Congestive Heart Failure

What is congestive heart failure?

Congestive heart failure (CHF) is when your heart muscle does not pump enough blood for your body to function normally. The heart might have become stiff and can’t relax enough to fill with blood, or it has been weakened and can’t pump enough blood out. Either way, breathing becomes very hard. CHF can also cause your kidneys to retain fluid instead of flushing it out. That fluid can build up in the legs, abdomen, or lungs.

CHF is a serious condition, and it can be fatal. But many people with CHF can lead active lives if they are getting medical treatment and following a heart-healthy lifestyle.

Most common symptoms

The most common symptoms of congestive heart failure are:

• Trouble breathing when you:
  • Exercise or move around
  • Lie down flat (orthopnea)
  • Bend over (bendopnea)
• Swelling in the ankles, feet, and/or legs
• Dry cough
• Extreme fatigue
• Abdominal bloating or swelling
• Feeling full after eating small amounts of food (early satiety)
• No appetite
• Nausea
• Poor concentration

Depending on the specific cause of CHF, additional symptoms may include:

• Chest discomfort when you move a lot, if CHF is due to coronary artery disease.
• Feeling lightheaded when you move a lot, if CHF is due to certain kinds of heart valve disease.
• Fast or irregular heartbeat, if CHF is due to abnormal heart rhythms (arrhythmias).

What causes congestive heart failure?

CHF is related to health issues a person already has, which are called existing or underlying medical conditions. You’re more likely to have CHF if you have coronary artery disease (blockages in the arteries that carry blood to your heart) or if you have had a heart attack. A heart attack starves the heart of oxygen, and that makes it less able to pump blood properly.

You’re also more likely to have CHF if you have high blood pressure, which makes the heart work harder and become harder and stiffer. That makes the heart less able to properly relax and can tire out the muscle over time.

Risk factors

Underlying conditions linked with getting diagnosed with CHF include:

• Coronary artery disease
• A previous heart attack
• Uncontrolled high blood pressure
• Diabetes
• Abnormal heart valves
• Severe lung disease
• Obesity
• Sleep apnea
• Heavy alcohol or drug use

Other, much more rare risk factors include:

• Genetic abnormalities that can cause inherited forms of CHF
• Thyroid disease
• Exposure to certain chemotherapy drugs or a history of radiation to the chest to treat cancer
• Certain types of long standing abnormal heart rhythms (arrhythmias)

How to treat heart failure

CHF is a serious heart condition. If you feel the symptoms of CHF such as trouble breathing while lying down or bending over, extreme tiredness, or bloating in your legs or abdomen, go to the emergency room.

If you have been diagnosed with CHF, you will need to be followed by a cardiologist (heart specialist). The first step is for your doctor to figure out the cause of your CHF and treat that.

Your cardiologist may send you to a CHF specialist—a cardiologist who only treats CHF—if you may need a left ventricular assist device (an implant that helps the heart to pump) or a heart transplant.

Medication

Medications can help CHF patients feel better and live longer. Possibilities include:

• Diuretics (e.g., furosemide or torsemide) help get rid of fluid build-up by causing you to pee more often.
• Beta blockers (e.g., metoprolol, carvedilol) help make it easier for the heart to pump,  suppress abnormal heart rhythms, and lower the effects of the hormone adrenaline on the heart.
• ACE inhibitors (e.g., lisinopril, enalapril), angiotensin receptor blockers (e.g., valsartan, losartan), and mineralocorticoid receptor antagonists (spironolactone) help the heart pump more efficiently over time.
• Sacubitril/valsartan (Entresto) is a relatively new medication, and has been shown to be better than ACE inhibitors for people with CHF. It also helps the heart pump more efficiently over time.

In addition to taking medication, it’s important to commit to a heart-healthy lifestyle:

• If you smoke, quit.
• If you’re overweight, try to lose weight and maintain a healthy weight.
• If you drink alcohol, stop completely. Alcohol is toxic to the heart.
• Limit your salt intake.

Procedures

Sometimes, specific cardiac procedures or surgeries may be recommended. These include:

• Coronary artery bypass grafting surgery: This open-heart surgery uses other blood vessels to bypass (go around) blockages in your coronary arteries.
• Cardiac resynchronization therapy: Inserting a special type of pacemaker helps the left and right sides of the heart pump in sync.

What are the 4 stages of congestive heart failure?

Heart failure gets worse over time if it isn’t treated. CHF has four stages:

Stage A is pre-heart failure. This is when your risk of developing heart failure is high because of family history or medical conditions you have, like high blood pressure, diabetes, or a history of alcohol abuse. In this stage, if you make major lifestyle changes, you might be able to avoid developing CHF altogether.

Stage B is still pre-heart failure. That means you have some type of heart disease (e.g., coronary artery disease, heart valve disease, etc.), but have not developed symptoms of HF. Lifestyle changes can help but likely won’t be enough. Depending on your underlying condition, your doctor may start you on medication, like beta blockers and/or ACE inhibitors.

Stage C means you've been diagnosed with heart failure. You have symptoms like shortness of breath, fatigue, weak legs, or swollen feet or ankles. Stage C treatment—in addition to the treatments for Stages A and B—likely calls for more medication, including pills to remove fluid by making you urinate more.

Stage D means advanced congestive heart failure. The symptoms are serious and don't get better with treatment. Your doctor will talk with you about the need for additional drugs and possibly surgeries or procedures.

How long can you live with congestive heart failure?

That depends on how much the disease has progressed, how old you are when you’re diagnosed, and how well you stick to your treatment plan. If your CHF is caught early and treated immediately, you could lead a longer life. But often CHF is not caught early, so about 50% of people with CHF live five years past diagnosis, and about 10% to 25% of people survive 10 years or more.