What is congestive heart failure?
Written by Ysandra Prille A. Tabilon
Congestive Heart Failure (CHF) is also identified as heart failure (HF) or congestive cardiac failure (CCF). It is the primary cause of death throughout the globe. It is also a life-threatening disorder in which it impairs the heart’s ability to pump blood. There is fluid accumulation around the cardiac muscle, placing strain on the heart. Thus, it impairs blood circulation.
The term “heart failure” might be misleading to some people. When you have the condition, it doesn’t imply that you have a failing or are about to quit working cardiac organ. Instead, your pumping organ has a mechanical problem that can’t keep up with your body’s demands.
Your cardiac muscle loses its ability to contract over time, limiting the amount of blood it can hold. That is why it enlarges and beats faster to make room for the blood. But, this extra effort can cause palpitations. Additionally, shortness of breath is another consequence of fluid build-up in the lungs.
Your other body organs, such as your kidneys, also attempt to compensate in various ways. Yet, these extra efforts have drawbacks and consequences, such as organ failures. Regardless of how well your body compensates and the number of treatments you receive, HF is often progressive. In a nutshell, it deteriorates over time.
Common Types of CHF
The condition has two types which are the left-sided CHF and right-sided CHF. A person can develop both types together, but usually, the left side problem occurs first. If left untreated, it will then progress to the right side.
The most common one is the left-sided CHF. It occurs when your left ventricle does not pump blood well as it used to. This can be detrimental to your lungs since it results in fluid build-up. Additionally, it comes in two types: Diastolic HF and Systolic HF.
The second type of CHF is right-sided CHF. It occurs when the right ventricle is incapable of supplying blood to the lungs. As a result, blood becomes congested in the blood vessels. Fluid accumulation will occur in your lower extremities, abdomen, and vital organs.
There is no single examination for diagnosing CHF. Your doctor will most likely take into account your medical and family history. This will also include your physical examination and other tests for your heart. The test may involve the following:
- Electrocardiogram (EKG)
- Chest X-ray
- Holter monitor
- Exercise stress test
- Cardiac Catheterization
- Ejection Fraction (EF)
- Electrocardiogram (EKG or ECG)
CHF can manifest itself as an acute or chronic condition. While some people may not exhibit symptoms, this does not mean they are clear of the disease. Symptoms range in severity from moderate to severe. The common signs and symptoms of CHF are the following:
- Shortness of breath
- Fatigue and weakness
- Swelling in the legs, ankles, feet, and abdomen
- Rapid or irregular heartbeat (palpitations)
- Very rapid weight gain from fluid build-up
- Coughing or wheezing that persists with white or pink blood-tinged mucous
- Nausea and lack of appetite
- Dizziness, confusion, difficulty concentrating, fainting.
- Difficulty concentrating or decreased alertness
- Chest pain if HF is due to Myocardial infarction
It is necessary to see a doctor if you exhibit some of the symptoms. These include chest pain, fainting, rapid heartbeat, shortness of breath, and constant coughing. Although, it is crucial to avoid self- diagnosing with such symptoms as HF. It could be the cause of other health problems.
The condition occurs due to added stress in your heart that makes it work too hard, in the long run, damaging it. Certain lifestyle factors can also increase your chance of myocardial infarction and stroke. These include smoking, obesity, consuming fatty foods, and physical inactivity. These factors can also contribute to cardiac failure.
As you age, your heart loses some of its ability to pump blood, but it doesn’t mean all people will get the condition. Other individuals are more susceptible than others. These individuals are those that have underlying conditions. Some common conditions that contribute to HF include the following:
Coronary artery disease. This condition occurs when there is a build-up of fatty deposits in the walls of your arteries. As a result, less blood will reach the heart due to fatty substances blocking your blood supply. It can contribute to hypertension, which might result in HF over time.
Myocardial infarction. It may result in CHF because the damaged heart tissues after a heart attack are unable to contract well. It will impair your pumping organ. Sometimes, it can strike at any time following a myocardial infarction.
