Congestive Heart Failure

Cardiovascular

Congestive heart failure (CHF) occurs when the heart loses the ability to pump blood effectively. A healthy heart will nourish the cells of the body due to its’ ability to supply the body with oxygen and essential nutrients with timely and efficient pumping. Your heart beats approximately 100,000 times per day and pushes around 2,000 gallons of blood through your vessels. With CHF, your body loses the ability to perform this function effectively. As a result, the heart will try to compensate by increasing in size and pumping strength, causing the heart muscle to weaken. This occurs because the heart is not pumping as well as it should, causing blood to accumulate and stretch. During the initial phase of stretching the heart will pump with more force and when the heart muscle is stretched beyond a certain point, weakening occurs. Lastly, the heart beats faster – because your heart cannot pump effectively with each beat, it tries to beat more to do the job. This results in an increased heart rate. The heart eventually cannot keep up with the workload and compensation fails, at which point symptoms begin to set in. Blood can back up and accumulate in one or more parts of the circulatory system, and health complications develop.

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Symptoms

The symptoms of congestive heart failure include:

  • Shortness of breath (with exertion or when sleeping)
  • Moist cough
  • Feeling dizzy
  • Appetite loss
  • Swelling in the lower extremities
  • Weight gain
  • Swelling in the abdomen
  • Fast pulse rate
  • Getting up to urinate during the night

Types

There are a few different types of congestive heart failure:

Left-sided heart failure. This leads to increased fluid in the lungs.

Right-sided heart failure. This leads to increased fluid in the veins.

Systolic heart failure. The left ventricle loses the ability to pump properly.

Diastolic heart failure. The left ventricle loses the ability to completely fill with blood.

Risk Factors

The most common risk factors for congestive heart failure include:

Age. As you get older, you are at increased risk for CHF. It tends to occur more often in people over 65.

Gender. CHF tends to be more common in men. Women are at higher risk for diastolic heart failure.

Smoking. Cigarette smoking is rarely studied to be connected with CHF. However, an older study revealed that men with a history of smoking had a markedly increased risk for hypertension and congestive heart failure.

Ethnic group. Studies show that CHF is more common in the African-American population and often occurs before the age of 50 years. They are more likely to die from the condition than Caucasians which can be related to social disparities in health care.

Genetics. If you have a history of congestive heart failure in the family, you are at increased risk. The genetic component is still being researched in an effort to identify which genes cause the disease.

Lifestyle. If you smoke, don’t exercise, drink alcohol, or use street drugs, the risk of CHF is considerably higher.

Overweight. Being overweight puts excess strain on the heart and is a risk factor for CHF. Also, people who are overweight are at higher risk for hypertension and diabetes, two conditions that increase the risk of congestive heart failure.

Diabetes. Diabetics are at increased risk for CHF because of the damage high blood sugar causes to the circulatory system. Certain diabetic medications can also damage heart function.

Medications. Certain medications that are taken on a long-term basis can raise the risk of CHF. These include steroids, anti-fungal medications, and certain drugs used for the treatment of cancer.

Diagnosis

The following tests can help with diagnosis:

Blood tests. The doctor will check to see how well your kidneys, liver, and thyroid work. They will also run a test called a BNP (B-Natriuretic Peptide) that can indicate heart failure.

Electrocardiogram. An electrocardiogram can indicate any heart rhythm issues or a history of a heart attack.

Chest x-ray. Chest x-rays can show an enlarged heart or fluid in the lungs. This test can show the actual chambers of the heart filling and emptying blood. It can also diagnose any valve issues or other problems that may be causing your symptoms, especially congenital defects in the heart muscle.

Treadmill stress testing. The doctor may have you exercise to see how your heart functions when it is working harder. For people who cannot walk, there is an injectable drug that causes your heart to beat faster, mimicking the effect of exercise.

Cardiac CT scan or MRI. These are scans that can take accurate pictures of the heart tissue to help detect abnormalities. The doctor places a catheter into your groin or arm and injects dye. This travels into the arteries and veins. The doctor takes a special x-ray and can see any blockages in the circulatory system. During this test, the doctor can also perform an angioplasty which involves opening up any blocked vessels that may be seen.

If you are diagnosed with CHF, the doctor will classify the disease to come up with the best treatment plan. The classifications are:

Class I. During this stage, you may be able to do plenty of physical activity without feeling out of breath. With good lifestyle changes (quitting smoking, abstaining from alcohol, dietary changes), and treating high blood pressure the disease is very manageable.

Class II. At the stage II point, physical activity becomes limited. There are symptoms like fatigue and shortness of breath with exercise.

Class III. Physical activity becomes severely limited at this point and any activity may cause you to feel out of breath. You do feel better at rest.

