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Heart failure (HF)/Congestive heart failure (CHF)

Introduction-

The term “heart failure” makes it sound like the heart is no longer working at all and there’s nothing that can be done. Actually, heart failure means that the heart isn’t pumping as well as it should be. Congestive heart failure is a type of heart failure that requires seeking timely medical attention, although sometimes the two terms are used interchangeably.

Your body depends on the heart’s pumping action to deliver oxygen- and nutrient-rich blood to the body’s cells. When the cells are nourished properly, the body can function normally. With heart failure, the weakened heart can’t supply the cells with enough blood..

Keywords-

• Heart attack: -A heart attack is damage to the heart muscle due to the blockage of a coronary artery, which supplies blood to the heart. The heart muscle sustains damage because blood is not getting to it, so it becomes starved of oxygen.
• Systolic heart failure-Systolic heart failure means that the heart muscle cannot pump blood around the body properly. It is not a heart attack.
• Cardiac arrest-A cardiac arrest is when the heart and blood circulation both stop, and the person has no pulse.

Synonymous-

Heart failure (HF), also known as congestive heart failure (CHF), decompensatio cordis (DC), and congestive cardiac failure (CCF),  

Definition-

 It is when the heart is unable to pump sufficiently to maintain blood flow to meet the body tissue's needs for metabolism

Causes and risk factors-

Any condition that damages the heart muscle can cause systolic heart failure. These conditions include:

• Coronary artery disease:- The coronary arteries supply the heart muscle with blood. If these become blocked or narrowed, the flow of blood reduces, and the heart does not receive the blood supply that it needs.
• Heart attack: -A sudden blockage of the coronary arteries causes scarring in the heart’s tissues and decreases how effectively it can pump.
• Nonischemic cardiomyopathy:- This disease involves weakness of the heart muscle due to causes other than blockages in the coronary arteries. Possible causes include genetic conditions, drug side effects, and infections.
• Conditions that overwork the heart:- Examples include valve disease, hypertension (high blood pressure), diabetes, kidney disease, and heart abnormalities present at birth.

The following are risk factors for congestive heart failure:

• Diabetes, especially type 2 diabetes
• Obesity
• Smoking
• Anemia
• Thyroid problems, including hyperthyroidism and hypothyroidism
• Lupus
• Myocarditis, or the inflammation of the heart muscle, which usually occurs due to a virus and can lead to left sided heart failure
• Heart arrhythmias, or abnormal heart rhythms — a fast heartbeat can weaken the heart, and a slow heartbeat can reduce blood flow, causing heart failure
• Atrial fibrillation, an irregular and often rapid heartbeat
• Hemochromatosis, a condition in which iron accumulates in the tissues
• Amyloidosis, where one or more organ systems accumulate deposits of abnormal proteins

 

Types of heart failure-

There are several different types of heart failure. It may affect just one side of the heart — the oxygenated or deoxygenated side — or both sides.

Types of congestive heart failure include:

1.Left sided heart failure-Left sided heart failure is the most common form of congestive heart failure. It usually develops as a result of coronary artery disease.

The left side of the heart is responsible for pumping blood to the rest of the body. In people with left sided heart failure, blood backs up into the lungs as the heart does not effectively pump it away. This issue can, in turn, cause shortness of breath and fluid buildup.

2.Right sided heart failure- The right side of the heart pumps blood to the lungs, where it collects oxygen. Right sided heart failure typically follows left sided heart failure. However, it can sometimes occur due to other conditions, such as lung disease or pulmonary hypertension.

3.Biventricular heart failure- If heart failure affects only the oxygenated side of the heart, it is called left heart failure. If it involves just the deoxygenated side (which pumps blood to the lungs), it is called right heart failure.

In biventricular heart failure, there are problems with both sides of the heart. Biventricular heart failure can occur with cardiomyopathy.

4.Diastolic heart failure- Diastolic heart failure occurs when the heart muscle is stiffer than usual but pumps normally. As the heart is stiff, it does not fill up with blood properly because it does not relax normally. Doctors refer to this as diastolic dysfunction.

When the heart does not fill up with blood, this results in increased pressure inside the heart, which can cause a backup of fluid into the lungs.

5.Systolic heart failure- Systolic dysfunction describes the heart’s inability to pump efficiently after filling with blood. It often occurs if the heart becomes weak or enlarged, which can occur on either side of the heart.