Hypertension (High blood pressure). Uncontrolled hypertension raises your risk of developing HF and sudden cardiac death. It pushes your heart to pump harder to keep blood flowing throughout your body. This stresses your pumping organ, causing it to grow larger and weaker over time.
Abnormal heart valves. This problem results from endocarditis or congenital abnormality. The valves do not open or close with each heartbeat like they used to be. As a result, cardiac muscles must pump more blood to keep circulation going. When the strain becomes severe, cardiac arrest can occur.
Other risk factors for HF include obesity and diabetes. Also, people with lung diseases are at risk because of the connection between the lungs and the heart. Sometimes, a sleeping disorder such as sleep apnea can also be fatal. This is because it may also result in complications such as CHF.
CHF is a long-term chronic condition that worsens over time. According to the American College of Cardiology and American Heart Association, the condition has four stages (A, B, C, and D). It ranges from an increased risk of acquiring the disease to advanced HF.
Moreover, there are treatments on each stage that prevent you from moving to the next stage. But, when your condition worsens, you will have to advance to the next stage. Once you’ve entered that stage, there is no more going back. As a result, you will have lower chances of surviving.
Stage A. It is a stage that refers to pre-cardiac failure. It suggests that you are more likely to develop the condition because it runs in your family. It could also be due to underlying diseases like hypertension, diabetes, coronary artery disease, and others. History of alcohol abuse, drug use may also be factors.
The treatment plans for this stage include having a healthy lifestyle and medications.
Stage B. It is a stage considered to be a silent cardiac failure because it is asymptomatic. You have a systolic left ventricular dysfunction but without any symptoms of HF. In an echocardiogram, your ejection fraction will show a reading of 40 percent or less. The treatments are the same as those in stage A, but with more drugs and possible surgery.
Stage C. In this stage, you will show signs and symptoms of HF. It includes difficulty breathing, fatigue, oedema, and others. You will also encounter problems with your pumping chambers. Treatments for this stage are those in stages A and B, but with more medications and therapies.
Stage D. This is the final stage of cardiac failure. In this stage, you will show severe symptoms even at minimal exertion or at rest. You will have to undergo advanced specialized treatments. It will include mechanical circulatory support, cardiac transplant, and others.
The New York Heart Association (NYHA) developed another type of class for CHF. It has four stages (Class I, II, III, and IV) depending on your pumping organ’s functional capabilities.
Class I. You won’t have any adverse symptoms (asymptomatic). You are still able to do physical activities without experiencing fatigue and dyspnea.
Class II. Slight limitation of physical activities because of experiencing fatigue, palpitation and dyspnea
(mild). But you are comfortable when resting.
Class III. Marked limitation of physical activities. Minimal activities will result in weakness, increased pulse rate, dyspnea, and others (moderate). But, when you’re resting, you’re comfortable and experiencing no problems.
Class IV. You aren’t able to join in physical activities without experiencing discomfort (severe). HF symptoms are evident at all times, even when you are at rest.
A person’s CHF life expectancy varies from a person and will depend on various factors. It depends on what stage you are in, how severe it is, and whether you have any other underlying conditions.
According to statistics, about half of those diagnosed with CHF can live for five years. Yet, only around thirty percent will live for ten years. Moreover, around 21 percent of individuals who had cardiac transplants are still alive after 20 years.
You may have a higher chance of living a longer life if the condition gets discovered and managed early. If the illness is severe, it is most likely difficult to expect a longer life expectancy.
Younger people diagnosed with CHF have a longer life expectancy than older individuals. This could also be because invasive procedures for severe stages are no longer effective at a certain age. In most situations, survival beyond one year after diagnosis is uncommon.
