Congestive Heart Failure (CHF)

Congestive heart failure (CHF) occurs when the heart muscle doesn’t pump blood as well as it should. You have four heart chambers. The upper half of your heart is made up of two atria, and the lower half of your heart is made up of two ventricles.

The ventricles pump blood to your body’s organs and tissues, and the atria receive blood back as it circulates back from the rest of your body. CHF develops when your ventricles can’t pump enough blood volume to the body. Eventually, blood and other fluids can back up inside your:

• Lungs
• Abdomen
• Liver
• Lower body

Symptoms

Heart failure can be ongoing (chronic), or it may start suddenly (acute). Heart failure signs and symptoms may include:

• Shortness of breath with activity or when lying down
• Excess fluid in body tissues like the ankles, feet, legs, or abdomen
• Coughing or wheezing
• Weight gain that can’t be attributed to anything else
• Fatigue and weakness
• Increased heart rate
• Feeling confused or disoriented
• Rapid or irregular heartbeat
• Nausea and lack of appetite
• Difficulty concentrating or decreased alertness
• Chest pain if heart failure is caused by a heart attack

When to see a doctor

See your doctor if you think you might be experiencing signs or symptoms of heart failure. Call 911 or emergency medical help if you have any of the following:

• Chest pain
• Fainting or severe weakness
• Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting
• Sudden, severe shortness of breath and coughing up white or pink, foamy phlegm

Causes/Risk Factors

There are several CHF causes and risk factors, which can include:

• Coronary artery disease: Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.
• Heart attack: A heart attack is a form of coronary artery disease that occurs suddenly. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
• Heart valve disease: – this is when the valves in your heart that control which way the blood is flowing through the chambers of the heart stop functioning properly and become too leaky or too narrow.
• High blood pressure: Your heart works harder than it has to if your blood pressure is high.
• Irregular heartbeats: These abnormal rhythms, especially if they are very frequent and fast, can weaken the heart muscle and cause heart failure.
• Congenital heart disease: Some people who develop heart failure were born with problems that affect the structure or function of their heart.
• Diabetes
• Certain medications
• Certain foods, particularly frequent consumption of food high in salt
• Excessive drinking. Too much alcohol can weaken the heart muscle and lead to heart failure.
• Sleep apnea
• Smoking or using tobacco
• Obesity
• Viruses: Certain viral infections can cause damage to the heart muscle.

Treatments

Treatment options depend upon your overall health and how far your condition has progressed. Treatments include:

Various medications

• Common heart failure medications that can improve your well being and extend your life include:
• ACE inhibitors like ramipril or perindopril
• ARBs like losartan, candesartan, irbesartan or telmisartán
• ARNI like Entresto
• Beta Blockers like metoprolol, bisoprolol, or carvedilol
• MRAs like spironolactone and eplerenone
• Water pills like furosemide
• Such newer medications like ivabradine, empagliflozin, dapagliflozin, and vericiguat
• Surgeries and procedures such as angioplasty (a procedure to open up blocked arteries) or heart valve surgery.
• Device therapy such as pacemakers and defibrillators

Most common types of CHF

Left-sided CHF is the most common type of CHF. It occurs when your left ventricle – the main pumping chamber of the heart - doesn’t properly pump blood out to your body. As the condition progresses, fluid can build up in your lungs, which makes breathing difficult.

There are two kinds of left-sided heart failure:

• Systolic heart failure: occurs when the left ventricle fails to contract normally. This reduces the level of force available to push blood into circulation. Without this force, the heart can’t pump properly, you may feel tired or dizzy, your blood pressure may be low.
• Diastolic failure: or diastolic dysfunction, happens when the muscle in the left ventricle becomes stiff. Because it can no longer relax, the heart can’t quite fill with blood between beats.
• Right-sided CHF: occurs when the right ventricle has difficulty pumping blood to your lungs. Blood backs up in your blood vessels, which causes fluid retention in your lower extremities, abdomen, and other vital organs. A common sign of this is swelling of ankles.
• It’s possible to have left-sided, right-sided and diastolic CHF at the same time. Usually, the disease starts in the left side and then travels to the right as it progresses.

How is CHF diagnosed?

There are a variety of tests used to diagnose CHF. Your doctor may order one or more the following:

• Blood tests to check your levels of BNP, kidney function and electrolytes in your blood
• Chest X-ray
• Electrocardiogram (ECG)
• Echocardiogram
• Stress test
• Cardiac catheterization
• MRI

Prevention

Some factors are based on genetics, but lifestyle can play a role as well. You can control or eliminate many of the risk factors for heart disease by making healthy lifestyle changes and/or by taking medications. Lifestyle changes you can make to help prevent CHF, or at lease delay onset include:

• Not smoking
• Maintaining a heart healthy well-balanced diet
• Reducing sodium (salt) in your diet
• Exercising regularly
• Maintaining a healthy weight
• Drinking alcohol in moderation
• Reducing and managing stress