Congestive heart failure: What you need to know
We depend on the pumping action of the heart to deliver nutrient- and oxygen-rich blood to every cell in the body. When cells are not nourished adequately, it is not possible for the body to function properly.
If the heart is weakened and cannot supply the cells with sufficient blood, the patient becomes tired and breathless. Everyday activities that were once taken for granted become challenging.
Heart failure is a serious condition, and there is usually no cure. However, with the right treatment, the patient can still lead an enjoyable, meaningful, and productive life.
According to the National Heart, Lung and Blood Institute, approximately 5.7 million people in the United States have heart failure.
Heart failure, heart attack, and cardiac arrest
Heart failure comes in many forms and has many causes.
Here, we explain some important terms:
- Heart attack - this is death of heart muscle due to the blockage of a coronary artery. The heart muscle dies because it is starved of oxygen (because blood is not getting to it).
- Heart failure - this means the heart muscle cannot pump blood around the body properly. It is not a heart attack.
- Cardiac arrest - this means the heart stops, blood circulation stops, and there is no pulse.
Heart failure is caused by any conditions that damage the heart muscle. These include:
- Coronary artery disease - the coronary arteries supply the heart muscle with blood. If these are blocked or the flow is reduced, the heart does not receive the blood supply it needs.
- Heart attack - a sudden block of the coronary arteries; this causes scars in the heart's tissues and decreases how effectively it can pump.
- Cardiomyopathy - damage to the heart muscle other than by artery or blood flow problems; for instance caused by drug side effects or infections.
- Conditions that overwork the heart - for instance, valve disease, hypertension (high blood pressure), diabetes, kidney disease, or heart defects present from birth.
The following are risk factors for congestive heart failure; they may make it more likely:
- Diabetes - especially diabetes type 2.
- Obesity - people who are both obese and have diabetes type 2 have an increased risk.
- Smoking - people who smoke regularly run a significantly higher risk of developing heart failure.
- Anemia - a deficiency of red blood cells.
- Hyperthyroidism - overactive thyroid gland.
- Hypothyroidism - underactive thyroid gland.
- Myocarditis - inflammation of the heart muscle, usually caused by a virus, leading to left-sided heart failure.
- Heart arrhythmias - abnormal heart rhythms, they may cause the heart to beat too fast, creating more work for the heart. Eventually the heart may weaken, leading to heart failure. If heartbeat is too slow not enough blood may get out from the heart to the body, leading to heart failure.
- Atrial fibrillation - an irregular, often rapid heart beat; patients with atrial fibrillation have a higher risk of hospitalization due to heart failure, a study found.
- Emphysema - a chronic disease that makes it hard for the patient to breathe.
- Lupus - the patient's immune system attacks healthy cells and tissues.
- Hemochromatosis - a condition where iron accumulates in the tissues.
- Amyloidosis - one or more organ systems in the body accumulate deposits of abnormal proteins.
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Fatigue and dizziness are possible symptoms of heart failure.
The following are possible symptoms of heart failure:
Congested lungs - fluid builds up in the lungs and causes shortness of breath even when resting and particularly when lying down. It can also cause a hacking, dry cough.
Fluid retention - because less blood is being pumped to the kidneys, it can cause water retention. This can cause swollen ankles, legs, and abdomen. It can also cause weight gain and increased urination.
Fatigue and dizziness - because less blood is reaching the organs of the body, it can cause feelings of weakness. Because less blood is reaching the brain is can also cause dizziness and confusion.
Irregular and rapid heartbeats - to try and counteract the lack of blood being pumped with each contraction of the heart, the heart might pump more quickly.
Heart failure shares symptoms with other conditions, and if anyone has the symptoms, it does not mean they have heart failure.
However, anyone who experiences more than one of the symptoms should tell their doctor and ask for an evaluation of their heart.
People who have been diagnosed with heart failure should monitor their symptoms carefully and report any sudden changes to their doctor immediately.
There are many different types of heart failure:
Left-sided heart failure
Left-sided heart failure is the most common form of congestive heart failure. The left side of the heart is responsible for pumping blood to the rest of the body. Blood backs up into the lungs as it is not effectively pumped away from the heart. This can cause shortness of breath and fluid buildup.
Right-sided heart failure
The right side of the heart pumps blood to the lungs where it collects oxygen. Right-side failure is, most often, caused by fluid build-up in the lungs due to left-side failure. Sometimes it can occur due to other conditions, including lung disease.
Diastolic heart failure:
This occurs when the heart muscle is stiffer than normal. Because the heart is stiff, it does not fill up with blood properly; this is known as diastolic dysfunction.
Because the heart does not fill up with blood, it cannot pass as much blood around the body as is necessary. This can occur on either side of the heart.
Systolic heart failure:
Systolic dysfunction describes the heart's inability to pump efficiently after filling with blood. It often occurs if the heart is weak or enlarged. This can occur on either side of the heart.
