Both pneumonia and heart failure are common conditions that can result in shortness of breath. By definition, pneumonia is an inflammation that results in filling of the air spaces of the lungs—usually due to infection. Heart failure can also result in congestion of the lung air spaces by salt and water displaced from the circulation because of a high fluid pressure “backed up” behind the left ventricle. On a chest x-ray, different distributions of opacification of the lungs can help distinguish the two conditions. Pneumonia is usually associated with fever. Heart failure may be associated with other findings of fluid retention including elevation of a heart failure blood test. Nevertheless, especially in patients with a history of heart disease, distinguishing between the two conditions can be difficult including the possibility that both could be present at the same time. Whereas pneumonia usually requires antibiotics to improve, heart failure with lung congestion may need therapies to increase the removal of excess salt and water from the body.

Several important points emerged from your question. First, I would define ejection fraction as the amount of blood ejected by the heart with each beat as a fraction of what it starts with at the beginning of a beat. For example, if the heart has a 100ml of blood at the beginning and ejects 60ml leaving 40ml, that would be an ejection fraction of 60%. If the heart were to flatten like a pancake when it contracted, the ejection fraction would then be 100%, but that never happens. Normally the heart ejects about 2/3 of the blood it starts with at the beginning of a beat. So if your grandmother has an ejection fraction of 29%–that is seriously decreased but it’s not 29% of 100%, but 29% of a normal range of 55-75%.

Secondly, your mother was given a diagnosis of “Heart Failure”, I like to use the analogy of a car–this would be like a mechanic saying you have “engine trouble”. The question is why? For example is there a problem with her heart arteries (“fuel lines”)? Is her heart muscle weak despite an adequate blood supply (“bad cylinders”)? Does she have a problem with the electrical activation of her heart (” a problem with the distributor”). The answer to these questions may lead to specific therapies that could help her.

Lastly, In general, there are recommendations that should come from her doctor and medical team, including medication, diet and exercise. Please look at the sections in our website specific to these topics which may help.

Hi Greg,

As you know, sleep apnea is a relatively common condition typically associated with periodic obstruction of breathing by the tongue during sleep. Frequently it is suspected when someone is noted to be a loud snorer and has fatigue during the day due to ineffective rest at night. It is more common in individuals who are overweight–the condition can be improved by weight loss. It is often treated by having someone wear a special mask at night that provides continuous positive airway pressure (CPAP) to prevent or relieve the tendency to airway obstruction.

It has been increasingly recognized that untreated sleep apnea can exacerbate the findings of heart failure if someone is prone to the condition. Blood pressure is elevated during episodes of obstructive breathing at night. Other hormonal systems are activated as well that lead to the progression of heart failure. Ironically, heart failure itself can complicate things by making disordered breathing more likely. In general, if you have a suspicion for sleep apnea, it is best to be evaluated, especially if you have a history of heart failure. Whether sleep-apnea by itself can cause heart failure or cardiomyopathy without other risk factors is currently uncertain, but a topic of ongoing clinical research.

A leaky heart valve that regulates the direction of the flow in or out of the left ventricle (atrial or aortic) can by itself lead the heart to weaken. The heart is working “overtime”. If the hearts impaired condition is too advanced it is possible that the surgery to repair or replace would be too risky.

In those cases medications including diuretics and others can still help. Other factors including your father’s age at this time may also be relevant.

There are 2 aspects to your question. Cough is a symptom that has many causes including congestion of the lungs associated with heart failure. When this is the cause, cough often improves with an increase in  the dose of diuretics- less commonly, a dry cough especially at night may be a side effect of a class of heart failure medications called angiotensin-converting enzyme inhibitors (for example, lisinopril, enalapril, captopril).

Fluid retention associated with heart failure usually is seen in the locations of the body most affected by gravity: the ankles, calves, or possibly abdomen. Although facial swelling may be seen with heart failure, other causes should in general be considered (such low protein states or facial inflammation). If this symptom persists, you should bring this up with your doctor.