Heart Failure (Congestive Heart Failure)

Heart failure is a long-term condition in which your heart can’t pump blood well enough to meet your body’s needs all the time. Treatment includes exercise and medicine at first and possible surgical procedures when heart failure gets worse. Your outlook depends on a range of factors, including how well you take care of yourself.

What is heart failure?

Heart failure, or congestive heart failure, is a long-term condition that gets worse over time. Although the name sounds like your heart has stopped working, heart failure means your heart isn’t able to pump blood as well as it should. When your heart has less pumping power, that can damage your organs and fluid can collect in your lungs.

What are the types of heart failure?

There are many causes of heart failure, but the condition is generally broken down into these types:

Left-sided heart failure

Heart failure with reduced left ventricular function (HF-rEF)

The lower left chamber of your heart (left ventricle) gets bigger and cannot squeeze (contract) hard enough to pump the right amount of oxygen-rich blood to the rest of your body.

Heart failure with preserved left ventricular function (HF-pEF)

Your heart contracts and pumps normally, but the bottom chambers of your heart (ventricles) are thicker and stiffer than normal. Because of this, your ventricles can’t relax properly and fill up all the way. Because there’s less blood in your ventricles, your heart pumps out less blood to the rest of your body when it contracts.

Right-sided heart failure

Heart failure can also affect the right side of your heart. Left-sided heart failure is the most common cause of this. Other causes include certain lung problems and issues in other organs.

What is congestive heart failure?

This is a state in which your heart hasn’t been able to handle the blood volume. This causes an accumulation in other parts of your body, most commonly in your lungs and lower extremities (feet/legs).

What are the complications of heart failure?

Some of the complications from heart failure include:

• Irregular heartbeat.
• Sudden cardiac arrest.
• Heart valve problems.
• A collection of fluid in your lungs.
• Pulmonary hypertension.
• Kidney damage.
• Liver damage.
• Malnutrition

What are the heart failure stages?

Heart failure is a chronic condition that gets worse with time. There are four heart failure stages (Stage A, B, C and D). The stages range from “high risk of developing heart failure” to “advanced heart failure.”

Stage A

Stage A is considered pre-heart failure. It means you’re at high risk of developing heart failure because you have a family history of heart failure or you have one or more of these medical conditions:

• Hypertension.
• Diabetes.
• Coronary artery disease.
• Metabolic syndrome.
• History of alcohol abuse.
• History of rheumatic fever.
• Family history of cardiomyopathy.
• History of taking drugs that can damage your heart muscle, such as some cancer drugs.

Stage B

Stage B is considered pre-heart failure. It means your healthcare provider has given you a diagnosis of systolic left ventricular dysfunction but you’ve never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram (echo) that shows an ejection fraction (EF) of 40% or less. (See “Diagnosis” section for more about ejection fraction.) This category includes people who have heart failure and reduced EF (HF­-rEF) due to any cause.

Stage C

People with Stage C heart failure have a heart failure diagnosis and currently have or previously had signs and symptoms of the condition.

There are many possible symptoms of heart failure. The most common are:

• Shortness of breath.
• Feeling tired (fatigue).
• Less able to exercise.
• Weak legs.
• Waking up to urinate.
• Swollen feet, ankles, lower legs and abdomen (edema).

Stage D and reduced EF

People who have Stage D HF-rEF have advanced symptoms that don’t get better with treatment. This is the final stage of heart failure.

SYMPTOMS AND CAUSES

What are the symptoms of heart failure?

Symptoms of heart failure include:

• Shortness of breath.
• Feeling tired (fatigue) and having leg weakness when you’re active.
• Swelling in your ankles, legs and abdomen.
• Weight gain.
• Need to urinate while resting at night.
• Rapid or irregular heartbeats (palpitations).
• A dry, hacking cough.
• A full (bloated) or hard stomach, loss of appetite or upset stomach (nausea).

There may be times that your symptoms are mild or you may not have any symptoms at all. This doesn’t mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe and may come and go.

Unfortunately, heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms. It’s important to let your doctor know if you have new symptoms or if your symptoms get worse.

What causes heart failure (congestive heart failure)?

Although the risk of heart failure doesn’t change as you get older, you’re more likely to have heart failure when you’re older.

Many medical conditions that damage the heart muscle can cause heart failure. Common conditions include:

• Coronary artery disease.
• Heart attack.
• Cardiomyopathy.
• Heart issues present at birth (congenital heart disease).
• Diabetes.
• High blood pressure (hypertension). This is a common cause in people assigned female at birth.
• Arrhythmia (abnormal heart rhythms, including atrial fibrillation).
• Kidney disease.
• Having obesity.
• Tobacco and recreational drug use.
• Medications. Some drugs used to fight cancer (chemotherapy) can lead to heart failure.

DIAGNOSIS AND TESTS

Heart Failure Diagnosis

In order to determine if you have heart failure, your healthcare provider needs to know about your symptoms and medical history. They will ask you about things such as:

• Other health conditions you have, such as diabetes, kidney disease, chest pain (angina), high blood pressure, high cholesterol, coronary artery disease, or other heart problems.
• If you have a family history of heart disease or sudden death.
• If you smoke or use tobacco.
• How much alcohol you drink.
• If you’ve had chemotherapy and/or radiation.
• The medications you take.

What types of tests are used to diagnose heart failure?

You’ll have tests to see how bad your heart failure is and what caused it. Common tests include:

• Blood tests.
• NT-pro B-type Natriuretic Peptide (BNP) blood test.
• Cardiac Catheterization.
• Chest X-ray.
• Echocardiogram (echo).
• Magnetic resonance imaging (MRI).
• Electrocardiogram (EKG or ECG).
• Multigated Acquisition Scan (MUGA scan).
• Stress test.

MANAGEMENT AND TREATMENT

How is heart failure treated?

Your treatment will depend on the type of heart failure you have and, in part, what caused it. Medications and lifestyle behaviors are part of every treatment plan. Your healthcare provider will talk to you about the best treatment plan for you. Treatment is the same, regardless of gender.

As heart failure gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure. Since you can’t move backward through the heart failure stages, the goal of treatment is to keep you from moving forward through the stages or to slow down the progression of your heart failure.

PREVENTION

How can I prevent heart failure?

Although you can’t control some risk factors like age, family history or race, you can change your lifestyle to give yourself the best chance of preventing heart failure. Things you can do include:

• Staying at a healthy weight.
• Eating foods that are good for your heart.
• Exercising regularly.
• Managing your stress.
• Stopping the use of tobacco products.
• Not drinking alcohol.
• Not using recreational drugs.
• Taking care of other medical conditions you have that can increase your risk.