Congestive heart failure (CHF) is when the heart muscle doesn’t pump blood as well as it should. In Hong Kong, people with high blood pressure and coronary artery diseases are far more likely to develop heart failure. Congestive heart failure can be fatal and requires timely medical attention. It is important to recognize and treat congestive heart failure as early as possible.
What is Congestive Heart Failure?
Congestive heart failure, sometimes simply called heart failure or CHF, is a condition in which the heart can't pump enough blood to meet the body's needs. It usually occurs because one or both sides of the heart become too weak or stiff. In most cases, such a defect occurs in the left part of the heart more often.
Congestive heart failure is a serious long-term condition that gradually worsens. Although congestive heart failure cannot usually be cured, patients are still able to live a full and enjoyable life when they manage the condition with heart failure medications and adopt a healthy lifestyle. Support from family and friends is helpful as well.
Causes of Congestive Heart Failure
Congestive heart failure is often the result of a number of problems affecting the heart at the same time, for example:
- Coronary heart disease (where the arteries that supply blood to the heart become clogged up with fatty plaques)
- High blood pressure (which put extra strain on the heart as it pumps blood against the pressure)
- Arrhythmias (irregular heart rhythm, may result in atrial fibrillation)
- Congenital heart disease (birth defects)
- Certain conditions affecting the cardiac muscle (cardiomyopathy)
If you are suffering from congestive heart failure, it means that your heart muscle is unable to pump enough blood to meet the body’s demand for blood and oxygen supply. The heart tries harder to make up for the insufficient pumping by developing more muscle fibres to pump stronger and faster. The body would also compensate by narrowing blood vessels to keep blood pressure up. As these changes mask and compensate heart failure problems temporarily, patients may not realize the condition initially. As heart muscles enlarge and demand more and more oxygen, the heart can’t keep up with the workload eventually. Causing the experiences of fatigue, breathing problems or other symptoms that prompt a trip to the doctor.
Stages of Congestive Heart Failure
Doctors usually classify congestive heart failure according to the New York Heart Association (NYHA) Functional Classification, with class 1 being the least severe and 4 being the most severe.
CLINICAL SIGNS & SYMPTOMS
|No limitation of physical activity. Ordinary physical activity does not cause undue breathlessness, fatigue or palpitation.|
|Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in undue breathlessness, fatigue or palpitation.|
|Marked limitation of physical activity. Comfortable at rest, but minor physical activity causes fatigue, palpitation, or dyspnea.|
|Unable to carry on any physical activity without discomfort, and may have symptoms of heart failure even during rest. If any physical activity is undertaken, discomfort increases.|
Risk Factors of Congestive Heart Failure
You may develop congestive heart failure more readily with these risk factors:
- Hypertension: High blood pressure is a leading cause of congestive heart failure.
- Previous heart attack(s): People who have had a heart attack are at risk of congestive heart failure.
- Coronary artery disease: Fatty buildup in the coronary artery may reduce blood flow to the heart, causing a heart attack.
- Diabetes: Diabetes markedly increases the risk of coronary artery disease and causes direct damage to the structure of the heart, which can lead to heart failure.
- Obesity: Being overweight is linked to many cardiovascular diseases and adversely affects the left ventricular structure of the heart.
- Family history: People with a family history of early heart disease are more likely to develop cardiovascular diseases and congestive heart failure.
- Sex: Men have a higher rate of congestive heart failure than women.
- Age: Heart failure can occur at any age, but it is most common in older adults.
Signs and Symptoms of Congestive Heart Failure
In the early stages of congestive heart failure, changes are usually unnoticeable. Signs and symptoms may develop quickly (acute heart failure) or gradually over weeks to months (chronic heart failure).
Typical signs and symptoms of heart failure are:
- Breathlessness after activity or at rest: It may be worse when you're lying down, and you may wake up at night needing to catch your breath.
- Fatigue: Feeling tired most of the time and finding exercise exhausting.
- Oedema: Swollen ankles and legs, and sudden weight gain.
- A persistent cough or wheezing, which may be worse at night.
- Loss of appetite
- Dizziness and fainting
- Arrhythmia and palpitation: Rapid heart rate and irregular heartbeat.
Congestive heart failure can result in HEART ATTACK with the below signs and symptoms:
- Angina: Severe chest pain, pressure or tightness
- Pain or discomfort radiating to the shoulders, neck or arms
- Unexplained sweating
If you experience the above signs and symptoms of HEART ATTACK, YOU MUST GET HELP IMMEDIATELY! Get help from people nearby, call 999 and seek emergency service right away!
Complications of Congestive Heart Failure
If not properly treated, congestive heart failure may result in the following complications:
- Angina and heart attack: When the heart doesn’t receive enough oxygen, it may cause angina and a sudden and fatal heart attack.
- Atrial fibrillation: Irregular heartbeats can result.
- Pulmonary hypertension: Left side heart failure commonly causes pulmonary hypertension, which may eventually lead to right side heart failure afterwards.
- Renal failure: As the heart pumps less blood into the kidney, kidney function is impaired and metabolic waste cannot be removed from the body.
