What Is Congestive Heart Failure?

More than five million people in the United States have heart failure.

While the term "congestive heart failure" (also known as heart failure) may sound like the heart has stopped working, it actually means that the heart isn't pumping as well as it should.

Still, heart failure is a serious condition that is often the end stage or final outcome of many cardiovascular conditions.

The American Heart Association (AHA) reports that more than five million people in the United States have heart failure, and that half of those diagnosed die within five years.

While there's no cure for heart failure, medications and healthy lifestyle changes can help manage the condition and allow people to maintain a good quality of life.

What Happens During Heart Failure?

Congestive heart failure occurs when there's a reduction in blood flow to the body and a backup (congestion) of blood into the lungs, liver, abdomen, and lower extremities.

However, not all heart failure is congestive: A person might have shortness of breath or weakness due to heart failure and not have any fluid building up.

During heart failure, the body tries to compensate for reduced blood flow in other ways by:

• Enlarging the heart chamber so it can stretch more and contract more strongly in order to pump more blood. An enlarged heart can cause your body to retain fluid, your lungs to become congested with fluid, and your heart to beat irregularly.
• Developing more muscle mass because the contracting cells of the heart get bigger. This initially lets the heart pump more strongly.
• Pumping faster to increase your heart's output.
• Diverting blood away from other tissues and organs such as the kidneys, the heart, and brain.

These compensations may mask heart failure temporarily, but eventually heart failure gets worse, and people start to experience fatigue, breathing problems, and other symptoms.

This may explain why it takes some people years to realize that they have heart failure.

Types of Congestive Heart Failure

The heart's left side, right side, or both sides can be affected during heart failure. However, the left side is usually affected first.

Left-sided heart failure: The left ventricle is larger than the other chambers and essential for normal function because it provides most of the heart's pumping power.

In left-sided (also called left ventricular) heart failure, the left side of the heart must work harder to pump the same amount of blood.

There are two types of left-sided heart failure:

• Systolic failure occurs when the left ventricle loses its ability to contract normally. The heart can't pump with enough force to push enough blood into circulation.
• Diastolic failure (also called diastolic dysfunction, heart failure with preserved ejection fraction, or HFPEF) occurs when the left ventricle becomes stiff so the heart can't properly fill with blood during the resting period between each beat.

Right-sided heart failure: Right-sided (also called right ventricular) heart failure usually occurs because of left-sided failure.

When the left ventricle fails, increased fluid pressure is transferred back through the lungs causing damage to the heart's right side.

When the right side loses pumping power, blood backs up in the body's veins causing swelling or congestion in the legs, ankles, gastrointestinal tract, and liver.

Causes

The following conditions can cause heart failure, yet many people aren't aware that they have them:

• Coronary artery disease is the most common cause of heart failure. It causes narrowing of the arteries that supply blood to the heart muscle.
• Previous heart attack can leave scar tissue that interferes with the heart muscle's ability to pump normally.
• High blood pressure (also called hypertension) makes your heart work harder than it should to circulate blood throughout your body.
• Heart valve disease caused by past rheumatic fever or other infections, forces your heart to work harder to keep blood flowing as it should; over time this extra work weakens the heart.
• Infections of the heart valves and/or heart muscle, such as endocarditis or myocarditis, can weaken the heart.
• Congenital heart disease or defects that you're born with can cause healthy parts of your heart to work harder to pump blood through your heart. This extra strain can lead to heart failure.
• Heart muscle damage (such as cardiomyopathy) brought on by many causes, including diseases, infections, alcohol abuse, and drugs use, can lead to heart failure.
• Irregular heartbeats (called heart arrhythmias) may cause your heart to beat too fast, which can weaken the heart and prevent it from getting enough blood to the body.
• Chronic lung disease, such as chronic obstructive pulmonary disease (COPD) or emphysema can cause heart failure.
• Blood clot in the lungs (called pulmonary embolism) may cause right heart failure.
• Anemia and excessive blood loss can lead to heart failure.
• Diabetes complications can contribute to heart failure because the condition tends to lead to hypertension and atherosclerosis, both of which have been linked to the disease.
• Obesity can cause a cardiomyopathy, which is disease of the heart muscle. Being obese can also cause the heart to work much harder than it would for non-obese people.
• Medications and supplements may worsen heart failure or interfere with heart failure medicines.
• Alcohol abuse can cause a cardiomyopathy, leading to a diseased heart muscle and a reduction in blood-pumping capacity.