Class IV. This is the most severe stage and you may feel tired and out of breath even at rest.

Treatments

Medications

ACE (angiotensin-converting enzymes) inhibitors. Ace inhibitors open up blood vessels to bring blood pressure down and help make blood flow easier through veins and arteries. This helps take some of the strain off the heart muscle.

Beta-blockers. Beta-blockers can help slow down your heart if it is beating too fast. They can also treat high blood pressure and help reduce damage to your heart.

Diuretic therapy. Diuretics help remove excess fluids out of body tissues. They do make you go to the bathroom more often. One benefit is they help remove the fluid from your lungs and reduce shortness of breath and coughing.

Digitalis. These medications increase the force of heart contractions. It also can slow down the rate at which your heart beats. People on these medications need to be monitored for toxicity.

Inotropes. If you are suffering from heart failure that is not responding to oral medications, you may need to be hospitalized. Inotropes are given intravenously to help the heart pump more effectively.

Medical Procedures

If you are unresponsive to medications or the cause of your heart failure can be corrected with a procedure or device, there are a few things your cardiologist can do:

Angioplasty. This procedure is very similar to an angiogram and can be done at the same time. A catheter is passed through the groin or arm and a balloon attached to the tip is inflated within the narrowed part of the artery. Often, a metallic mesh (stent) is inserted to help keep the newly widened vessel patent. This procedure is used when the cause of a failing heart is a blocked vessel.

Coronary bypass grafting (CABG). If several vessels in the heart become critically blocked, angioplasty may not be an option and surgery will be required. During a CABG, a cardiac surgeon may be able to replace the blocked arteries with blood vessels harvested from elsewhere in the body.

Valve repair or replacement. If you have a bad heart valve, the doctor can try to repair or replace it. Heart valve repair is known as “valvuloplasty” and helps the blood to flow out properly. If surgeons cannot repair the valve, they may replace it with a prosthetic valve.

Pacemakers. Surgeons can implant a pacemaker to help correct abnormal heart rhythms. These include implantable defibrillators (ICD) and cardiac resynchronization therapy (CRT). ICD’s can keep the heart at a more normal rhythm, while a CRT works directly on the ventricle to keep it pumping in sync with the heartbeat.

Ventricular assisted devices (VADs). VADs are implanted near the heart and help pump the blood.

Heart transplant. In severe heart failure, you may be eligible for a heart transplant. There is usually a waiting list for a new heart. Your doctor will try to keep you as healthy as possible with medications while you wait.

Alternative Treatments and Home Remedies

With your doctor’s approval, the following alternative medicine supplements may be helpful for congestive heart failure:

Omega-3 fatty acids. Fish oil supplements contain Omega-3 fatty acids that may improve cardiac health. However, they may not be safe for everyone so it’s important to discuss any new supplements you are taking with your doctor.

Co-Q10. There has been some small amount of research on this supplement and it is thought to be helpful with heart failure. It isn’t recommended that vitamin E be taken in combination with Coenzyme Q-10 because vitamin E may make heart failure worse.

Prevention

To help prevent CHF, any risk factors need to be treated and managed. These include:

  • Diabetic blood sugar control
  • Quitting smoking
  • Restricting alcohol use
  • Eating a healthy low-salt and low-fat diet
  • Keeping weight in a healthy range
  • Treating high blood pressure and heart disease

If you are diagnosed with CHF, the following lifestyle modifications can reduce heart damage and slow the progression of the disease:

Monitor any changes in your weight. Weigh yourself daily and report a weight gain of 2 to 3 pounds to your physician. This can mean you are retaining too much fluid.

Try to restrict sodium intake. Read your food labels and eat as low salt as possible.

Exercise if it is okay with your doctor. It is believed that exercise is good if you only have a mild case of CHF.

Rest when your body tells you to. If you start to feel out of breath or tired, rest with your head and chest elevated.

Reduce stress. Learn relaxation techniques and reduce anxiety. This can help reduce the strain on your heart.

References

American Heart Association. (2017, May 31). What is heart failure? Retrieved from heart.org: https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure

He, Jiang, et. al. (2001, April 9) Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Archives of Internal Medicine, 161. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/647874

Eriksson, H. et. al. (1989, July) Risk factors for heart failure in the general population: the study of men born in 1913. European Heart Journal, 10(7), 647-656. Retrieved from PubMed.gov:
https://pubmed.ncbi.nlm.nih.gov/2788575/

Mayo Clinic Staff. (2020, May 29). Heart failure. Retrieved from https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142

Tillman, F., Kim, J. Makhlouf, T., Osae, L. (2019, May 15). A comprehensive review of chronic heart failure pharmacotherapy treatment approaches in African Americans. Therapeutic Advances in Cardiovascular Disease, (13). Retrieved from PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535737/

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