What is Congestive Heart Failure?

Congestive Heart Failure (CHF) is a chronic, progressive condition in which the heart gradually weakens to the point it can’t pump enough blood to meet the body’s needs. This leads to a buildup of fluids in the lungs, liver and lower body known as “fluid congestion,” and is why doctors refer to the disease as “congestive” heart failure.

Heart disease is the leading cause of death both in the US and Nevada, and accounts for up to 27% of all deaths in Nevada. Stroke, which CHF can directly affect, is the third leading cause of death in the US and accounts for up to 5% of all deaths in Nevada. Combined, heart disease and stroke account for nearly 1-in-3 deaths in the state of Nevada.

What types of congestive heart failure are there?

Your heart consists of four chambers, with the upper two being the left and right atria, and the lower two being the left and right ventricles. The atria receive blood as it enters the heart so that the ventricles can then pump it through the body’s circulatory system and supply blood to the body’s tissues and organs.

There are two main types of CHF, with the most common being left-sided CHF and the other being right-sided CHF.

Left-sided CHF occurs when the left ventricle can’t pump enough blood. This results in the lungs filling with fluid, causing breathing to become difficult.

This may be due to either:

• Systolic failure–Systolic failure occurs when the left ventricle can’t contract normally, which prevents it from moving enough blood through the circulatory system.
• Diastolic failure–With diastolic failure, the muscles of the left ventricle become rigid. This prevents the chamber from refilling with enough blood to then be pumped through the circulatory system.

With right-sided CHF, the right ventricle is unable to pump enough blood to the lungs which can result in blood accumulating in the body’s vessels. This causes fluid buildup in the lower extremities, abdomen and other vital organs.

While it is possible to have both right-sided and left-sided CHF at the same time, the disease typically starts on the left and moves to the right as it progressively worsens. This is why early detection and treatment are critical.

The four congestive heart failure stages

If left untreated, congestive heart failure symptoms may go from non-existent to disabling.

This is divided into four classes:

1. In class I, there may be no symptoms during normal physical activity. At this stage, CHF is manageable through lifestyle change, medication and regular monitoring by a specialist.
2. In class II, normal physical activity may cause palpitations, fatigue and breathing difficulty, though you may still feel comfortable while at rest. This is also a stage at which CHF can be managed through lifestyle change, medication and regular monitoring by a specialist.
3. In class III, you may still be comfortable at rest, although physical activity is likely becoming noticeably more difficult. At this stage, even mild exertion may cause palpitations, fatigue and breathing difficulty, and working closely with a specialist is critical due to the need for more complicated treatments.
4. In class IV, symptoms may be apparent even while at rest, and any physical exertion becomes difficult. While CHF is incurable once it reaches this stage, specialists can still provide quality of life and palliative care treatments.

Congestive heart failure causes

Heart failure is often the result of the occurrence of another heart condition, including:

• Coronary artery disease
• Damaged or faulty heart valves
• Heart attack
• High blood pressure
• Congenital heart defect

There are also other factors and conditions which can lead to CHF, including:

• Diabetes
• Sleep apnea
• Obesity
• Genetics
• Viral infection
• Alcohol abuse
• Tobacco use

Who is most at-risk for congestive heart failure?

CHF is the leading cause of hospitalization for those age 65 or older, and there are currently 5.7 million people in the US with the disease. It occurs in men more than women, with risk increasing with age.

For instance, one Portuguese study shows those age 25-49 as having a 1.36% prevalence-rate, which increases sharply to 7.63% in the age 60-69 group, and then to 16.14% for those over 80.

It should also be noted that hypertension is the most common risk factor for CHF and is present in 66% of cases studied. The next most common risk factor is smoking, which occurred in 51% of cases studied.

Congestive heart failure prevention and management

While CHF is irreversible once the heart is damaged, it is possible to avoid damage through early detection and treatment.

This may include lifestyle changes, medications and possibly surgery.

For instance, lifestyle changes your specialist may encourage include:

• Losing weight
• Exercising
• Quitting smoking
• Avoiding or limiting alcohol use
• Avoiding or managing stress

Medications may include:

• Angiotensin-converting enzymes (ACE) inhibitors
• Angiotensin II receptor blockers
• Angiotensin-receptor neprilysin inhibitors (ARNIs)
• I_f channel blocker
• Beta-blockers
• Aldosterone antagonist
• Hydralazine and isosorbide dinitrate may be used to treat CHF in those of African decent
• Other medications such as blood thinners, anticoagulants or cholesterol-lowering drugs may also be used to reduce blood pressure
• Diuretics may be used to ease symptoms of edema

Surgical options may include:

• An implantable cardioverter-defibrillator may be installed to control heartbeat in the event of arrhythmia
• Cardiac resynchronization therapy may be performed using a small pacemaker to make the two ventricles work in synchronicity
• A left ventricle assist device may be used, which is a battery-powered pump which helps maintain the heart’s pumping power
• Surgery may be used to correct or replace a defective valve or to clear blocked arteries
• Coronary artery bypass surgery may be used to reroute blood flow around a clogged section of artery
• Heart transplants may be used in extreme cases in which the heart can no longer function to the point that lifestyle changes, dietary changes, medications and other surgeries are unable to help

Congestive heart failure diet

Eating a heart-healthy diet can not only help you manage and improve symptoms of CHF, but it can also help you avoid the disease in the first place.

This means eating a diet high in fibrous fruits, vegetables, legumes and whole grains which limits red meat, saturated fats and sodium. Sweets and added sugars should also be avoided, and foods containing healthy fats should be prioritized. These include fish, nuts, and heart-friendly oils such as olive oil or avocado oil.

Speak to us about CHF

Whether or not you suspect you have this progressive and debilitating disease, scheduling an appointment with a cardiology specialist to speak about CHF is an important first step in managing or avoiding it.