CHF has no cure as of the moment. Although, there are many treatments available to slow further damage. Treatments are also useful in preventing the condition from worsening. The sort of treatment used depends on the severity of the individual’s disease. Among the features of a treatment plan include the following:
Medications. Patients will need a variety of drugs, each of which will address a particular symptom of the illness. To get the benefits of your medications, you must take them exactly as prescribed by your physician. Some medications usually prescribed to treat the condition includes:
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin II receptor blockers
- Angiotensin-receptor neprilysin inhibitors (ARNIs)
- Aldosterone antagonists
Surgical Procedures. Surgery is not recommended for the treatment of HF. But, doctors will recommend it once they detect a correctable cause of the condition. The common reason for a surgery is due to heart valve malfunction or a blocked coronary artery. Some possible surgical procedures and implantable diseases may include:
- Biventricular pacing therapy
- Implantable cardioverter defibrillator (ICD)
- Ventricular assist devices (VAD therapy)
- Cardiac resynchronization therapy (CRT)
- Left ventricular assist device (LVAD)
- Cardiac transplantation
- Percutaneous coronary intervention
Lifestyle modifications. A healthy lifestyle can enhance the quality of life for patients with CHF. It may serve to lessen HF symptoms and slow the progression of your illness. Several of the healthy lifestyle choices you must make include the following:
- Quit smoking
- Engage in moderate exercise
- Eat healthy foods
- Limit fluid intake
- Lose weight
- Restrict salt intake
- Manage stress
- Avoid alcohol and caffeine drinks.
It was once believed that your pumping organ was incapable of regeneration following a heart attack, let alone a cardiac failure. After depletion of oxygen, the cardiac muscle dies and does not generate new muscle cells. The heart then replaces the dead tissues with ﬁbroblasts scar tissues. The problem is that fibroblasts lack the ability to pump, which weakens the cardiac organ.
Yet, new studies discovered that the heart is able to renew the cardiac muscle cells as well as scarring. It is also capable of self-repair, but the rate of regeneration is very slow. It shows that the damaged organ had recovered to the level of a healthy heart’s pumping ability. Further research is being conducted at the moment.
Fluid accumulation is a common clinical symptom of CHF. To help your overworked organ with pumping blood, your kidneys produce more renin. This results in more aldosterone production, followed by sodium and water retention.
Excessive fluid build-up can be fatal. This could be a signal that your condition is worsening. Thus, it is critical to maintaining a healthy fluid balance. A well-known method of reducing excess fluid is by taking Diuretics. It is a non-prescription medication referred to as “water pills.”
It aids in removing salt and water from your body and avoids fluid build-up by making you urinate more often. It reduces the amount of fluid moving through your blood vessels. Diuretics have three classifications: thiazide, loop, and potassium-sparing diuretics. It is critical that you must consult your physician to determine what matches you.
Another way would be the fluid removal therapy that uses ultrafiltration. It is capable of removing up to four liters of excess fluid in eight hours. Right after the procedure, you will experience instant relief from the symptom. Thus it helps in improving one’s quality of life.
Ali, Y. (2020, August 3) Heart Failure: Simple Ways to Manage Fluid Buildup. HealthCentral.
American Heart Association (2017, May 31) Causes of Heart Failure. Heart Organization. https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure/causes-of- heart-failure
Blumental, R. & Jones, S. (n.d.) Congestive Heart Failure: Prevention, Treatment and Research. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/congestive- heart-failure-prevention-treatment-and-research
Conha, J. (2020, October 5) How Long Can You Live with Congestive Heart Failure? emedicinehealth.
Kohli, P. (2021, May 28) Congestive heart failure: Life expectancy and stages. Medical News Today.
Levin, H. (2003) New Developments in Congestive Heart Failure: The Use of Ultrafiltration. Cath LabDigest. https://www.hmpgloballearningnetwork.com/site/cathlab/articles/New-Developments- Congestive-Heart-Failure-The-Use-Ultrafiltration
Mayo Clinic. (2021, July 21) Heart Failure. Mayo Clinic. https://www.mayoclinic.org/diseases- conditions/heart-failure/symptoms-causes/syc-20373142
Paddock, C. (2017, October 5) Severe heart failure may be reversible. Medical News Today.
Tang, K. (2020, February 12) Understanding the four stages of heart failure. Top Doctors.
Young, B. (2021, May 11) What’s the Outlook for Congestive Heart Failure? Healthline.