Congestive Heart Failure (CHF) Explained
The causes of heart failure can vary according to which side of the heart it affects. However, several prevention methods — including following a heart-healthy diet and doing regular exercise — can lower your overall risk of heart disease and its associated risks.
Read on to learn more about CHF and why it happens, including when it is a medical emergency and how to prevent it.
CHF, also called heart failure, occurs when the heart muscle has become damaged or has to work too hard because of heart disease and other conditions, such as obesity. Although the heart continues to beat, the damaged heart does not pump enough oxygen-rich blood around the body, resulting in potentially life threatening congestion in the lungs and other tissues of the body.
CHF is a common complication of heart attack and other types of heart disease that damage the heart muscle. These conditions include hypertension, heart valve disorders, arrhythmias, and cardiomyopathy. CHF can also happen due to anemia.
In addition to the categories of left sided heart failure with reduced ejection fraction and left sided heart failure with preserved ejection fraction, heart failure can also be caused by pathologies of the right ventricle.
Left vs. right sided heart failure explained
CHF can affect both the left and right sides of the heart, but it can affect one side more than the other, depending on the location and severity of the damage.
In left sided CHF, the left side of the heart is damaged and unable to effectively pump blood from the heart to the rest of the body. This results in blood backing up into the lungs and increasing blood pressure in the lungs. This increase in pressure causes a buildup of fluid in the lungs, which can lead to a life threatening condition called acute pulmonary edema.
Most people with heart failure have chronic pulmonary edema or pulmonary congestion. Acute pulmonary edema is rare and occurs in the setting of an acute event such as a heart attack, a hypertensive emergency, or acute damage to one of the heart valves.
In right sided CHF, the right side of the heart is damaged and unable to effectively relax to permit blood to flow from the body back into the heart. This results in a backup of blood and an increase in pressure in the veins that carry blood from the body to the heart. In turn, this leads to the swelling of the lower extremities and an increase in abdominal bloating, with an occasional feeling of early satiety.
CHF symptoms develop due to a lack of adequate blood delivery to tissues and organs of the body due to inefficient heart pumping. Symptoms can vary among individuals and differ depending on the severity of the condition and the side of the heart affected.
It is possible to have some symptoms of both left sided and right sided CHF. Early symptoms may develop slowly, and in some cases, you may not have any noticeable symptoms until CHF has progressed and become severe.
Symptoms of CHF can include:
- swelling, which may include swelling of the:
- weight gain
- difficulty breathing
- shortness of breath
- chest pain
- an ongoing cough
- blood in the phlegm
- a decrease in urination
- difficulty lying flat
- abdominal bloating
- early satiety
Seek immediate medical care for an evaluation if you or someone you are with has any of the following symptoms:
- moderate to severe shortness of breath, notably with minimal activity
- an inability to lie flat because of difficulty breathing
- a reduction in urination or no urination
- chest pain
- dizziness, lightheadedness, or syncope (passing out)
- a wet cough or a cough that produces frothy sputum
Contact your physician if you experience:
- moderate shortness of breath with moderate activity
- progressive water weight gain
- abdominal bloating and early satiety
- progressive swelling in the legs and abdomen
CHF is a common complication of heart conditions that damage the heart muscle or make it work too hard. This makes the heart weak and unable to pump blood effectively through the body.
Conditions or factors that can cause CHF include:
- Atherosclerosis, or coronary artery disease: This involves a buildup of plaque on the walls of the coronary arteries. Atherosclerosis is a type of arteriosclerosis.
- Heart attack: Also called myocardial infarction, this leads to the death of heart tissue due to a lack of oxygen.
- Cardiomyopathy: This means that a person has diseased heart muscle.
- Myocarditis: This is a type of inflammation of the heart.
- Cardiac arrhythmias: These are unusual heart rhythms.
- Congenital heart diseases: These heart diseases or irregularities are present at birth.
- Hypertension: This is also called high blood pressure.
- Diabetes: This chronic condition affects your body’s ability to use sugar for energy.
- Obesity: An unhealthy diet or a lack of physical activity can raise the risk of CHF.
- Advanced age: People ages 65 years and older have a higher risk of CHF.
- Hyperthyroidism: Doctors may also call this overactive thyroid.
- Severe anemia: People with anemia have a low number of red blood cells.
The life expectancy of a person with heart failure can vary according to several factors, including:
- their age
- their sex
- their socioeconomic status
- their ejection fraction
- their cardiac risk factors
- the presence or absence of coronary artery disease
A 2019 review found the following life expectancies for people with different stages of heart failure.
|Stage||Explanation||Survival at 5 years from diagnosis|
|A||high risk of heart failure but without symptoms or structural heart disease||97%|
|B||structural heart disease but without signs or symptoms of heart failure||96%|
|C||structural heart disease with past or current symptoms of heart failure||75%|
|D||advanced heart failure||20%|
Life expectancy for people with heart failure is constantly improving due to better knowledge and treatment options. There are several ways to reduce your risk of heart failure and the complications it can cause.
The survival rate refers to the proportion of people who are still alive for a length of time after receiving a particular diagnosis. For example, a 5-year survival rate of 50% means that 50%, or half, of the people are still alive 5 years after receiving the diagnosis.
It is important to remember that these figures are estimates and are based on the results of previous studies or treatments. A person can consult a healthcare professional about how their condition is going to affect them.
