Article

Congestive Heart Failure (CHF)
February 06, 201901,095

Congestive Heart Failure (CHF): Causes, Symptoms, Treatment, and Prevention

What is Congestive Heart Failure (CHF)?

Congestive Heart Failure (CHF) is a serious and chronic disease where the muscles of the heart become weakened over time. The heart gradually loses its ability to pump blood around the body.1 Eventually, blood begins to flow into the heart faster than it can be pumped out. This causes it to become congested or backed-up.2

Around 5.8 million people in the United States of America are living with CHF; with 700,000 new cases reported every year.3 CHF is the most commonly diagnosed condition in hospitalized patients over the age of 65.2

Who Gets Congestive Heart Failure and Am I at Risk?

CHF can affect both children and adults, but it is more common in adults. The older you get, the weaker your heart muscles become. If you are 65 years or older, you are at high risk of CHF.4

There are several risk factors that can contribute to the development of CHF1:

  • Family history
  • Smoking
  • Obesity
  • Lack of physical exercise
  • High intake of saturated fats, cholesterol and trans fats
  • Diabetes
  • Anemia

If you have one or more of the above risk factors, you are at risk of developing CHF.

What Causes Congestive Heart Failure?

CHF is usually caused by a combination of medical problems affecting the heart at the same time. This puts the heart muscles under stress, causing them to weaken over time.5

Common causes of CHF include:

  • Cardiomyopathy – a condition where the heart muscle becomes larger to compensate for its poor ability to pump.5
  • Congenital heart disease – a condition where infants are born with structural defects in their hearts.5
  • Coronary heart disease – a condition where the arteries responsible for carrying blood to the heart become blocked by fat.5
  • Cardiac arrhythmias – abnormal heart rhythm.5
  • Damage to the heart valves5
  • High blood pressure, especially in the lungs5
  • Myocarditis – infections that attack the heart muscles1

In addition to these, chemotherapy, radiotherapy, HIV/AIDS, drug and alcohol abuse, thyroid disorders and obstructive sleep apnea (difficulty breathing while sleeping) can worsen the damage done to the heart.3

Congestive Heart Failure Pathophysiology

The heart has four chambers. Blood enters the heart through the upper two chambers (atria) and is pumped out from the bottom two chambers (ventricles).1

When the heart muscles begin to weaken due to the above-mentioned conditions, the left ventricle that pumps blood to the body tries to compensate. It becomes larger or thicker over time.1

Eventually, the left ventricle may no longer be able to compensate any further. At this point, the volume of blood entering the heart becomes greater than what is being pumped out. Pressure begins to build up in the atria (upper two chambers) and the veins.3

The built-up pressure in the heart and veins has the following effects on the body6:

  • The kidney’s ability to remove excess water and sodium from the blood is decreased.
  • Water is retained in the body tissues. This happens most often in the ankles, abdomen and feet.
  • Water is also often retained in the lungs. This is known as pulmonary edema and can lead to shortness of breath or difficulty breathing.

What are the Most Common Types of Heart Failure?

According to the American Heart Association (AHA)6, there are three main types of heart failure:

  • Left-sided heart failure– the heart cannot pump out enough blood to the body. There are two types of left-sided heart failure6:
    • Systolic – the left ventricle becomes weak. It cannot contract strongly enough to pump blood to the body.
    • Diastolic – the left ventricle becomes stiff. It cannot fill with enough blood between each heartbeat.
  • Right-sided heart failure– the heart cannot pump out enough “used” blood to the lungs to be replenished with oxygen.6
  • Congestive heart failure– fluid backs up into the lungs and body tissues.1

Congestive Heart Failure Stages

CHF can increase in severity over time. Doctors classify CHF according to how severe the symptoms are.

Classes of “function capacity” (I-IV)6:

  • Class I – Normal daily physical activity does not cause shortness of breath, heart palpitations or fatigue. There is no limitation of exercise.
  • Class II – Normal daily physical activity causes shortness of breath, heart palpitations and fatigue. There is mild limitation of exercise.
  • Class III – Less than normal amounts of daily physical activity cause shortness of breath, heart palpitations and fatigue. There is significant limitation of exercise.
  • Class IV – Shortness of breath, heart palpitations and fatigue are experienced even when resting. No physical exercise can be done at all.

Classes of “objective assessment” (A-D)6:

  • Class A – no signs of CHF (no symptoms or difficulty during exercise).
  • Class B – signs of mild CHF (mild symptoms or difficulty during exercise).
  • Class C – signs of moderately severe CHF (moderately severe symptoms or difficulty during exercise).
  • Class D – signs of severe CHF (severe symptoms or difficulty even during rest).

