Chronic Heart Failure
What is Chronic Heart Failure?
Also called congestive heart failure, chronic heart failure occurs when the heart muscle is damaged or weakened and can no longer circulate blood effectively to provide oxygen and nutrients for the body's tissues and organs.
The most common causes are coronary artery disease, high blood pressure, and prior heart attacks which impair the heart's pumping ability over time. Heart infections, arrhythmias, congenital heart defects, and cardiomyopathies can also cause heart failure. As the weakened heart struggles, blood and fluid can back up into the lungs and other areas causing congestion. The body responds by retaining fluid and activating certain neurohormonal processes. But these compensatory mechanisms eventually become overwhelmed, leading to worsening heart failure.
There are different types and functional classifications of heart failure, namely, systolic vs. diastolic heart failure, left-sided vs. right-sided heart failure, and acute vs. chronic heart failure. The New York Heart Association (NYHA) Functional Class system is a widely used classification that describes the severity of heart failure symptoms in four stages:
- Class I
Individuals with heart disease but without resulting limitations in physical activity. Ordinary physical activity does not cause undue fatigue, palpitations, or shortness of breath.
- Class II
Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitations, or shortness of breath.
- Class III
Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity leads to symptoms.
- Class IV
Severe limitations. Symptoms even at rest, and any physical activity worsens them.
Causes & Symptoms of Chronic Heart Failure
Chronic heart failure stems from conditions that chronically overwhelm the heart's pumping capabilities. Coronary artery disease, high blood pressure, cardiomyopathy, congenital defects, and lifestyle factors play major roles. Determining the origin and addressing reversible factors early on is key to preserving heart function.
Chronic Heart Failure Causes
- Coronary artery disease (CAD)
CAD is the most common cause of CHF. CAD occurs when the arteries that supply the heart with blood become narrowed or blocked, which can reduce the amount of oxygen that reaches the heart muscle. This can lead to heart muscle damage, which can eventually lead to CHF.
- High blood pressure (hypertension)
Hypertension can put a strain on the heart, making it work harder to pump blood. Over time, this can lead to heart muscle damage and CHF.
Cardiomyopathy is a group of diseases that weaken the heart muscle, making it difficult for the heart to pump blood effectively. There are many different types of cardiomyopathy, and some of them are genetic in nature.
- Heart valve disorders
Heart valve problems can interfere with the flow of blood through the heart, making it harder for the heart to pump blood effectively. Some common heart valve problems include mitral valve regurgitation, aortic stenosis, and tricuspid valve regurgitation.
- Heart attack (myocardial infarction)
A heart attack occurs when blood flow to the heart muscle is blocked, which can damage or destroy heart muscle tissue. This can lead to heart failure if enough heart muscle is damaged.
Irregular heart rhythms can disrupt the heart's pumping action and make it harder for the heart to pump blood effectively. Some common arrhythmias that can lead to CHF include atrial fibrillation and ventricular tachycardia.
Diabetes can damage blood vessels and nerves, which can lead to heart muscle damage and CHF.
Excess body weight puts added strain on the heart, which can lead to heart muscle damage and CHF over time.
- Certain medications and substances
Long-term use of certain medications, alcohol abuse, or illicit drug use can contribute to heart muscle damage.
Chronic Heart Failure Symptoms
- Shortness of breath (dyspnea)
Reduced pumping ability can lead to fluid accumulation in the lungs, causing breathlessness, especially during physical activity or while lying down.
- Fatigue and weakness
Insufficient blood flow to the body's tissues can lead to fatigue, weakness, and reduced exercise tolerance.
- Swelling (edema)
Fluid retention can cause swelling in the legs, ankles, and feet, often becoming more noticeable in the evening.
- Rapid or irregular heartbeat (palpitations)
The heart may struggle to maintain a regular rhythm, leading to palpitations or a sensation of a racing heart.
- Persistent cough or wheezing
Fluid buildup in the lungs can result in a chronic cough or wheezing.
- Increased urination at night
Fluid accumulation during the day may lead to increased urination at night.
- Sudden weight gain
Rapid weight gain may indicate fluid retention and worsening heart failure.
- Loss of appetite
Reduced blood flow to the digestive system can lead to a decreased appetite.
- Confusion or impaired thinking
Insufficient blood flow to the brain can cause confusion or difficulty concentrating.
Testing & Diagnosis for Chronic Heart Failure
The diagnosis of chronic heart failure (CHF) can be difficult, as the symptoms can be similar to other conditions.
