The heart works continuously to deliver oxygen to every part of the body. When it can no longer pump or fill well enough to meet the body's needs, heart failure develops.
The term congestive heart failure (CHF) is commonly used for heart failure when reduced heart function leads to a buildup of fluid, particularly in the lungs, legs, feet or abdomen. Heart failure does not mean that the heart has stopped working. It means the heart is not functioning effectively enough to meet the body's demands.
Heart failure is a long-term condition, but it can often be managed with medicines, lifestyle changes, treatment of its underlying cause and, when necessary, medical devices or surgery. In this article, Begin Health Life explains the reasons of heart failure, it's symptoms and ways to prevent or treat the heart failure.
What Is Congestive Heart Failure?
Congestive heart failure occurs when the heart cannot pump enough blood or cannot fill properly between beats. When the heart's pumping ability is reduced, blood can begin to back up. This can increase pressure in the blood vessels and cause fluid to move into surrounding tissues.
If the left side of the heart is affected, fluid may accumulate in the lungs, making breathing difficult. If the right side is affected, fluid commonly collects in the legs, feet or abdomen. Heart failure can also involve both sides of the heart.
This is why the condition can cause two major problems at the same time: reduced blood flow and fluid buildup.
What Causes Heart Failure?
Heart failure usually develops because another condition has damaged, weakened or stiffened the heart over time.
Common causes and risk factors include:
- Coronary artery disease: Narrowed heart arteries can reduce blood flow to the
heart muscle.
- Heart attack:
Damage from a heart attack can leave part of the heart muscle weaker.
- High blood pressure:
The heart has to work harder against elevated pressure, which can
eventually make the heart muscle thick or stiff.
- Heart valve disease:
Damaged or abnormal valves can make the heart work harder.
- Abnormal heart rhythms: Some persistent or very rapid rhythms can weaken the
heart.
- Diabetes:
Diabetes increases the risk of several conditions that can contribute to
heart failure.
- Obesity:
Excess body weight is associated with increased heart-failure risk.
- Heart muscle diseases: Cardiomyopathy and some infections or inherited
conditions can affect the heart muscle.
- Myocarditis: Inflammation of heart muscles can weaken the heart's pumping ability leading to heart
failure.
- Congenital heart disease: Structural heart problems present from birth can
eventually contribute to heart failure.
Cardiovascular risk also changes during a woman's transition through menopause. This does not mean that menopause directly causes heart failure. Rather, the menopause transition can coincide with changes in several cardiovascular risk factors that deserve attention.
In reality, several heart conditions can exist together to lead to heart failure. For example, long-standing high blood pressure and coronary artery heart disease may both contribute to the development of heart failure.
Symptoms of Congestive Heart Failure
Heart failure symptoms can develop gradually, and some people initially notice them only during physical activity. As the condition progresses, symptoms may become more noticeable.
Common heart failure symptoms include:
- Shortness of breath during activity or while lying down
- Persistent tiredness or weakness
- Swelling of the ankles, legs or feet
- Reduced ability to exercise
- Rapid or irregular heartbeat
- Persistent cough or wheezing
- Abdominal swelling or a feeling of fullness
- Loss of appetite or nausea
- Difficulty concentrating
- Rapid weight gain caused by fluid retention
Breathlessness when lying down or waking during the night struggling to breathe can occur when fluid builds up in or around the lungs.
A sudden increase in body weight can also be important. In someone already diagnosed with heart failure, a rapid increase may indicate that the body is retaining more fluid rather than gaining body fat.
Types of Heart Failure
Heart failure can be described in several ways depending on which part of the heart is affected and how the heart functions.
Left-Sided Heart Failure
The left side pumps oxygen-rich blood to the body. When it cannot work effectively, pressure can build up toward the lungs, contributing to shortness of breath.
Right-Sided Heart Failure
The right side sends blood toward the lungs. Right-sided failure can contribute to fluid accumulation in the legs, feet and abdomen. It often develops as a consequence of left-sided heart failure, although other conditions can also affect the right side.
Heart Failure With Reduced Ejection Fraction
Normally 50% to 70% of the blood in left ventricles are pumped out. In heart failure with reduced ejection fraction (HFrEF), the main pumping chamber reduces below 40% and cannot squeeze strongly enough.
