Congestive Heart Failure
- Medicine Community & Research
- Aug 17, 2024
- 7 min read
By Sanjana Malkareddy
From Unsplash
Overview
What is congestive heart failure?
Affecting at least 6 million people in the United States, congestive heart failure (CHF), also called heart failure, is a chronic condition where the heart still works; however, it is unable to pump blood properly to meet the body’s demands. During this condition, blood backs up in other body parts, since the heart cannot manage the blood volume as it should. Body parts commonly affected include the feet, legs, and lungs.
Stages of congestive heart failure
Stage A or pre-heart failure means you don’t have heart failure, but are at a high risk of developing it if you have a family history of it or if at least one of these conditions applies to you. The conditions include high blood pressure, diabetes, ischemic heart disease, metabolic syndrome, history of alcohol abuse or rheumatic fever, family history of cardiomyopathy, or a history of taking drugs that harm heart muscle.
During stage B your left ventricle isn’t functioning properly or has an irregular structure but you’ve never shown any symptoms of heart failure or both.
During stage C you have formerly or presently experienced symptoms of heart failure and have a diagnosis of it.
Stage D and reduced EF (ejection fraction) is the last stage of congestive heart failure and your symptoms during this stage don’t get better with treatment.
Types of congestive heart failure
There are three types of congestive heart failure: left-sided heart failure, right-sided heart failure, and high-output heart failure.
Left-sided heart failure
This type of heart failure affects the left side of the heart. There are two types associated with it:
Systolic heart failure is when the left ventricle isn’t strong enough to pump blood out to the body. This is also called heart failure with reduced ejection fraction.
Diastolic heart failure is when the left ventricle can’t properly fill up with blood due to stiffness. This is also called heart failure with preserved ejection fraction.
Causes
People with the following conditions have a high risk of getting left-sided heart failure. The conditions include ischemic heart disease, myocardial infarction, hypertension, heart valve disease, irregular heart rhythms, or infiltrative diseases.
Symptoms
Symptoms may be mild initially but may worsen as the heart condition progresses. Symptoms include persistent coughs, shortness of breath, waking up due to shortness of breath or the inability to lie flat at nighttime, increased weight, and edema in body parts such as the abdomen, legs, or ankles. As the heart’s condition worsens, it has to work vigorously to fulfill the body’s needs. This can lead to complications such as arrhythmias, cardiac shock, and cardiomegaly.
How is left-sided heart failure diagnosed?
Healthcare providers diagnose this condition by asking patients about their medical history and performing a physical exam. Further tests include laboratory tests and imaging studies. Laboratory tests include:
A BNP blood test is used to check BNP protein levels. High numbers of BNP can indicate heart failure because your heart produces more BNP when it works harder to pump blood.
A metabolic panel may also be ordered to study the kidneys and liver’s function plus electrolytes like potassium and sodium.
Tests that are performed related to imaging studies include:
An electrocardiogram or EKG tests the electrical activity of the heart.
An echocardiogram or ECHO is used to show the movement and blood flow of the heart.
A coronary angiogram is used to analyze the blood vessels of the heart.
A cardiac MRI is used to get a thorough image of the heart.
Treatments
Although there is no cure for left-sided heart failure, there are a variety of treatment options available. The treatment options that work for you vary depending on if you have systolic or diastolic heart failure. Medication treatment options to enhance heart function include:
Medications such as ACE inhibitors, Angiotensin II receptor blockers, and Angiotensin-receptor neprilysin inhibitors ease blood vessels and aid in reshaping the heart.
Aldosterone antagonists prevent symptoms from getting worse as they manage stress hormones. This type of medication is also considered as a diuretic.
Beta-blockers decrease your pulse and reduce the speed and force of your heartbeat.
Digoxin aids in managing pulse.
Diuretics assist in eliminating the body’s extra fluid.
Sodium-glucose transport protein 2 (SGLT2) inhibitors work to reduce extra fluid.
If symptoms don’t improve or laboratory tests or imaging studies show your condition worsening, a procedure might be done as a treatment option. Procedures may include:
A biventricular pacemaker is an implanted device that uses electrical signals to trigger the heart’s pumping action, so the heart can efficiently pump oxygenated blood to the body.
An electrical cardioversion is a procedure that gets rid of arrhythmias.
An implantable cardioverter defibrillator (ICD) is an implanted device that notices irregular heart rhythms and transmits an electrical signal to restore sinus rhythm.
A left ventricular assist device (LVAD) is an implanted pump that helps the heart pump blood throughout the body.
As a last option, a heart transplant can be performed to replace a heart that can no longer function with a healthy donor heart.
Right-sided heart failure
This type of heart failure affects the right side of the heart; the right side receives deoxygenated blood from the veins and sends it to the lungs to become oxygenated. Right-sided heart failure is when the right ventricle of the heart is not strong enough to pump a necessary amount of blood to the lungs. This can lead to numerous problems including:
Veins accumulated with blood.
Due to the buildup of blood in the veins, pressure increases in the veins.
The increase in pressure results in fluid getting pushed out of the veins and into different tissues.
A buildup of fluid causes edema in body parts such as the legs or abdomen.
