself daily. Call us if you gain more than 2 pounds in one day or 5 pounds in one week.   
  • Swelling (edema) in your legs, ankles, feet, hands, or abdomen. This is caused by fluid retention. 
  • Fatigue or sudden decrease in ability to do usual activities. 
  • Coughing or wheezing. It may mean fluid is building up in your lungs. 
  • Fast or uneven heartbeat. The heart may work harder to pump blood.  
  • Loss of appetite.
  • Increased urination may happen, especially at night. Your body may retain fluid during the day and get rid of it at night.
  • Dizziness or fainting can be caused by reduced blood flow, low blood pressure, or heart rhythm disturbances (slow or fast heart rate).


Heart failure can be caused by:

  • Heart valve abnormalities. Normally, the heart valves open and close, keeping blood moving. Abnormal valves either allow blood to leak or fail to open completely. 
  • Disturbances of the heart's electrical rhythm. This may cause the heart to beat too fast, too slowly, or irregularly. 
  • Coronary artery disease. A buildup of plaque and fatty substances block or slow down blood flow in the arteries that supply the heart. This can cause a heart attack that can damage the heart muscle and cause heart failure. 
  • High blood pressure makes the heart work harder to circulate blood. The heart muscle becomes thicker and stiffer and unable to pump effectively.
  • Cardiomyopathy is an abnormality of the heart muscle. It can weaken the heart's contraction. 
  • Congenital heart defects. Heart chambers and/or valves may not be normally formed at birth.
  • An abnormally fast heart rate. 


Stages of heart failure

Heart failure is a chronic condition that gets worse over time. Medications cannot cure heart failure but they can lessen symptoms. They can also prolong and improve the quality of your life.

Class I

No symptoms

Class II

Symptoms during intense activity (beyond typical daily actions)

Class III

Symptoms during everyday activity

Class IV

Symptoms much of the time, even while at rest

Please report any and all symptoms when you have phone or in-person visits with us. Tell us right away if symptoms worsen or change. This may mean that your heart failure is progressing.


We diagnose heart failure based on your symptoms and a physical exam. During your visit, we will discuss your symptoms and order additional tests to confirm the diagnosis. These tests may be done in the Emergency Department if your symptoms are severe.  

Blood Tests

A complete blood count (CBC) measures many things including the number and size of red blood cells. It also tells us if you are anemic.

A brain natriuretic peptide (BNP) test. Higher levels of BNP in the blood may suggest more severe heart failure. High BNP can be also be caused by:

  • Chronic kidney disease 
  • Pulmonary embolism 
  • Acute illness

Creatinine testing tells us how your kidneys are working. Heart failure and the medications used to treat it affect the kidneys. Monitoring creatinine is important when your condition or treatment changes.

Potassium can be affected by heart failure medications and changes in kidney function.

A lipid panel measures cholesterol levels. Cholesterol can contribute to the buildup of plaque and blockage of arteries. Managing cholesterol reduces your risk of heart attack or stroke. 

Thyroid-stimulating hormone (TSH). High TSH levels indicate that your thyroid hormone level is low (hypothyroidism).  We monitor TSH because low thyroid hormones can: 

  • Increase your risk of developing heart failure. 
  • Cause symptoms that look similar to heart failure symptoms.

Additional Tests

An EKG/ECG (electrocardiogram) shows the electrical activity of your heart as a series of spikes and dips. This shows the rhythm of your heart. This may suggest changes to the structure of your heart that could have been caused by a prior heart attack.

An echocardiogram uses sound waves to look at the size, shape, and functioning of your heart. This test may be done while you are at rest or before and after exercise. We place an ultrasound probe on different points of your chest.

Cardiac catheterization looks at the arteries that supply blood to the heart muscle. The test determines whether there is a buildup of plaque that is blocking blood flow and causing heart failure.

Stress testing is a noninvasive procedure to evaluate the blood flow to your heart.


Treatment for heart failure can prolong your life and help you to feel better. Treatments focus on lessening symptoms and slowing the progression of the illness. 

Looking after yourself is crucial. This includes making regular exercise and a healthy diet part of your lifestyle every day.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.