For example, if you have mild or no symptoms, but your doctor has noticed a high amount of pressure in your heart and veins, you would be classified as having a function capacity I and objective assessment D.1

CHF often worsens over time, so even if you are diagnosed with a mild class now, you could move to a more serious class at a later stage.6 It is important to keep monitoring symptoms and going for regular check-ups with your doctor.

Congestive Heart Failure Symptoms

The following are common CHF symptoms to look out for3,4:

  • Extreme tiredness/fatigue – occurs when the heart cannot pump enough blood and oxygen to the body. Lack of oxygen to your muscles and brain can cause you to feel very weak and tired.
  • Shortness of breath or wheezing – occurs when fluid builds up in the lungs, making it difficult to breathe.
  • Swollen ankles, legs, abdomen or the veins in your neck – occurs when fluid builds up in the body tissues.
  • Weight gain for no reason – caused by fluid-retention.
  • Tender stomach and nausea – occurs when fluid builds up in the abdomen, causing pain and sometimes nausea.
  • Fast, irregular or pounding heartbeat – occurs when blood becomes congested in the heart.
  • Dizziness or feeling faint – occurs when there is decreased blood flow and oxygen to the brain.

If you are experiencing any of these symptoms, let your doctor know. It is possible that you may have CHF and further tests need to be done.4

Congestive Heart Failure Diagnosis

Your doctor will diagnose CHF by first finding out information about your medical and family history, then performing a physical exam and diagnostic tests.7

1. Medical and family history7:

  • Your doctor will initially ask whether you or others in your family have any disease or condition that can cause CHF.
  • They will also ask about the symptoms are you experiencing, how often you experience them and how much they affect your daily routine.

2. Physical exam7:

  • Your doctor will first listen to your heartbeat to see if it is normal.
  • They will then listen to your lungs for any sounds of gurgling or fluid.
  • They will lastly feel your ankles, legs and abdomen to check for any swelling.

3. Diagnostic tests7:

There is no single test that can diagnose CHF. Your doctor may refer you to a cardiologist or may suggest performing one or more of the following tests7:

  • Electrocardiogram (EKG or ECG) – electrical detection of the rhythm and speed of your heart.
  • Chest X-rays – a picture is taken of the inside of your chest to check if your heart is enlarged or if there is fluid in your lungs.
  • Brain natriuretic peptide (BNP) blood test – BNP is a hormone that is released during heart failure.
  • Echocardiography – sound waves are used to create a moving picture of your heart.
  • Doppler ultrasound – sound waves are used to detect the direction and speed of blood flow.
  • Holter monitor – electrodes are strapped to your chest and a portable recorder is carried around with you in your pocket for 24 – 48 hours.
  • Nuclear heart scan – a safe, radioactive substance is released into your blood to create a picture of how well blood is flowing through your heart.
  • Cardiac catheterization – a thin tube is inserted into a vein in your groin, arm or neck and threaded into your heart. This allows your doctor to see inside your heart.
  • Coronary angiography – a special dye is injected through a catheter into your blood stream to create a picture of your heart.
  • Stress test – physical exercise is done just before one of these diagnostic tests is performed. This can make it easier to detect heart problems.
  • Cardiac MRI – magnets, radio waves and a computer are used to create still and moving pictures of your heart.
  • Thyroid function tests – if the levels of thyroid-stimulating hormone are too low or too high in the blood, this can lead to heart failure.

Congestive Heart Failure Treatment

Treatment of CHF is usually aimed at decreasing the symptoms and slowing down the progression of the disease.4 The type of treatment your doctor decides to use will depend on how severe your symptoms are.5

The most common methods of treatment include1,5,6:

  • Lifestyle changes:
    • Improving the quality of your diet
    • Getting enough physical exercise
    • Decreasing your alcohol consumption
    • Quitting smoking
    • Getting enough rest
    • Improving the way you deal with stress
    • Losing excess body weight
  • Medications6,7:
    • Diuretics – to get rid of extra fluid:
      • Bumetanide (Bumex), Furosemide (Lasix)
    • ACE inhibitors – to widen and relax blood vessels:
      • Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Prinivil, Zestril)
    • Beta blockers – to slow down the heartbeat and protect the heart from further damage:
      • Bisoprolol (Zebeta), Carvedilol (Coreg), Metoprolol succinate (Toprol XL)
    • Angiotensin receptor blockers or ARBs – if you cannot tolerate ACE inhibitors well, your doctor may prescribe these instead:
      • Losartan (Cozaar), Valsartan (Diovan), Candesartan (Atacand), Irbesartan (Avapro).4
    • Anticoagulants – to thin the blood and prevent clots from forming10:
      • Aspirin, heparin, warfarin
    • If you have high anxiety levels, your doctor may prescribe a tranquilizer.
  • Addressing underlying disorders – for example, reducing high blood pressure.
  • Surgery2:
    • Pacemakers – devices implanted in your chest to control your heart rhythm.
    • Ventricular Assist Devices (VAD therapy) – devices implanted in your chest to help your heart pump blood better.
    • In severe cases, arteries may need to be opened surgically or heart valves may need to be replaced.
    • Heart transplant – this is only considered as a last resort.