Causes
The majority of the time right-sided heart failure is caused by left-sided heart failure. As a result, some causes of right-sided heart failure are similar to left-sided heart failure. Some causes include ischemic heart disease, hypertension, or a prior myocardial infarction. However, not all causes of right-sided heart failure result from left-sided heart failure. For example, pulmonary hypertension, pulmonary embolism, or chronic obstructive pulmonary disease (COPD) can also cause right-sided heart failure.
Symptoms
The main symptom of this type of heart failure is edema in the GI tract, liver, lower back, legs, feet, and ankles. Other symptoms include shortness of breath, chest pain, and heart palpitations. If your condition gets worse you may also experience weight and muscle mass loss.
How is right-sided heart failure diagnosed?
A healthcare provider diagnoses right-sided heart failure by evaluating patients' symptoms, performing a physical exam, and checking for edema. Tests like an EKG, ECHO, chest X-ray, and blood tests (typically to look for BNP levels) may be performed to check heart function. Additional tests such as an MRI, CT, cardiac catheterization, stress test, and a nuclear cardiac stress test may be performed to confirm the diagnosis or to exclude other illnesses causing your symptoms. Another way to diagnose right-sided heart failure includes a heart biopsy, but healthcare providers rarely do this procedure to diagnose this condition.
Treatments
Right-sided heart failure is focused on treating the cause of the condition and improving symptoms. Right-sided heart failure can occur due to different causes and not all causes are treatable. Treatment options include:
Changing your lifestyle can relieve symptoms and prevent the condition from progressing rapidly. Changes include discontinuing smoking and avoiding or restricting caffeine and alcohol. Managing your health by eating food that benefits the heart, keeping track of fluid intake, maintaining a healthy weight, exercising, getting abundant sleep, and managing stress are good ways to improve your quality of life while living with this condition.
Cardiac rehab can also prevent right-sided heart failure from progressing rapidly. Healthcare providers oversee cardiac rehab, where patients receive training on exercise that is adjusted for their goals for their health. Activities such as education on how to live with your condition, ways to improve quality of life, and counseling on managing stress are also included.
Other treatment options include medications. Types of medications may include those that reduce blood pressure such as ACE inhibitors, Angiotensin II receptor blockers, and Angiotensin-receptor neprilysin inhibitors. Drugs that reduce heart rate (beta-blockers and if channel blockers) and those that eliminate extra fluid (diuretics). Other medications include anticoagulants, medicines that lower cholesterol, and digoxin.
If your condition is severe, devices such as an ICD, LVAD, and cardiac resynchronization therapy (a sort of pacemaker) may be suggested.
If the treatments above aren’t working, surgery might be performed as a last option. Although there is no specific surgery that can cure this disease, there are surgeries that help correct parts of the defective heart. For example, an angioplasty, coronary bypass surgery, heart valve surgery, or a heart transplant may be performed.
High-Output Heart Failure
This type of heart failure is uncommon and occurs when the heart becomes overworked and isn’t able to do its job. The blood vessels widen, causing your body to require more blood as it goes through oxygen quicker, or your blood travels around instead of through the arterioles. This leads to more blood going through veins, preventing your body from getting the needed blood. Similar to its name, high-output heart failure is when the cardiac output is about 8 liters of blood per minute, while a normal heart’s cardiac output is 5 to 6 liters per minute.
Causes
Causes for high-output heart failure include a BMI above 30 (most common cause), liver disease, arteriovenous fistula or shunts, acute anemia, pulmonary disease, sepsis, overactive thyroid, or rare blood cancers.
Symptoms
Symptoms of this condition include shortness of breath, extreme tiredness, edema, heart palpitations, and tachycardia.
How is high-output heart failure diagnosed?High-output heart failure is diagnosed by a healthcare provider performing a physical exam, examining medical history, and assessing any causes that may trigger this condition. Tests to diagnose this condition include a blood test to measure natriuretic peptides, EKG, transthoracic echocardiogram, cardiac catheterization, CT scan, and a cardiac MRI.
Treatments
Once you’re in a stable condition a healthcare provider will determine what’s causing this condition and based on the cause a healthcare provider will provide an appropriate treatment plan. Treatments include medications such as diuretics, inotropes, and other medications specific to your condition.
Conclusion
Keeping your heart healthy is essential to surviving. Learning about various diseases that can harm our hearts and inhibit them from functioning properly is an important step to maintaining a healthy heart. By learning about these diseases you can change your lifestyle accordingly or make any additional changes and try to prevent any of these diseases from affecting you later in life.
Citations
High-output heart failure. Cleveland Clinic. (2024a, May 1). https://my.clevelandclinic.org/health/diseases/24660-high-output-heart-failure
professional, C. C. medical. (n.d.-a). Congestive heart failure: What does it mean?. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure
professional, C. C. medical. (n.d.-b). Left-sided heart failure: Symptoms, causes and treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22181-left-sided-heart-failure
Right-sided heart failure: Left-sided heart failure, symptoms. Cleveland Clinic. (2024b, May 1). https://my.clevelandclinic.org/health/diseases/21494-right-sided-heart-failure