- Anemia: Patients with congestive heart failure produce less oxygen-carrying haemoglobin in red blood cells.
- Severe weight loss (cardiac cachexia): Severe heart failure can affect muscle and fat metabolism, causing muscles and other tissues to waste away.
Diagnosis of Congestive Heart Failure
To diagnose heart failure, your doctor will look for the corresponding signs and symptoms. Your doctor will also perform physical examinations and heart tests. If congestive heart failure is suspected or confirmed, you may be referred to a cardiologist.
Doctors may suggest one or more of the below tests to make the diagnosis of congestive heart failure:
- Blood tests: Blood test results can show the presence of anemia and reflect kidney and thyroid health. Levels of B-type natriuretic peptide (BNP) can also indicate heart failure.
- Electrocardiogram (ECG or EKG). This simple and painless test records the electrical signals in your heart to check for heart rhythm and heart problems beat.
- Echocardiogram: It uses soundwaves to show images of your heart’s valves and chambers. Your doctor may combine an echocardiogram with tests called Doppler ultrasound to check the blood flow across your heart’s valves.
- Chest X-ray: It shows the size of your heart and whether there is fluid buildup around your heart and lungs.
- Breathing tests (spirometry or peak flow test): You may be asked to blow into a tube to check whether you have lung problems contributing to breathlessness.
Treatment of Heart Failure
A healthy lifestyle, which includes a well-balanced diet, exercising and not smoking, can help keep the signs and symptoms of congestive heart failure under control. These are the same healthy lifestyle changes recommended to prevent heart diseases.
Nevertheless, since heart failure can compromise the immune system and make a person more vulnerable to infections, all heart failure patients may be recommended to take the annual flu vaccine and the one-off pneumococcal vaccine.
In many cases, heart failure patients need to take more than 2 different medications for the rest of their lives. Some of the major medicines for congestive heart failure include:
- ACE inhibitors or Angiotensin-2 receptor blockers (ARB), such as ramipril, enalapril, losartan and valsartan. They work by primarily relaxing the narrowed blood vessels and reducing blood pressure, which makes it easier for the heart to pump blood around the body.
- Beta-blockers, usually bisoprolol, carvedilol or metoprolol. They lower blood pressure by reducing heart rate.
- Mineralocorticoid receptor antagonists (MRAs), mainly spironolactone or eplerenone. They help lower blood pressure and reduce fluid around the heart by increasing urination. Side effects of high blood potassium can result.
- Diuretics, in which furosemide or bumetanide are most widely used. They promote urination to eliminate water and sodium to reduce blood volume, thereby reducing blood pressure.
- Ivabradine, a drug to lower heart rate.
- Digoxin, a drug to lower heart rate.
- Hydralazine, a drug to relax blood vessels and lower blood pressure.
- Nitrates, commonly as isosorbide dinitrate or isosorbide mononitrate, are emergency medicines for angina and heart attack.
Some people with heart failure may require surgery to implant a cardiac resynchronization therapy pacemaker beneath the chest wall. A pacemaker is a small device that monitors heart rate continuously and sends electrical pulses to the heart to keep it beating regularly and at the right rhythm.
When most of the above treatments fail, a heart transplant may be the last treatment option. A heart transplant is a complex surgery with high risks, and patients often have to wait for a long period of time for a suitable and available donor.
Prevention of Heart Failure
A healthy lifestyle lowers your risk of developing heart diseases and may help prevent congestive heart failure from getting worse. Stay healthy by:
- Quit smoking and alcohol: Tobacco and alcohol are the major risk factors for many cardiovascular diseases. Read our advice about alcohol and smoking cessation.
- Eat a healthy diet: Avoid foods that are high in cholesterol, saturated fat, salt and sugar. A Mediterranean diet or veganism may help prevent cardiovascular disease.
- Exercise regularly: Aim to exercise for at least 150 minutes of moderate aerobic activity per week. You can also consider urban hiking. If you have been diagnosed with heart disease or ever had a heart attack, consult your doctor before starting a new exercise plan.
- Maintain a healthy weight: Work out your BMI and find your ideal weight.
- Stay positive and mentally healthy: Manage your stress through exercise and relaxation techniques like yoga or deep breathing. If you are stressed or depressed, don’t hesitate to seek help from family, friends or healthcare professionals.
LVEF is the percentage of blood that is pumped out of the left ventricle by each ventricle contraction. The left ventricle is one of the four chambers in your heart. It pumps blood out of your heart to the whole body. A normal LVEF should be 50% or greater, meaning that at least 50% of the total blood in the left ventricle is pumped out by each heartbeat.
This article was medically reviewed by Dr. Adrian Cheong 張仁宇醫生. Dr. Cheong is a cardiologist practicing at the Virtus Medical Group now. He graduated from the University of Oxford and spent years working in the UK, including at the Royal Brompton and Harefield Hospitals. Dr. Cheong is particularly interested in dealing with coronary artery disease, valve disease, heart failure, minimally invasive surgery on arteries, veins and valves.
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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.