 

Congestive Heart Failure Prognosis

CHF is a very serious condition that worsens slowly over time. It can begin to limit the activities you do and can be fatal.8

Treatment can help to slow down this process and improve your quality of life significantly. It is still possible to live a long and productive life with CHF.7

Try to keep a positive attitude and outlook. Depression and anxiety are common side-effects of CHF, so make sure you get all the emotional support you need.2

In general, the progression of CHF is quite unpredictable. Some people can live for many years, while others get worse very quickly. Make sure you follow the guidelines that your doctor gives you.5

Living with CHF

Tips on how to manage your CHF on a daily basis2,3:

  • Weigh yourself daily – if you gain two to three pounds in one day, or 5 pounds in 5 days, call your doctor.
  • Monitor your symptoms – if you begin to struggle with breathing or begin feeling faint, stop and rest. If these symptoms become worse, call your doctor. If you experience chest pain, call 911
  • Keep track of your health – learn to take your blood pressure and pulse. Get any necessary blood tests done regularly (as suggested by your doctor).
  • Flu shots or pneumonia vaccines – lung infections would put extra strain on your already compromised lungs. Keep yourself healthy and take precautions against infections.
  • Maintain a healthy lifestyle – make sure you eat foods that are good for your heart and get enough physical exercise daily. Speak to your doctor about the amount of physical exercise you should be doing.

Congestive Heart Failure Diet: What to Eat and What to Avoid

Certain foods have been linked to a healthier heart than others. According to the AHA6, the quality of the Western diet has worsened over recent years and the number of people with CHF has increased too. Improvement of your diet can prevent further heart damage and slow down the progression of CHF.6

These are foods you should limit (1-2 times per week)6,7:

  • Saturated fats – butter, lard, chicken skin, visible fat on meat, cream, refined coconut oil.
  • Trans fats – block or stick margarines, shortenings, cakes, pies, cookies, pastries, microwave popcorn, crisps, battered or crumbed foods, fast food, deep-fried foods, doughnuts, cake and frosting mixes, ice cream, non-dairy creamers, frozen dinners, packaged puddings.
  • Salt and foods high in sodium – canned foods, fast foods, non-dairy creamers, processed meats (hot dogs, baloney, salami, sausages), stock powders, packet sauces, soups or gravy.
  • Foods high in sugar or high fructose corn syrup – sweetened beverages, sodas, sweetened cereals and mueslis, bakery items, candies, white bread, granola and energy bars, frozen yogurt and ice cream, canned or dried fruit, smoothies.
  • Processed (refined) starches – white breads, pastas, noodles, crackers, bagels, muffins, rice and cereal.
  • Red, fatty meats – beef, lamb, mutton, pork. Choose leaner cuts of meat where you can.

These are foods you should eat daily8:

  • Vegetables:
    • Frozen or fresh vegetables are best.
    • Eat a variety of colors and types.
    • Leave the skins on where possible.
    • Roast or steam rather than boiling or frying vegetables.
    • Eat half a cup of cooked or one cup of raw vegetables at each meal.
  • Fruits:
    • Whole fruits are best.
    • Eat a variety of different types and colors.
    • Fruits with deeper colors are best (berries, peaches).
    • Eat at least two fruits every day.
    • One serving equals: one fist-sized fruit; ½ cup chopped fruit; ¼ cup dried fruit; or ½ cup 100% fruit juice.
  • Whole-grains:
    • Choose starches that are high in fiber: whole-wheat breads, brown pastas, whole-grain crackers, oatmeal and brown rice.
    • Aim to have one to two servings of starch at each meal.
    • One serving equals: 1 slice bread; ½ cup cooked cereal, 1 cup cereal flakes; or ½ cup cooked rice or pasta (about the size of your fist).
  • Poultry, fish and lean meats:
    • Eat up to six cooked ounces every day.
    • One cooked ounce is roughly the size of a deck of playing cards.
    • Remove the skin off chicken and trim visible fat off meat.
    • Eat at least two servings of fish every week.
    • Choose fresh, fatty fish: salmon, herring, mackerel, tuna, black cod, anchovies, sardines, rainbow trout, mussels and oysters.
  • Nuts, seeds and legumes:
    • Add beans, chickpeas and lentils to your stews, soups, curries and salads.
    • Add chopped up nuts and seeds to your stir-fries or salads.
    • Choose nuts and seeds that are high in omega 3: walnuts, chia seeds, flaxseeds, hemp seeds, butternuts (white walnuts), pecan nuts, pine nuts.
    • Choose raw rather than salted nuts.
  • Low-fat dairy products:
    • Try to use milk products that are 0% to 1% fat.
    • Choose natural, unflavored yogurts that are either fat-free or low-fat.
    • Eat cheese that is low in fat, such as fat-free, low-fat or dry-cured cottage cheese.
    • Aim for two to three servings of dairy every day (one serving equals: one cup of milk or yogurt; or 1½ ounce of cheese).

