Congestive Heart Failure

What is Congestive Heart Failure?

Congestive heart failure (CHF) is a serious condition affecting more than 6 million American adults. The hearts of people with CHF cannot pump enough blood to supply the body’s needs. This causes blood and fluid to accumulate in the lungs and limbs, making breathing and physical activity more difficult. Chronic CHF is a progressive condition that typically worsens over time. According to the Centers for Disease Control and Prevention, there were 1 million hospitalizations for CHF in 2010, most of them involving people aged 65 and over. 

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A Deep Dive into Congestive Heart Failure

Learn About Congestive Heart Failure

What are the Types?

CHF can affect the pumping chambers (ventricles) on the left, right or both sides of the heart.

  • Left-sided CHF is divided into two main subtypes. 
    • Diastolic CHF occurs when the left ventricle muscle thickens and becomes stiff, so it does not relax and fill with blood normally.
    • Systolic CHF occurs when the left ventricle muscle becomes thin and stretched, so it does not contract and pump out blood with normal force.
  • Right-sided CHF occurs when the right ventricle does not pump enough blood to the lungs. 
  • Biventricular CHF involves problems with both the left and right ventricles.
 
What are the Causes?

Most often, CHF is caused by health conditions that place excess stress on the heart, such as:

  • arrhythmia (abnormal heartbeat)
  • coronary artery disease
  • diabetes
  • heart valve disease
  • high blood pressure
  • kidney disease
  • thyroid disorders
 
What are the Stages?

CHF can progress through the following four stages:

  • Stage A: high risk of CHF but no structural heart disease or symptoms 
  • Stage B: structural heart disease but no symptoms
  • Stage C: structural heart disease and symptoms of CHF
  • Stage D: refractory (treatment resistant) CHF that requires specialized treatment

CHF is further categorized by measures of heart function. The first measurement is primarily ejection fraction, or how much blood is pumped out with each heartbeat. The second measurement is the severity of symptoms in relation to physical activity. 

 

Signs & Symptoms 

CHF does not always cause symptoms in the early stages. When symptoms do occur, they may include:

  • dry cough
  • dyspnea, or shortness of breath
  • fatigue
  • fluid retention, or edema, in the limbs, lungs and other organs
  • rapid or irregular heartbeat
  • reduced capacity for physical activity

How is congestive heart failure diagnosed?

To diagnose the type and stage of congestive heart failure, a cardiologist will conduct tests of heart structure and function, such as:

 

Echocardiograms

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Echocardiograms

Echocardiograms use sound waves to capture images of the heart in action and measure ejection fraction.

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Electrocardiograms

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Electrocardiograms

Electrocardiograms (which can be abbreviated as EKG or ECG) assess heart rate and rhythm.

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Electrophysiology

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Electrophysiology

Electrophysiology (EP) studies to check electrical signals inside the heart.

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Imaging Studies

Imaging Studies

Imaging Studies

Imaging studies such as computed tomography (CT) scans, magnetic resonance imaging (MRI) or positron emission tomography (PET) scans.

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Personalized Treatments for Congestive Heart Failure

Various Treatment Options

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Currently, there is no cure for CHF. The most appropriate treatment plan depends on the type and severity, with the goal of improving symptoms and delaying progression to the next stage. 

Lifestyle changes may be recommended, such as limiting salt and fluid intake, regular physical activity, weight management and blood pressure controlCertain medications can support the cardiovascular system in the following ways:

  • improving heartbeat strength
  • relaxing blood vessels
  • removing sodium and fluid from the body
  • slowing the heart rate

Devices to assist heart function could be involved, such as

  • biventricular pacemakers
  • implantable cardioverter defibrillators (ICDs)
  • mechanical heart pumps (ventricular assist devices or total artificial heart)In addition, surgery may be needed to repair heart defects or damage.

In some severe CHF cases, heart transplant surgery may be considered.