 

Sign and symptoms-

Some common symptoms are-

• Excess fluid in body tissues like the ankles, feet, legs, or abdomen
• Coughing or wheezing
• Shortness of breath
• Weight gain that can’t be attributed to anything else
• General fatigue
• Increased heart rate
• Lack of appetite or feeling nauseated
• Feeling confused or disoriented

 

Type of heart failure	Description
Left-sided heart failure	Fluid may back up in your lungs, causing shortness of breath.
Right-sided heart failure	Fluid may back up into your abdomen, legs and feet, causing swelling.
Systolic heart failure	The left ventricle can't contract vigorously, indicating a pumping problem.
Diastolic heart failure (also called heart failure with preserved ejection fraction)	The left ventricle can't relax or fill fully, indicating a filling problem.

 

 

Diagnostic test-

1.Physical examination-Your cardiologist will perform a physical exam, which will involve listening to your heart with a stethoscope to detect abnormal heart rhythms.

2.Electrocardiogram-Abnormalities in your heart’s rhythm, such as a rapid heartbeat or irregular rhythm, could suggest that the walls of your heart’s chamber are thicker than normal. That could be a warning sign for a heart attack.

3.Echocardiogram-An echocardiogram uses sound waves to record the heart’s structure and motion. The test can determine if you already have poor blood flow, muscle damage, or a heart muscle that doesn’t contract normally.

4.MRI-An MRI takes pictures of your heart. With both still and moving pictures, this allows your doctor to see if there’s damage to your heart.

5.Stress test-Stress tests show how well your heart performs under different levels of stress.

Making your heart work harder makes it easier for your doctor to diagnose problems.

6.Blood tests-Blood tests can check for abnormal blood cells and infections. They can also check the level of BNP, a hormone that rises with heart failure.

7.Cardiac catheterization-Cardiac catheterization can show blockages of the coronary arteries. Your doctor will insert a small tube into your blood vessel and thread it from your upper thigh (groin area), arm, or wrist.

Medical treatment-

Many different medications are available to treat the symptoms of congestive heart failure. They include:

1.ACE inhibitors: Angiotensin-converting enzyme inhibiting drugs reduce the heart’s workload by helping the arteries relax and lowering blood pressure. ACE inhibitors boost the performance of the heart and can improve the person’s quality of life.

2.ARBs: Angiotensin receptor blockers reduce symptoms of heart failure and prevent blood pressure from rising. They include candesartan, losartan, and valsartan.

3.ARNIs: Angiotensin receptor-neprilysin inhibitors reduce strain on the heart to help treat heart failure.

4.SGLT2 inhibitors: Also called gliflozins, sodium-glucose cotransporter-2 inhibitor drugs may help prevent and treat heart failure, according to a 2019 study.

5.Diuretics: Diuretics help relieve ankle swelling and fluid retention. These drugs also relieve breathlessness resulting from heart failure. Diuretics remove water and salt from the kidneys in the urine. The three main types of diuretics are loop diuretics, thiazide diuretics, and potassium-sparing diuretics.

6.Anticoagulants: -Anticoagulant drugs thin the blood, making it harder for the blood to clot and helping prevent a stroke. The most common anticoagulant is warfarin. Doctors will monitor a person closely when they are taking this medication.

7.Digoxin:-A drug called digoxin slows down the heartbeat to treat a fast, irregular heart rhythm and improves the strength with which the heart contracts.

8.Beta-blockers.-All heart failure patients benefit from taking beta-blockers.

9.Antiplatelet drugs-Medications that stop blood platelets from forming clots are called antiplatelets. Aspirin is an antiplatelet drug that can be suitable for people with a very high risk of a heart attack or stroke and a low risk of bleeding or those who have previously had a heart attack or stroke..

Surgical treatment-

Not everyone with heart failure responds to drug treatment. In these cases, there are some surgical options:

1.Coronary artery bypass graft: Doctors commonly recommend this procedure when coronary artery disease is the cause of congestive heart failure.

2.Heart valve surgery: This procedure repairs a defective valve that makes the heart pump inefficiently.

3.Implantable left ventricular assist device (LVAD): For hospital inpatients who have not responded to other treatments, an LVAD can help the heart pump blood. Doctors may use it for individuals who are waiting for a transplant.

4.Heart transplant: If no other treatments or surgeries help, a transplant is the final option. The medical team will only consider a heart transplant if the person is healthy other than the problem with their heart.

Complications-

If you have heart failure, your outlook depends on the cause and the severity, your overall health, and other factors such as your age. Complications can include:

1.Kidney damage or failure-Heart failure can reduce the blood flow to your kidneys, which can eventually cause kidney failure if left untreated. Kidney damage from heart failure can require dialysis for treatment.

2.Heart valve problems-The valves of your heart, which keep blood flowing in the proper direction through your heart, may not function properly if your heart is enlarged or if the pressure in your heart is very high due to heart failure.

3.Heart rhythm problems- Heart rhythm problems (arrhythmias) can be a potential complication of heart failure.

4.Liver damage-Heart failure can lead to a buildup of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for your liver to function properly.