It involves a comprehensive assessment that combines various medical tests and examinations to accurately understand the heart's structure, function, and overall health. Here are some key diagnostic approaches used in the evaluation of chronic heart failure:
- History and physical examination
The doctor will ask about your symptoms, medical history, and family history. They will also do a physical examination, which may include listening to your heart and lungs, checking your blood pressure, and looking for signs of fluid retention such as swelling in your ankles or legs.
- Electrocardiogram (EKG)
This test records the electrical activity of your heart. It can be used to identify arrhythmias (abnormal heart rhythms), heart muscle damage, and other heart problems that can cause CHF.
- Chest X-ray
This test can show the size and shape of your heart, as well as any fluid buildup in your lungs. It can also be used to rule out other lung diseases that can cause similar symptoms to CHF.
This test uses sound waves to create images of your heart. It can be used to measure the size and function of your heart, as well as to identify any structural problems such as heart valve disease.
- Blood tests
Blood tests can be used to check for electrolyte imbalances, kidney problems, and other conditions that can contribute to CHF. They can also be used to measure levels of natriuretic peptides (BNP and NT-proBNP), which are hormones that are released by the heart in response to stress. High levels of BNP and NT-proBNP can be a sign of CHF.
- Cardiac MRI
This test uses a strong magnetic field and radio waves to create detailed images of your heart and surrounding structures. It can be used to diagnose and assess CHF, as well as to evaluate the effectiveness of treatment.
- Nuclear imaging
This type of imaging uses radioactive tracers to create images of the body. In cardiac nuclear imaging, the tracer is injected into the bloodstream and travels to the heart. The tracer emits gamma rays, which are detected by a special camera. The camera creates images of the heart that show how well the blood is flowing through the coronary arteries. Nuclear imaging can be used to diagnose coronary artery disease, assess the severity of heart disease, and evaluate the effectiveness of treatment.
- Holter monitor
This portable device records the electrical activity of your heart for 24-48 hours. This allows doctors to see how your heart is functioning over time and to identify any arrhythmias (abnormal heart rhythms). Holter monitors can be used to diagnose a variety of heart conditions, including CHF, coronary artery disease, and arrhythmias.
- Event monitor
This portable device records the electrical activity of your heart only when you experience symptoms such as chest pain, shortness of breath, or palpitations. This allows doctors to see what is happening to your heart during these events and to diagnose the underlying cause. Event monitors are often used to diagnose arrhythmias that are not detected by a Holter monitor.
- Cardiac catheterization
This minimally invasive procedure in which a thin, flexible tube (catheter) is inserted into a blood vessel in the arm or leg and threaded up to the heart. The catheter is used to inject dye into the coronary arteries so that they can be seen on an x-ray. Cardiac catheterization is used to diagnose coronary artery disease, assess the severity of heart disease, and perform angioplasty or stenting to open blocked coronary arteries.
Chronic Heart Failure Treatments
While there is no cure for chronic heart failure, various treatments can help manage symptoms and improve quality of life. Treatment is aimed at improving the heart's pumping function, minimizing fluid buildup, managing contributing factors, and preventing complications.
Treatment plans will be tailored to each patient's specific case. The goal is to stabilize and preserve heart function while continually monitoring for any changes in status. With proper long-term management guided by a skilled cardiovascular team, many individuals can successfully control chronic heart failure symptoms and complications. Some key chronic heart failure treatments include:
Such as diuretics, ACE inhibitors, beta blockers, and aldosterone antagonists to eliminate fluid, lower blood pressure, improve pumping capacity, and ease strain on the heart.
- Lifestyle changes
Dietary adjustments to limit salt and fluids, smoking cessation, maintaining a healthy weight, and increasing appropriate physical activity can help manage chronic heart failure.
- Device therapies
Implantable cardioverter defibrillators (ICDs) and biventricular pacemakers with cardiac resynchronization therapy (CRT) may be options for some individuals.
- Cardiovascular surgery
Coronary bypass surgery may be performed in some cases to improve blood supply to the heart muscle. Other surgical interventions can reshape or repair heart valves.
- Heart transplant
In end-stage heart failure, transplantation may be considered for eligible patients.
- Palliative care
Providing symptom relief, emotional support, and improved quality of life.
- Supportive care
Ongoing monitoring and help managing medications and lifestyle changes through cardiac rehab programs.