According to the Centers for Disease Control and Prevention, approximately 6.4 million American adults suffer from heart failure, which contributed to 1 in 8 deaths in 2017.
Heart failure does not mean that your heart has stopped, it just means that it is not pumping enough blood. This weakened ability to pump blood causes fluid and blood to rise in the lungs, making breathing difficult and causing swelling in the ankles, feet and legs.
People 65 years of age or older, overweight people, people who have had a heart attack, and African Americans are most at risk for CHF. It also affects more men than women.
Heart failure can affect the left side of the heart, the right side, or both. Each type has slightly different symptoms. The type of CHF also affects the type of treatment.
Left heart failure
Left heart failure occurs when the left ventricle of the heart no longer pumps enough blood. This is the most common type of failure. For this reason, the veins that carry blood from the lungs – the pulmonary veins – accumulate with the blood. When this happens, people may experience shortness of breath, difficulty breathing, or coughing. It gets worse during physical activity.
There are two types of failure on the left side.
Systolic or heart failure with reduced ejection fraction (HFrEF)
The left ventricle can no longer contract normally and the heart is too weak to push enough blood into the body.
Diastolic or heart failure with preserved ejection fraction (HFpEF)
The left ventricle becomes rigid and loses its ability to relax, and the heart does not fill properly with blood between beats.
Right heart failure
Right heart failure occurs when the right ventricle cannot pump enough blood to the lungs, causing a build-up of blood in the veins that bring blood to the lungs. This causes fluid from the veins to leak into surrounding tissue. Fluid usually collects in the legs, but sometimes it can also accumulate in the belly or genitals.
Biventricular heart failure
Heart failure on both sides of the heart is called biventricular heart failure. This type combines the symptoms of left and right heart failure.
Four CHF steps
Congestive heart failure has four stages. It starts with stage I – sometimes called class I or heart failure. It then progresses over time to stage IV, sometimes called class IV or advanced heart failure.
Treatment recommendations and symptoms are different depending on the stage.
|Step||Symptoms||Treatment and care|
|I||Often there are no symptoms and daily life is not affected. But sometimes people start to have trouble breathing when they go to bed because of fluid buildup.||At this point, CHF can be managed with lifestyle changes and certain medications.|
|II||Shortness of breath, palpitations and tiredness during activity and routine tasks.||Management is similar to phase I but with more monitoring.|
|III||Physical activity leads to more severe stage II symptoms. Simple tasks like walking to the mailbox cause extreme respiratory distress.||People will need to work closely with their health care provider to manage symptoms and discuss treatment plans.|
|IV||Advanced heart failure. Physical activity is almost impossible and people can be confined to sitting on chairs and sleeping in straight beds.||Treatment at this point is aimed at increasing a person’s comfort.|
Symptoms of congestive heart failure
Signs of heart failure can appear in anyone at any age, even in young children who may be born with heart defects. But it usually affects older people with a heart weakened by other illnesses.
There may be no symptoms in the early stages, but people start to have symptoms in stage II and they get worse gradually, especially without treatment.
- Bluish skin and fast breathing
Respiratory spasms and wheezing similar to asthma
Disorientation, brain fog, more pronounced confusion in the elderly
Fainting, dizziness, weakness or fatigue
Get tired easily
Feelings of anxiety, suffocation and restlessness
Hacking, dry cough that occurs more often when lying down
Having to urinate more often at night
Pulmonary congestion and difficulty breathing blood back into the lungs
Nausea, abdominal swelling, tenderness, or pain (may result from fluid build up in the body and blood supply in the liver)
Swelling (edema) due to fluid buildup, especially in the feet, ankles, and legs
Weight gain due to fluid build-up or weight loss due to poor absorption of nutrients and decreased appetite
Causes and risks
Congestive heart failure is usually caused by another disease or health condition. This is especially true of conditions that cause heart damage or make it work harder than it should. The most common health conditions that can cause heart failure are high blood pressure, coronary artery disease, and previous heart attacks.
Health conditions that can cause CHF include:
Parasites of the heart muscle
Cardiac valve disorders
Kidney failure, which causes fluid to build up in the blood, making the heart more difficult to work
Narrowing or hardening of the arteries, coronary artery disease
Previous heart attack
Problems in the electrical conduction system of the heart
Pulmonary embolism or blood clot in the lungs
Certain types of lung problems
Thyroid problems that speed up or slow the pumping of the heart
Type 2 diabetes
Untreated high blood pressure
One in five Americans will develop heart failure, according to the American Heart Association. Some people are more at risk of developing the disease. Some of these risks, such as maintaining a healthy weight, can be changed. Other risks, such as genetics, are not.