You can reduce your risk of developing heart disease and CHF by:
- eating a heart-healthy diet that is low in saturated and trans fats and high in fiber, whole grains, fruits, and vegetables
- limiting alcohol intake to one drink per day for women and two drinks per day for men
- maintaining a moderate weight
- not smoking
- participating in a regular exercise program
- reducing excessive stress, if possible
- seeking regular medical and prenatal care and following your treatment plan for such conditions as high cholesterol, obesity, hypertension, and diabetes
In addition to a complete medical history and physical examination, diagnostic procedures for heart failure may include the following:
- Chest X-ray: This diagnostic test uses electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- Echocardiogram: This noninvasive test uses sound waves to produce a study of the motion of the heart’s chambers and valves. As a healthcare professional passes an ultrasound transducer over the heart, the echo sound waves create an image on the monitor.
- Electrocardiogram: This test records the electrical activity of the heart, shows unusual rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
- B-type natriuretic peptide (BNP) testing: BNP is a hormone released from the ventricles in response to the increased wall tension (stress) that occurs with heart failure. The higher the BNP levels, the worse the heart failure.
Treatment for CHF includes preventive care to minimize the risk factors for heart attack and other forms of heart disease.
General preventive and treatment measures include the following:
- Making certain lifestyle and dietary changes can help you achieve and maintain an ideal weight and fitness level. Doctors recommend a heart-healthy diet that is low in saturated fats, trans fats, and sodium. Excessive salt consumption leads to fluid retention and increases blood pressure.
- Seeking regular medical care and getting treatment for risk factors such as high cholesterol, hypertension, obesity, smoking, diabetes, and excessive alcohol consumption can help you reduce the risks associated with heart failure.
- Taking all prescribed medications, measuring your weight daily, and regularly monitoring your symptoms can also help reduce these risks.
- Doctors may also try to prevent CHF by placing an implantable cardioverter defibrillator (ICD). ICDs are beneficial for people with low ejection fractions and those who have had an episode of asymptomatic ventricular arrhythmia. When the ICD detects a ventricular arrhythmia, it can act as a pacemaker to pace the arrhythmia to stop. When the pacing approach does not stop the arrhythmia, the ICD can deliver a shock to terminate the ventricular arrhythmia.
Some medications that can help treat CHF include:
- angiotensin-converting enzyme inhibitors
- angiotensin II receptor blockers
- combination valsartan/sacubitril
- aldosterone blockers
- cholesterol-lowering medications, or statins
Interventional and surgical management
A variety of surgical procedures may be used in the treatment of some cases of CHF, including:
- Angioplasty and stent placement or coronary artery bypass: These options may help treat severely blocked coronary arteries.
- Valve surgery: This can repair or replace damaged heart valves.
- Pacemaker implantation: Pacemakers can control unusual heart rhythms.
- ICDs: These can help prevent dangerous ventricular arrhythmias and sudden cardiac death.
- Implantable pulmonary artery pressure monitor: This device can assess for early signs of pulmonary congestions.
- Left ventricular assist device: This connects to the heart to improve its function.
- Heart transplant: This may be the only treatment option in cases of CHF where medications and lifestyle and dietary changes do not improve heart function.
You can help minimize the risk of serious complications of CHF by following the treatment plan that you and your doctor design specifically for you.
Serious and life threatening complications of CHF can include:
- cardiac arrest
- cardiogenic shock
- pulmonary edema
- serious or fatal cardiac arrhythmias, such as atrial fibrillation, ventricular tachycardia, or ventricular fibrillation
Here are some other frequently asked questions about CHF. These questions have all been answered by Dr. Payal Kohli, M.D., FACC.
How long does end stage congestive heart failure last?
End stage heart failure is a condition that usually has a very poor outlook without additional aggressive treatments, such as a left ventricular assistant device or heart transplant.
The duration or progression of the disease depends on the condition of the heart at diagnosis and how the symptoms respond to treatment.
How long can a person live with congestive heart failure?
This varies depending on the stage of the heart failure and the condition of the heart at diagnosis (see table above). For example, according to one estimate, someone who has stage C heart failure has a 75% chance of being alive 5 years later.
However, treating the heart with appropriate medical therapy is important regardless of the stage in order to improve survival as much as possible.
Is congestive heart failure curable?
There are certain types of heart failure wherein the function of the heart can return to “normal” after appropriate medical treatment.
Heart failure is not considered “cured” because a person is at risk of experiencing heart dysfunction again. However, the function of the heart is essentially normal, and the outlook is excellent.
What are the beginning stages of congestive heart failure?
In the early stages of heart failure, the heart is at risk of having problems or actually starts to have some problems with functioning without always manifesting symptoms.
How do you get rid of fluid from congestive heart failure?
You can use medications called diuretics, which are water pills that help the body get rid of excess fluid.
There are also other medications that help the heart work more efficiently, as well as some with other functions, such as the excretion of glucose in the urine, which can also help get rid of excess fluid.
CHF develops when the heart can no longer efficiently pump blood around the body because there is too much damage to or strain on the heart muscle.
CHF usually happens because of a secondary condition. However, you can reduce your risk of heart failure and its complications by eating healthily, exercising, reducing stress, and attending regular medical checkups.
Heart failure can be life threatening, and it may come on suddenly. There is currently no cure, but there are ways to help manage the condition, including making lifestyle changes, taking medication, and undergoing surgery.