Congestive Heart Failure FAQs

  • Why does congestive heart failure cause edema1,6?
    • CHF happens when the heart muscle becomes weak and can no longer pump enough blood out. This causes blood to back-up or become congested in the heart.
    • The increased pressure from this congested blood prevents the kidneys from working properly. They are no longer able to remove the excess water and sodium from the blood. This causes water-retention.
    • This water-retention causes extra fluid in the lungs (pulmonary edema) and swelling in the ankles, legs and abdomen.
  • Can congestive heart failure be cured?
    • CHF cannot be cured completely, but treatment and improvement of your lifestyle can slow down its progression. You could still live a long and productive life.7
    • If CHF becomes severe, there are surgical options that can help improve how your heart functions. These include pacemakers, ventricular assistance devices (VAD) and heart transplant (last resort).2
  • Is congestive heart failure a chronic condition?
    • CHF is a chronic condition.
    • If not treated, the heart muscles will continue to weaken. This could eventually be fatal.
    • If treated, progression of CHF can be slowed down significantly. It is still possible to live a long and productive life.2
  • Is coughing a sign of congestive heart failure?
    • CHF often causes edema (water-retention) in the lungs.1,6
    • This can lead to shortness of breath, wheezing, coughing and difficulty breathing.1,6
  • Is congestive heart failure hereditary?
    • Certain type of heart muscle damage (known as cardiomyopathy) may have a genetic link, which in turn may lead to Your doctor may ask you about any risk factors or history of heart diseases in the family.11
    • Even though someone in your family may have CHF, it is still possible to prevent it by following a healthy lifestyle and going for regular health check-ups.7
  • Is congestive heart failure reversible?
    • It is not yet known whether the damaged heart muscles can be healed and the condition reversed.2
    • With the right treatment, symptoms can be decreased and quality of life can be improved significantly.1,2

References

  1. Better Health Channel. Congestive Heart Failure. Last revised December 2016. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/congestive-heart-failure-chf?viewAsPdf=true. Accessed August 28, 2017.
  2. Hopkins Medicine Foundation. Congestive Heart Failure: Prevention, Treatment and Research. http://www.hopkinsmedicine.org/health/healthy_heart/diseases_and_conditions/congestive-heart-failure-prevention-treatment-and-research. Accessed August 28, 2017.
  3. Columbia University Medical Centre. Cardiomyopathy and Congestive Heart Failure. http://columbiasurgery.org/conditions-and-treatments/cardiomyopathy-and-congestive-heart-failure.  Accessed August 28, 2017.
  4. National Centre for Farmworker Health (NCFH). About Heart Failure. http://consumerhealthchoices.org/wp-content/uploads/2016/03/BBDfactsheet-heartfailure-EN.pdf.  Accessed August 28, 2017.
  5. National Health Service. Heart Failure. Last revised August 1, 2016. http://www.nhs.uk/conditions/heart-failure/Pages/Introduction.aspx. Accessed August 28, 2017.
  6. American Heart Association. Heart Failure. Last revised May 8, 2017. http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp. Accessed August 28, 2017.
  7. National Heart, Lung and Blood institute. How Is Heart Failure Diagnosed? Last revised June 22, 2015. https://www.nhlbi.nih.gov/health/health-topics/topics/hf/diagnosis. Accessed August 28, 2017.
  8. American Heart Association. How do I follow a healthy diet? Answers by Heart Fact Sheets. 2015. http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300467.pdf. Accessed August 28, 2017.
  9. Deborah Foundation. Congestive Heart Failure. https://demanddeborah.org/medical-services/congestive-heart-failure/. Accessed August 28, 2017.
  10. Anticoagulant medicines – NHS Choices. Nhsuk. 2017. Last revised June 16, 2015. Available at: http://www.nhs.uk/conditions/Anticoagulant-medicines/Pages/Introduction.aspx#. Accessed August 28, 2017.
  11. Heart failure: When your heart doesn’t work efficiently. Mayo Clinic. 2017. Available at: http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/causes/con-20029801. Accessed August 28, 2017.

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