Heart muscle weakens with age and people over 65 are most likely to suffer from heart failure. They may also have more health problems that make them susceptible to heart failure.
Of all races, African Americans have the highest rate of heart failure. They tend to have younger symptoms, to have more deaths from heart failure, and to have more hospital visits due to the illness.
Overweight or obese people have a higher risk of heart failure because being overweight puts pressure on the heart. Overweight people also have an increased risk of type 2 diabetes and heart disease – both can lead to heart failure.
Previous heart attack
People who have ever had a heart attack have weaker heart muscles. This can lead to heart failure.
Heart failure can run in families. Children born with heart defects are also at risk for heart failure.
Drugs that cause or worsen CHF
In addition to health problems, some medications can cause or worsen CHF. Be sure to tell the doctor about all the medications you are taking.
Medications related to CHF include:
- Analgesics (NSAIDs and COX-2 inhibitors)
Anesthesia medications (desflurane, enflurane, halothane and others)
Diabetes medications (metformin, Onglyza (saxagliptin), Januvia (sitagliptin), Actos (pioglitazone), Avandia (rosiglitazone))
Antifungal drugs (itraconozole)
Certain chemotherapy agents, including Taxotere (docetaxel)
Antidepressants such as Celexa (citalopram)
Bipolar drugs like lithium
A cardiologist is usually the specialist who can diagnose CHF. The doctor will ask the patient about any symptoms, such as swelling or shortness of breath. It is important to tell the doctor if you have other health problems such as heart disease, high cholesterol, high blood pressure, kidney disease and diabetes.
In addition to a physical exam, the doctor may request tests to check CHF.
These tests help the doctor determine the cause of heart failure. They can also rule out heart failure. Many of them aim to examine the functioning of the heart and its pumping force.
Doctors will request blood tests for anemia and kidney or thyroid problems. Symptoms of these conditions can mimic heart failure. The doctor will also check the cholesterol level.
Natriuretic peptide Type B NT-pro (BNP)
People with heart failure have high levels of BNP in the blood – a hormone released from the lower chambers of the heart (ventricles). Depending on the severity of the heart failure, the levels of NT-pro BNP levels change. Higher levels mean that the ventricles are more stressed. People with a level of more than 450 picograms / milliliter (pg / mL) – one trillionth of a gram per milliliter – for patients under 50 years of age or 900 pg / mL for patients 50 years and older may mean insufficient cardiac.
Measuring the levels of a hormone called natriuretic peptide type B (BNP) can help diagnose heart failure and its stage. Higher levels mean more damage to the heart.
Doctors insert a long, thin tube called a catheter into an artery in the leg or arm. Sometimes doctors also insert dye to record videos of heart valves, chambers, and blood vessels. This can show how much the heart is pumping.
An x-ray can show the buildup of fluid around the lungs and heart and the size of the heart muscle.
An echo is an ultrasound that can show how well the heart is pumping, the function of the valves, blood flow and the size of the heart. It can measure pressure in the heart and ejection fraction (EF) – a measure of the blood pumped out of the heart with each beat.
Ejection fraction (EF)
EF measures the amount of blood the heart pumps each time it beats. Doctors can test EF using several methods: echocardiogram (echo), magnetic resonance imaging (MRI), multigated acquisition (MUGA), during cardiac catheterization and during nuclear stress test. Normal EF is between 55% and 70%. This can change depending on how heart failure is managed and treated. It can also help diagnose the stage of heart failure and tell the doctor how well the treatment is working.
Electrocardiogram (ECG or ECG)
Doctors use this test to check the electrical activity of the heart. The electrodes are connected to wires connected to sticky patches placed on a person’s body. The electrode information creates a graph on a monitor. Abnormal heart rhythms can signal heart failure.
Multigated acquisition scan (MUGA scan)
In this test, a special camera called a gamma camera creates a video of the heart rate and operation of the ventricles after the health care provider injects a small amount of radioactive dye into a vein.
A stress test shows doctors how the heart reacts to activity and stress. Patients can ride a treadmill or bicycle while blood pressure, heart rate, and the electrocardiograph are being measured. People who cannot exercise can take a drug that mimics exercise.
Treatment plans for CHF focus on stopping or slowing the progression of the disease because there is no cure for CHF. Once a person takes the next step, it is impossible to reverse it. Cardiologists are specialists who develop treatment plans for people with CHF.
Medication is the main treatment for CHF, and people with the disease usually need to take medicine for the rest of their lives to stay healthy. Patients should speak to their health care provider immediately if they develop side effects.
