Congestive Heart Failure

What is congestive heart failure?

Congestive heart failure (CHF) is a condition wherein your heart muscle does not pump an adequate amount of blood for your body's organs to function normally. This problem could be due to the ventricle of the heart becoming stiff, thus preventing it from relaxing enough to fill with blood. Alternatively, the heart might have been weakened and therefore can't pump out enough blood. Either way, normal blood flow is hindered, making it exceedingly difficult to breath. CHF could also prompt your kidneys to withhold fluid rather than expel it properly. This buildup can cause fluid retention in various areas such as your legs, abdomen, or even your lungs.

CHF happens to be a grave condition, and death can unfortunately be a consequence. However, according to the American Heart Association, numerous individuals afflicted with CHF are capable of leading active lives, given they are under proper medical care and rigorously following a lifestyle conducive to heart health.

What are the symptoms of heart failure?

As per the information provided by doctors and medical professionals, the most common symptoms of congestive heart failure are:

• Trouble breathing when you:
  • Exercise or move around
  • Lie down flat (orthopnea)
  • Bend over (bendopnea)
• Swelling in the ankles, feet, and/or legs
• Dry cough
• Extreme fatigue
• Abdominal bloating or swelling
• Feeling full after eating small amounts of food (early satiety)
• No appetite
• Nausea
• Poor concentration

Depending on the specific cause of CHF, additional symptoms may include:

• Chest discomfort when you move a lot, especially if CHF is due to coronary artery disease.
• Feeling lightheaded when you move a lot, needing to rest after moderate exertion - if CHF is due to certain kinds of heart valve disease.
• Fast or irregular heartbeat, especially at rest - if CHF is due to abnormal heart rhythms (arrhythmias).

What causes congestive heart failure?

CHF is typically caused by the inability of the heart to pump out enough blood from the heart, preventing any blood flow from backing up in your system. You're more likely to develop CHF if you already have diseases such as coronary artery disease (which involves blockages in the arteries that channel blood to your heart) or if you have suffered a heart attack. A heart attack can starve the heart of oxygen, rendering it less capable of pumping blood correctly and causing problems with circulation.

You're also statistically more likely to develop CHF if you suffer from high blood pressure. This forces the heart to do extra work and become harder and stiffer over time. This causes the heart to be less able to properly relax and tires the muscle over time.

How is heart failure diagnosed?

In diagnosing your condition, the doctor's prognosis would first rely on your shared history and the results of a physical exam. If the information provided and symptoms observed align with those typical of a weakened heart struggling to manage blood flow, they will likely order an echocardiography (echo) to measure your ejection fraction, the term given to the percent of blood pumped out of your heart in a single beat. The results essentially speak to the efficiency of your heart. If this value is low, it can indicate potential underlying diseases of the heart. Other relevant checks include imaging, electrical activity tests, and a stress test, all of which aid in the diagnosis of heart failure and identification of the underlying causes.

Risk factors

Underlying conditions linked with getting diagnosed with CHF include:

• Coronary artery disease
• A previous heart attack
• Uncontrolled high blood pressure
• Diabetes
• Abnormal heart valves
• Severe lung disease
• Obesity
• Sleep apnea
• Heavy alcohol or drug use

Other, less common risk factors include:

• Genetic abnormalities that can cause inherited forms of CHF
• Thyroid disease
• Exposure to certain chemotherapy drugs or a history of radiation to the chest to treat cancer
• Certain types of long-standing abnormal heart rhythms (arrhythmias)

How do you treat heart failure?

If you experience symptoms of CHF such as trouble breathing while lying down or bending over, shortness-of-breath with mild exercise or activities, extreme tiredness, or swelling in your legs or abdomen, you should seek immediate medical attention.

If you have been diagnosed with CHF, regular monitoring by a cardiologist (heart specialist) is crucial. The prior course of action would be for your doctor to establish the cause of your CHF and initiate appropriate treatment.

Dependent on your case, your cardiologist may refer you to a CHF specialist—a cardiologist who solely focuses on CHF—if you may need a left ventricular assist device (an implant that aids the heart in pumping) or a heart transplant.