Heart Failure With Preserved Ejection Fraction
In heart failure with preserved ejection fraction (HFpEF), the heart may still eject a normal proportion of blood above 50%, but the heart muscle is too stiff to relax and blood cannot fill properly. Therefore, a normal blood ejection fraction does not automatically mean that a person cannot have heart failure. Ejection fraction is only one part of the overall assessment.
Heart Failure Stages
Healthcare professionals commonly describe heart failure using four stages, from people at risk to those with advanced disease.
- Stage A:
At risk for heart failure but without structural heart disease or
symptoms.
- Stage B:
Evidence of structural or functional heart problems or other signs of
pre-heart failure, but no current or previous symptoms.
- Stage C:
Current or previous symptoms of heart failure.
- Stage D:
Advanced heart failure in which symptoms significantly interfere with
everyday life or lead to repeated hospitalizations.
These stages help healthcare professionals identify risk and guide treatment. They are different from the NYHA functional classes, which describe how much heart-failure symptoms limit physical activity. It classifies the pre-existing heart failure based on measures of symptoms and heart's functional capacity to Class I to Class IV.
How Is Heart Failure Diagnosed?
There is no single test that diagnoses every case of heart failure. Doctors consider symptoms, medical history, physical examination and test results together.
Common tests may include:
- Echocardiogram:
Uses sound waves to examine the heart's structure, pumping function and
filling.
- Electrocardiogram (ECG/EKG): Checks the heart's electrical activity and rhythm.
- Blood tests:
Can identify substances associated with heart strain and evaluate other
conditions that may affect the heart.
- Chest X-ray:
Can help identify an enlarged heart or fluid buildup in the lungs.
- Cardiac MRI: Provides detailed images of the heart when additional information is needed.
How Is Congestive Heart Failure Treated?
Treatment depends on the type and cause of heart failure, symptoms, ejection fraction and other health conditions.
Modern heart-failure treatment may include several medicines working in different ways. For people with heart failure with reduced ejection fraction, major guideline-supported medication groups include medicines that affect the renin-angiotensin system (RAS), beta blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors.
Diuretics, sometimes called water pills, may also be used when fluid buildup causes swelling or breathing problems.
Treatment may additionally involve:
- Managing high blood pressure and diabetes
- Treating coronary artery disease or valve disease
- Regular physical activity appropriate for the person's condition
- Cardiac rehabilitation
- Dietary changes recommended by the healthcare team
- Implantable heart devices in selected patients
- Surgery or other procedures when appropriate
The goal is not simply to reduce symptoms. Treatment can also help prevent worsening disease, reduce hospitalizations and improve quality of life.
Can Heart Failure Be Prevented?
Not every case of heart failure can be prevented, particularly when inherited heart conditions or unavoidable heart damage are involved. However, controlling major cardiovascular health risk factors can reduce risk.
Important steps include:
- Keep blood pressure under control.
- Avoid smoking.
- Maintain a healthy weight.
- Be physically active.
- Manage diabetes and cholesterol.
- Follow treatment for coronary artery disease.
- Eat a heart-healthy diet.
- Take prescribed medicines as directed.
Preventing or treating conditions that damage the heart is an important part of reducing the risk of heart failure. Managing blood pressure, cholesterol, diabetes, weight and smoking can help lower cardiovascular risk and may also reduce the risk of other cardiovascular conditions like heart attack and stroke.
When Should You Seek Medical Help?
Breathing difficulty, unexplained swelling, persistent fatigue or a sudden change in exercise ability should not simply be assumed to be normal aging.
Seek urgent medical care for severe or sudden shortness of breath, chest pain, fainting, severe weakness, or a rapid or irregular heartbeat accompanied by breathing difficulty or chest pain. Sudden severe breathlessness with coughing up white or pink foamy mucus is also an emergency warning sign.
If someone already has heart failure, a sudden worsening of symptoms or rapid weight gain from fluid retention should also be reported to their healthcare professional.
Final Takeaways
Congestive heart failure is a serious but treatable condition. Shortness of breath, swelling, persistent fatigue, reduced exercise ability and unexplained rapid weight gain can be important warning signs indicating the heart failure.
Heart failure can result from many heart conditions like coronary artery disease, high blood pressure, heart attack, valve disease and several others. Early diagnosis matters because treatment can address the underlying cause, control symptoms and help slow disease progression. Begin Health Life clarifies that the heart failure does not mean the heart stopping or pause, and many people can manage the condition for years with appropriate medical care and lifestyle changes.