Congestive Heart Failure

Basic Facts

  • There are several different kinds of congestive heart failure that can occur for different reasons including weakening of the heart muscle, stiffening of heart muscle, and dysfunction of the valves in the heart. 
  • Commonly, the heart’s pumping inefficiency causes a buildup of blood in the lungs, a condition called pulmonary congestion. 
  • Although most forms of congestive heart failure are life-long, the goal of treatment is to decrease the likelihood of disease progression, to lesson symptoms and to improve quality of life.

Types of Heart Failure

  • Left-sided Heart Failure - The left ventricle typically pumps out inadequate amounts of oxygenated blood to the rest of the body, and fluid backs up into the lungs.
  • Right-sided Heart Failure - The resistance to blood flow through the lungs exceeds the right ventricle’s ability to pump blood into the lungs. Consequently, blood backs up into the liver and other organs. The most common cause of right heart failure is actually left heart failure.
  • Systolic Heart Failure - The heart’s pumping function is depressed.
  • Diastolic Heart Failure - The heart is unable to fill up with an adequate amount of blood. Diastolic heart failure usually occurs because the muscular heart wall thickens and stiffens. Abnormal thickening of the heart muscle wall, called hypertrophy, has many causes, the most common of which is hypertension. Less commonly, hypertrophic cardiomyopathy may cause heart muscle to thicken. Up to 50% of patients with heart failure have diastolic heart failure. 
As the heart muscle weakens, the heart's pumping function decreases. Blood can back up into the lungs, liver, and other organs.
Congestive Heart Failure

The symptoms of heart failure often develop slowly because the body can compensate for early effects of the disease, thus the heart’s function may diminish significantly without noticeable symptoms. Symptoms include:

  • Shortness of breath (dyspnea),
  • Coughing, especially when lying flat,
  • Swelling and weight gain, and 
  • Fatigue

Some factors that can lead to congestive heart failure include:

  • Heart attacks and coronary heart disease
  • Uncontrolled or long-standing high blood pressure
  • Viral or bacterial infections
  • Complications during pregnancy 
  • Chronic alcohol abuse
  • Damage to the mitral and aortic valves 
  • Aortic valve disease
  • Cancer therapies
  • Certain courses of treatment for AIDS
  • Hyperthyroidism

Physicians diagnose congestive heart failure through a medical history and a physical exam. 

Shortness of breath on exertion, or dyspnea, and weakness are the two main symptoms physicians look for when diagnosing the condition. During an exam, a doctor may also hear rales, or wet crackles, indicating fluid in the lungs. Physicians may also listen with a stethoscope for sounds of a 'gallop,' or extra beat, in the heart that indicates abnormal heart function. 

Physicians use the following tests to confirm the diagnosis:

  • Blood work
  • Chest X-Rays
  • Echocardiogram - This test uses sound waves to create a moving picture of the heart, showing its size and shape, as well as how the heart chambers and valves are working.

The basic strategies for controlling heart failure are to prevent the progressive decrease in the heart’s pumping function and to relieve symptoms. Medication is often used to achieve these strategies. Physicians may prescribe:

  • ACE inhibitors help widen blood vessels, increasing the amount of blood the heart pumps and lowering blood pressure. 
  • Diuretics reduce fluid retention, a common symptom of heart failure.
  • Nitrates (nitroglycerin) temporarily dilates the coronary arteries. This increases blood flow to the heart, relieving chest pain or pressure.
  • Beta-blockers lower blood pressure and heart rate, reducing the workload on the heart.
  • Spironolactone treats fluid buildup.
  • Angiotensin receptor blockers (ARB) dilate (widen) the blood vessels to improve the amount of blood the heart pumps.
  • Sacubitril treats high blood pressure.

In some instances, the cause of heart failure may be reversible through one of the following: 

  • Angioplasty and Stenting - During this non-surgical procedure, a balloon attached to a small catheter is inflated within an artery to flatten the plaque against the artery wall, increasing the artery's diameter. In most cases, a stent, a metal-mesh tube, is expanded and left inside the artery to support the expansion and maintain blood flow.
  • Bypass Surgery - A physician replaces, or bypasses, the blocked artery with a healthy blood vessel harvested from the person or made from synthetic material.
  • Heart Valve Repair or Replacement Surgery

Lifestyle Changes

Physicians also recommend:

  • Quitting smoking,
  • Eating to control high blood pressure,
  • Eating to lower cholesterol,
  • Exercising,
  • Losing weight,
  • Controlling diabetes,
  • Limiting alcohol intake, and
  • Weighing daily to detect fluid build up.