Most people will initially see their doctor if they have symptoms. The doctor will discuss the symptoms with the patient. If the doctor suspects heart failure, he will recommend further tests, these may include:
- Blood and urine tests - these will check the patient's blood count and liver, thyroid, and kidney function. The doctor may also want to check the blood for specific chemical markers of heart failure.
- Chest X-ray - an X-ray will show whether the heart is enlarged. It will also show whether there is fluid in the lungs.
- An ECG (electrocardiogram) - this device records the electrical activity and rhythms of the patient's heart. The test may also reveal any damage to the heart from a heart attack. Heart attacks are often the underlying cause of heart failure.
- An echocardiogram - this is an ultrasound scan that checks the pumping action of the patient's heart. The doctor measures the percentage of blood pumped out of the patient's left ventricle (the main pumping chamber) with each heartbeat - this measurement is called the ejection fraction.
The doctor may also carry out the following additional tests:
- Stress test - the aim here is to stress the heart and study it. The patient may have to use a treadmill or exercise machine, or take a medication that stresses the heart.
- Cardiac MRI (magnetic resonance imaging) or CT (computed tomography) scan - they can measure ejection fraction as well as the heart arteries and valves. They can also determine whether the patient had a heart attack.
- B-type natriuretic peptide (BNP) blood test - BNP is released into the blood if the heart is overfilled and struggling to function properly.
- Angiogram (coronary catheterization) - a catheter (thin, flexible tube) is introduced into a blood vessel until it goes through the aorta into the patient's coronary arteries. The catheter usually enters the body at the groin or arm. A dye is injected through the catheter into the arteries. This dye stands out on an X-ray and helps doctors detect coronary artery disease (arteries to the heart that have narrowed) - another cause of heart failure.
Prevention and management
Giving up smoking is a way to reduce the likelihood of heart failure, or slow its progression.
There are many lifestyle changes that reduce the chances of developing heart failure, or at least slow down its progression. These include:
- Give up smoking.
- Eat sensibly, this includes plenty of fruit and vegetable, good quality fats, unrefined carbohydrates, whole grains, and the right amount of daily calories.
- Exercise regularly and stay physically active (check with your doctor).
- Keep blood pressure low.
- Maintain a healthy body weight.
- Quit alcohol, or at least consume alcohol within the national recommended limits.
- Get at least 7 hours good quality sleep each night.
- Mental stress may be bad for the heart over the long-term. Try to find ways of reducing exposure to mental stress.
- Individuals who already have heart failure should be up-to-date with their vaccinations, and have a yearly flu shot.
Damage to the heart's pumping action caused by heart failure cannot be repaired. Nevertheless, current treatments can significantly improve the quality of life of the patient by keeping the condition under control and helping relieve many of the symptoms.
Treatment also focuses on treating any conditions that may be causing the heart failure, which in turn lessens the burden on the heart. A doctor or cardiologist will discuss treatment options with the patient and suggest the best choices, depending on individual circumstances.
Some common treatments for heart failure include:
- ACE inhibitors (inhibitors of Angiotensin-Converting Enzyme) - these drugs help the arteries relax, lower blood pressure, making it easier for the heart to pump blood around the body - they lower the heart's workload. Ace inhibitors generally boost the performance of the heart and invariably improve the quality of life of the heart failure patient. These drugs are unsuitable for some patients, though. They can cause an irritating cough in some people.
- Diuretics - these help patients with swollen ankles. They also relieve breathlessness caused by heart failure. Diuretics remove water and salt from the kidneys in the urine. There are three main types of diuretics - loop diuretics, thiazide diuretics, and potassium-sparing diuretics.
- Anticoagulants - these drugs make it harder for the blood to clot; they help thin the blood and help prevent a stroke. The most commonly used anticoagulant is Warfarin. However, it has to be carefully monitored by the doctor to ensure the blood thinning effect is not excessive, and it will only be used if you have another reason to thin your blood. There have been a lot of studies on this discussion point. Most point toward no anticoagulation in patients without a diagnosis of afibrilation with or without another indication.
- Digoxin - a drug for patients with a fast irregular heart rhythm. Digoxin slows down the heartbeat.
- Beta-blockers - all heart failure patients benefit from beta-blockers.
- Antiplatelet medicine - these stop the blood platelets from forming clots in the blood. Aspirin is an antiplatelet drug that can be suitable for people with a very high risk of a heart attack or stroke and a low risk of bleeding. Current guidelines no longer recommend the widespread use of aspirin to prevent cardiovascular disease.
Not everybody with heart failure responds to drug treatment. There are some surgical options: Coronary artery bypass graft - this is the most common surgery for congestive heart failure that has been caused by coronary artery disease.
Heart valve surgery - to repair a defective valve that leads to increased heart work.
Implantable left ventricular assist device (LVAD) - for patients who have not responded to other treatments, and are hospitalized, this can help the heart pump blood. It is often used for individuals who are waiting for a transplant.
Heart transplant - if no other treatments or surgeries help, transplant is the final option. Transplants are only considered if the patient is healthy other than the problem with their heart.