Medication

Medicines like angiotensin receptor blockers or renin inhibitors can aid CHF patients by enabling them to feel better and potentially extend their lifespan.

• Diuretics (e.g., furosemide or torsemide) help get rid of fluid build-up by causing you to pee more often.
• Beta-blockers (e.g., metoprolol, carvedilol) help make it easier for the heart's ventricles to pump, suppress abnormal heart rhythms, and lower the effects of the hormone adrenaline on the heart.
• ACE inhibitors (e.g., lisinopril, enalapril), angiotensin receptor blockers (e.g., valsartan, losartan), and mineralocorticoid receptor antagonists (spironolactone) help the heart pump more efficiently over time.
• Sacubitril/valsartan (Entresto) is a relatively new medication, and has been shown to be better than ACE inhibitors for people with CHF. It also helps the heart pump more efficiently over time.

Alongside taking medication, it's crucial to adopt a heart-healthy lifestyle:

• If you smoke, quit.
• If you’re overweight, try to lose weight and maintain a healthy weight. Weight loss is the first line treatment for hypertension (high blood pressure).
• If you drink alcohol, stop completely. Alcohol is toxic to the heart.
• Reduce stress.
• Limit your salt intake and high-sodium foods.

Procedures

Depending on your condition, specific cardiac procedures or surgeries may be required. These include:

• Coronary artery bypass grafting surgery: This open-heart surgery uses other blood vessels to bypass (go around) blockages in your coronary arteries.
• Cardiac resynchronization therapy: Inserting a special type of pacemaker helps the left and right sides of the heart pump in sync.

What are the 4 stages of congestive heart failure?

Heart failure can exacerbate over time if left untreated, with the progression of CHF typically unfolding in four distinct stages:

Stage A is pre-heart failure. At this stage, a person's risk of developing heart failure is heightened due to existing medical conditions or a family's medical history such as high blood pressure (hypertension), diabetes, or a history of alcohol abuse. Major lifestyle changes at this stage could prevent the manifestation of CHF.

Stage B is still pre-heart failure. This means you are suffering from some sort of heart disease (e.g., coronary artery disease, heart valve disease, etc.) but are yet to present symptoms of HF. Lifestyle changes can help but typically won't suffice on their own. Depending on your underlying condition, a doctor may introduce medication like beta blockers and/or ACE inhibitors.

Stage C signals a diagnosis of heart failure. Symptoms such as shortness of breath, fatigue, weak legs, or swollen feet or ankles become noticeable. The treatment for Stage C includes additional medication beyond that prescribed for Stages A and B. This could include pills designed to induce urination and thereby reduce fluid buildup.

Stage D signifies advanced congestive heart failure where the symptoms have become severe and are resistant to treatment. Your doctor will discuss the need for additional medicines and possibly surgical procedures.

How long can you live with congestive heart failure?

That depends on how much the disease has progressed, how old you are when you’re diagnosed, and how well you stick to your treatment plan. If your CHF is caught early and treated immediately, you could lead a longer life. But often CHF is not caught early, so about 50% of people with CHF live five years past diagnosis, and about 10% to 25% of people survive 10 years or more.

How can you prevent heart failure?

Heart failure can be prevented by:

• Staying active. Get moderate aerobic exercise at least 150 minutes per week (usually 30 minutes a day, five days a week). The stress this puts on your heart can help it improve its functionality. If possible, also do two sessions of resistance training (using weights, resistance bands, or your own body weight) each week.
• Doing a cardiac rehabilitation program, which can improve your ejection fraction (the ability for your heart to pump most of the blood out of its ventricles/chambers).
• Keeping your weight in a healthy range.
• Not smoking or quitting smoking. Also stay away from secondhand smoke and, if you can, air pollution.
• Treating any health issues that can become underlying conditions, including high blood pressure, high cholesterol, or diabetes.
• Improve your diet. Eat mostly vegetables, fruit, fish, and lean meats. Avoid sweets, red meat, and unhealthy fats (trans and saturated fats).
• Avoid heavy alcohol or drug use.
• Taking preventative medications (such as aspirin or statins) if your doctor advises.