Risk Factors

Having any of the following conditions can increase your risk for heart failure:

• High blood pressure
• Past heart attack
• Diabetes
• Sleep apnea
• Congenital heart defects
• Valvular heart disease
• Viruses
• Alcohol use
• Tobacco use
• Obesity
• Irregular heartbeats

Life Expectancy after Heart Failure

Your life expectancy after heart failure depends on the cause of your condition, as well as other factors, including age.

However, the AHA reports that about half of people who develop heart failure die within five years of diagnosis.

Sources:

• About Heart Failure; American Heart Association
• Types of Heart Failure; American Heart Association
• Heart failure; Mayo Clinic
• Congestive Heart Failure; Johns Hopkins Medicine
• Heart Failure Fact Sheet; Centers for Disease Control and Prevention

Symptoms of Congestive Heart Failure

The signs of congestive heart failure can mimic those of other conditions.

People may experience different symptoms of congestive heart failure depending on how much of the heart's pumping capacity has been affected.

The following are the most common symptoms:

• Shortness of breath during rest, exercise, or while lying flat
• Sudden, severe shortness of breath
• Weight gain
• Visible swelling of the legs, ankles, and sometimes the abdomen, due to a buildup of fluid
• Fatigue and weakness
• Reduced ability to exercise
• Nausea, abdominal pain, loss of appetite
• Difficulty concentrating or decreased alertness
• Rapid or irregular heartbeat
• Chest pain if your heart failure is caused by a heart attack
• Persistent cough that can cause white or pink blood-tinged sputum
• Increased need to urinate at night

Since the symptoms of heart failure may indicate other conditions, be sure to contact your doctor immediately if you experience any.

Diagnosis of Heart Failure

To determine if you have heart failure, your doctor will take your complete medical history and conduct a physical examination.

He or she may also perform the following diagnostic procedures:

Blood Tests: By taking a blood sample, your doctor can have your kidney, liver, and thyroid function checked for indicators of other diseases that affect the heart or are affected by the function of the heart.

Your doctor may perform a blood test that checks for a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP) to help in diagnosing heart failure.

Chest X-ray: A chest X-ray can produce pictures of your internal tissues, bones, and organs so that your doctor can rule out conditions other than heart failure that may explain your symptoms.

If you have heart failure, X-ray results may show an enlarged heart and fluid buildup in your lungs.

Echocardiogram: An echocardiogram is a test that uses sound waves to create pictures of the heart. This test helps your doctor see the shape of your heart and how well it's pumping.

Heart chamber size and function, as well as valve structure, can all be detected by an echocardiogram.

An echocardiogram can also distinguish systolic heart failure from diastolic heart failure, and help your doctor look for valve problems or evidence of previous heart attacks, and other heart abnormalities that may be causing heart failure.

Electrocardiogram (ECG or EKG): During an electrocardiogram, wires are taped to your body to create a graph of your heart's electrical rhythm.

An EKG allows your doctor to diagnose heart rhythm problems and damage to your heart from a previous heart attack that may be the cause of your heart failure.

Stress Test: This test is used to measure how your heart and blood vessels respond to exertion, detect if you have coronary artery disease, and determine how well your body is responding to your heart's decreased capacity to pump.

There are several ways to perform a stress test, including the following:

• Walking on a treadmill or riding a stationary bike while attached to an ECG machine.
• Receiving a drug intravenously that stimulates the heart similar to exercise.

Your doctor may also order a nuclear stress test or a stress echocardiogram that allows him or her to see images of your heart while you're exercising.

Radionuclide Ventriculography or Radionuclide Angiography (MUGA Scan): During this test, radioactive substances called radionuclides are injected into your bloodstream with a shot or an IV.

You are then placed under a gamma camera which captures images of your heart as it beats.

This test allows your doctor to see how well your heart muscle is supplied with blood, how well your heart's chambers are working, and whether part of the heart has been damaged by heart attack.

Sources:

• About Heart Failure; American Heart Association
• Types of Heart Failure; American Heart Association
• Heart failure; Mayo Clinic
• Conditions We Treat: Congestive Heart Failure; Johns Hopkins Medicine

Treatment for Congestive Heart Failure

There are several lifestyle changes, as well as drugs and surgeries, that can help people diagnosed with heart failure.

