Congestive Heart Failure

Overview

Congestive heart failure also known as chronic heart failure (CHF) or simply heart failure is a condition where the heart fails to pump blood as properly as it should. It can take place when the heart muscle is too weak, or when another defect prevents it from circulating blood efficiently.

Some health conditions such as high blood pressure or coronary artery disease gradually leave the heart too stiff or weak to fill and pump blood properly.

Not all illnesses that lead to congestive heart failure can be reversed, but treatments can improve the symptoms and signs of heart failure and enable you to live longer. Lifestyle changes such as reducing sodium in your diet, exercising, managing stress, and losing weight can enhance the quality of your life.

Congestive heart failure is a serious health condition that can be fatal. In 2015, it affected approximately 40 million individuals in the world. At least 2% of adults worldwide have heart failure and for those over 65 years, the average increases to 6 to 10%.

Stages

Heart failure can be divided into four different stages namely stages A, B, C, and D. progression from one stage to another is associated with a reduction in 5-year survival rates.

  • Stage A: This is where a person has high risk of developing heart failure because of having other health conditions associated with development of HF. Some of them include diabetes, hypertension, and coronary artery disease. People in this stage do not have any structural problems with their heart and may not display any symptoms of HF.
  • Stage B: Individuals at this stage have already developed structural heart disease that is strongly connected to the development of heart failure. The person may have episodes of heart attack or enlarged left ventricle. However, they rarely show any signs or symptoms of heart failure.
  • Stage C: Individuals at this stage show or will have shown signs of HF associated with an underlying structural heart disease. The most common symptom is difficulty breathing. Those who no longer display symptoms but are currently under treatment for previous signs of HF are also in this category.
  • Stage D: Here, individuals have advanced structural heart disease and show significant signs of HF even when at rest. It is a very serious stage that requires specialist treatment such as continuous inotropic infusion, mechanical circulatory support, and cardiac transplant or hospital care.

Symptoms

The signs and symptoms of heart failure include:

  • Fatigue and weakness
  • Shortness of breath (dyspnea) when exerting yourself or lying down
  • Irregular or rapid heartbeat
  • Reduced ability to exercise
  • Swelling in the legs, feet, and ankles
  • Persistent wheezing or cough with white or pink blood-tinged phlegm
  • Lack of appetite and nausea
  • Increased need to urinate at night
  • Rapid weight gain from fluid retention
  • Swelling of the abdomen (ascites)
  • Difficulty concentrating or reduced alert levels
  • Chest pain in the heart failure is caused by a heart attack
  • Sudden, extreme shortness of breath and coughing up foamy, pink mucus

Causes

Congestive heart failure is caused by any condition that causes damage to the heart muscle. These include:

  • Heart attack: A sudden block of the coronary arteries that causes scars in the tissues of the heart and minimizes how effectively it can pump.
  • Coronary artery disease: These arteries are responsible for supplying the heart muscle with blood and when blocked or the flow is interfered with, the heart fails to receive sufficient supply of blood and becomes weak.
  • Cardiomyopathy: Damage caused to the heart muscle other than blood flow problems or artery damage. It may be damaged caused by infections or side effects of drugs
  • Conditions that overwork the heart: They include valve disease, diabetes, hypertension, heart defects that occur at birth, or kidney disease.

Risk Factors

You are at high risk of developing heart failure if you have:

  • Obesity: Obese people are at increased risk of heart failure due to inefficiency of blood circulation in the body.
  • Diabetes especially type 2
  • Smoking
  • Anemia – deficiency of red blood cells
  • Hyperthyroidism: overactive thyroid gland
  • Hypothyroidism: Underactive thyroid gland
  • Heart arrhythmias
  • Myocarditis
  • Atrial fibrillation
  • Lupus
  • Emphysema
  • Hemochromatosis
  • Amyloidosis  

Diagnosis

The doctor will take a cautious medical history, evaluate your symptoms, and undertake a physical examination. He or she will also check for hypertension, diabetes, or coronary artery diseases.

The doctor may use a stethoscope to listen to your lungs for signs of congestion. It also detects heart murmurs that may suggest presence of heart disease. The doctor may also order certain tests that include:

  • Blood tests: Checks for signs of diseases that can affect the heart.
  • Chest X-ray: Detects the condition of your lungs and heart and helps the doctor to detect abnormalities, if any exist.
  • Eletrocardiogram (ECG): Records electrical activity of the heart through electrodes attached to the skin.
  • Echocardiogram: It uses sound waves to generate a video image of the heart to help the doctor see clearly the heart’s structure and detect any abnormalities.
  • Stress test: It measures the health of the heart and how it responds to exertion

Other tests include cardiac computerized tomography (CT) scan, MRI, coronary angiogram, and myocardial biopsy.

Treatment

Treatment of heart failure can be medication alone or coupled with surgery. Medications often help improve signs and symptoms and make the heart become stronger. They also help repair part of the heart such as the heart valves to allow smooth flow of blood.

  • Medications Angiotensin-converting enzyme (ACE) inhibitors: They help widen blood vessels to lower blood pressure, decrease the workload of the heart, and improve blood flow. They include enalapril (Vasotec), captopril (Capoten), and lisinopril (Zestril).
  • Angiotensin II receptor blockers: They are often used as alternatives to individuals who cannot tolerate ACE inhibitors.
  • Beta blockers: It shows the heart rate and minimizes blood pressure as well as reverses certain damages of the heart.
  • Diuretics (Water pills): Makes you urinate more frequently to minimize the possibility of fluids accumulating in the body.
  • Aldosterone antagonists: They have supplementary properties that help individuals with severe systolic heart failure live longer. They include spironolactone and eplerenone.
  • Inotropes: They are intravenous medications that help individuals with severe heart failure under hospital care to improve heart pumping function and uphold blood pressure.

Surgery and Medical devices

In certain cases, doctors may recommend surgery to treat the fundamental problem that led to the heart failure.

The most common surgical treatments being studied and used today include coronary bypass surgery, heart valve replacement or repair surgery, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), ventricular assist devices (VADs), and heart transplant.

Heart transplant is the last option considered when medications and surgery fail. However, it is difficult and patients may be put under medications as they wait to get donors.

Sometimes patients are put under palliative care and end-of-life care. Palliative care is specialized medical care that focuses on easing the symptoms and improves quality of life.

It is normally undertaken in the hospital to persons with life-threatening illnesses such as severe heart failure. End-of-life care is the type of care given to patients who are waiting to die after all forms of treatments and interventions have failed.

Prevention

Prevention of heart failure is simply embracing lifestyle changes that promote heart-healthy living. Lifestyle factors include the following:

  • Maintain a healthy weight
  • Eat a heart-healthy diet
  • Stop or don’t smoke
  • Check your legs, ankles, and feet for swelling daily
  • Restrict sodium in your diet
  • Manage stress and control conditions that may trigger heart attack
  • Exercise regularly or be active
  • Consider getting vaccinations for influenza and pneumonia
  • Limit alcohol and fluids
  • Sleep easy

For more information on diagnosis and/or treatment, speak to a doctor, or get access to a hospital near you through the Uzima Health App.