If the drugs are not effective, patients may benefit from surgery to repair the heart valves or clean the blood vessels.
Angiotensin converting enzyme (ACE) inhibitors dilate blood vessels to lower blood pressure and reduce the workload of the heart. They also reduce the amount of hormones harmful to the heart.
Drugs in this class include Prinivil (Lisinopril) and Capoten (captopril). Common side effects include dizziness, increased potassium, drug cough, and changes in kidney function. Patients should have regular blood tests to check for kidney function.
Angiotensin II receptor blockers (or inhibitors)
These drugs work similarly to ACE inhibitors, but the side effects of dry cough are less severe.
Drugs in this class include Diovan (valsartan) and Cozaar (losartan). Like ACE inhibitors, these drugs can damage the kidneys, so testing kidney function is recommended. Common side effects include dizziness, changes in kidney function, and increased potassium levels.
These drugs make the heart beat more slowly and with less force. They also lower blood pressure.
Medicines in this class include Toprol (metoprolol) and Coreg (carvedilol). Common side effects are fatigue, dizziness, drowsiness, headache and upset stomach. Do not stop taking a beta blocker without talking to a healthcare professional.
People sometimes call diuretics “water pills” because they work by removing excess fluid from the body. Because diuretics cause the body to lose potassium, people may need to take potassium supplements.
Drugs in this class include Lasix (furosemide), Bumex (bumetanide) and Zaroxolyn (metolazone). Common side effects include dizziness, increased urination, skin rash, changes in kidney function, increased blood sugar, gout and dehydration.
These drugs work by preventing the body from producing too much aldosterone, a hormone that can damage the heart.
Drugs in this class include Inspra (eplerenone) and Aldactone (spironolactone). Common side effects include breast swelling or tenderness in men and women, increased potassium, and changes in kidney function. Patients should undergo routine kidney and potassium tests.
This medication slows the heart rate and may improve the pumping capacity of the heart. Blood tests are needed to find the right dose. Common side effects include digestive problems, lack of appetite and nausea.
Isosorbide dinitrate / hydralazine hydrochloride
This medication helps to relax the blood vessels and reduce the pressure on the heart. These drugs are primarily useful for treating heart failure in African Americans, and studies have shown that the drug can reduce the risk of death, according to the National Heart, Lung and Blood Institute.
Common side effects include dizziness, headache, and swelling of the extremities.
Prevent and live with CHF
Since heart failure is a serious and progressive disease, prevention is important. For people living with CHF, there are things they can do to stop or slow the progression of the disease and improve their quality of life.
“To avoid heart failure, other heart problems must be prevented.”
“To avoid heart failure, other heart problems must be prevented,” said cardiologist Johns Hopkins, Dr. Steven Jones.
Ways to prevent heart failure
- Exercise at least 5 days a week
Maintain a healthy body weight
Do not smoke
Eat more fruits and vegetables
Limit your alcohol consumption to 1 drink per day or avoid it
Do not drink more than 4 cups of coffee per day
Do not use illegal drugs
Talk to your doctor about medications that can increase the risk of CHF
Treat any existing conditions that may lead to CHF
Prognosis of congestive heart failure
The prognosis for CHF depends on the stage of the disease, the cause of the disease, and the effectiveness of the treatment.
In general, people with Class I or II CHF have the best prognosis. People with heart failure caused by coronary artery disease or primary cardiomyopathy had lower survival rates than people with other causes, according to researcher M. Matoba and colleagues from Kanazawa Medical University in Japan .
Average survival rates in CHF
- 1 year, 78.5 percent
3 years, 59.8 percent
5 years, 50.4%
10 years, 14.7%
Source: Japanese Circulation Journal
Improved quality of life
CHF currently has no remedy. People living with the disease need to adopt heart-healthy lifestyles and take medication regularly.
To stay healthy, here are some tips to follow.
Tips for living better with CHF
- Watch for symptoms and check for sudden weight gain and swelling in your legs and feet.
Monitor blood pressure and weight and do laboratory work regularly to keep track of your heart health and disease progression.
Stay positive and find ways to relieve stress, including finding relaxing hobbies, talking to a therapist, finding a support group, or talking to family and friends.
Ask questions about the stage of your illness and guidelines about your activity level. This includes work, sex and exercise. Depending on the stage of the disease, your doctor will make different recommendations for your level of activity, including work, sex and exercise.
Keep all appointments with your doctors.
Make any lifestyle changes recommended by your doctor. If you need help eating, ask to see a nutritionist or dietitian.