The goal of heart failure treatment is to address the underlying causes of the condition in order to reduce symptoms and improve health.

Treatments may include the following:

Medications

The following medications may help prolong your life after a diagnosis of heart failure:

• Angiotensin converting enzyme (ACE) inhibitors widen blood vessels to lower blood pressure, improve ejection fraction, reduce the workload on the heart, and decrease dangerous remodeling of the heart.
• Angiotensin receptor blockers (ARB) are an alternative to ACE inhibitors if they can't be tolerated.
• Beta-blockers slow your heart rate and reduce blood pressure, as well as limit or reverse some damage caused by systolic heart failure.
• Aldosterone blockers block the effects of the hormone aldosterone, which causes sodium and water retention that can contribute to heart failure.

Additionally, the following drugs can help reduce the symptoms caused by heart failure:

• Diuretics reduce the amount of fluid in the body.
• Vasodilator dilates the blood vessels and reduces workload on the heart.
• Digitalis help the heart beat stronger and with a more regular rhythm.
• Anti-arrhythmia medications help maintain normal heart rhythm and help prevent sudden cardiac death. However, because some anti-arrhythmics may actually cause heart failure, they must be taken with caution.

Surgery

While surgery isn't often used to treat heart failure, it may be recommended if your condition can't be helped with medications or dietary and lifestyle changes or if your doctor believes the cause of your heart failure can be fixed with surgery.

This may include problems caused by a malformed heart valve or a blocked coronary artery.

In these cases, the following surgeries may be recommended.

Angioplasty (also called Percutaneous coronary intervention) Angioplasty is performed to reopen blocked vessels.

During the procedure, a catheter with a small balloon-like device is threaded through a vein and opened once it reaches the clogged artery.

Then a small wire tube (called a stent) is placed into the artery to keep it open.

There is a slight risk of damage to the artery during this procedure, but angioplasty usually improves the condition.

Coronary artery bypass: During this surgery, your blood supply is rerouted around a blocked section of the artery.

Surgeons remove healthy blood vessels from another part of your body, such as a leg or the chest wall and then attach the vessels to your diseased artery so the blood can flow around the blocked section.

Heart transplant: For people with severe heart failure that can't be helped by medications or dietary and lifestyle changes, a heart transplant may be the only treatment option.

During a heart transplant, the surgeon connects you to a heart-lung machine, which takes over the functions of the heart and lungs while the damaged heart is replaced with a healthy one taken from a donor.

Then the major blood vessels are reconnected and the new heart begins working.

According to the American Heart Association (AHA), about 90 percent of people live for more than a year after receiving a heart transplant.

However, it can take several months to find a donor heart that is a good match. In fact, the AHA reports that only around 2,500 people receive a transplant each year.

Implanted Devices: The following devices can help improve heart function for some people with heart failure.

• Biventricular pacing/cardiac resynchronization therapy is a pacemaker that paces both sides of the left ventricle simultaneously to coordinate contractions and to improve the heart's function.
• Implantable cardioverter defibrillator (ICD) is similar to a pacemaker in that it senses when the heart is beating too fast and delivers an electrical shock to slow down the rhythm.
• Ventricular assist device (VAD) takes over the pumping function for one or both of the heart's ventricles or pumping chambers.
• Left ventricular restoration is the surgical reshaping of an abnormally oversized left ventricle to help the heart beat more effectively.

Lifestyle Changes

The following lifestyle habits can help relieve symptoms of heart failure and keep the condition from getting worse:

• Quit smoking
• Avoid alcohol
• Maintain a healthy weight
• Participate in moderate exercise
• Eat a heart-healthy diet low in saturated and trans fats and cholesterol
• Get adequate rest and sleep
• Control blood sugar, if you have diabetes
• Control high blood pressure
• Restrict salt in your diet
• Limit fluids
• Check your legs, ankles, and feet for swelling daily
• Consider getting vaccinations
• Reduce stress

Sources:

• About Heart Failure; American Heart Association
• Types of Heart Failure; American Heart Association
• Heart failure; Mayo Clinic
• Conditions We Treat: Congestive Heart Failure; Johns Hopkins Medicine

Source: http://www.everydayhealth.com