Congestive Heart Failure

Basic Facts

Congestive Heart Failure (CHF) occurs when the heart is not able to pump normally, which leads to a backup of fluid in the body. Commonly, this causes a buildup of blood in the lungs called "pulmonary congestion".
CHF can occur for different reasons, including weakening of the heart muscle, stiffening of heart muscle, and/or dysfunction of the valves in the heart.
Although most forms of congestive heart failure are life-long, the goal of treatment is to decrease the likelihood of disease progression, to lessen symptoms and to improve quality of life.

Heart Failure

Types of Heart Failure

Left-sided Heart Failure - The left ventricle inadequately pumps blood out to the body and fluid backs up into the lungs.
Right-sided Heart Failure - Increased pressure and resistance in the lungs exceeds the right ventricle’s ability to pump blood into the lungs. Consequently, fluid 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, though the pumping function is adequate (normal EF). Diastolic heart failure usually occurs because the heart muscle thickens and stiffens, most commonly due to hypertension. Less commonly, hypertrophic cardiomyopathy may cause heart muscle to thicken. About half of patients with heart failure have diastolic heart failure.

The symptoms of heart failure can occur suddenly (acute CHF), but more often develop slowly (chronic CHF) because the body can compensate for early effects of the disease, thus the heart’s function may diminish significantly without noticeable symptoms. Symptoms include:

Having to slow down or stop to catch your breath more often (called “dyspnea on exertion”)
Coughing or difficulty breathing when lying flat (called “orthopnea”)
Swelling in legs and/or abdomen (called “edema”)
Weight gain, especially rapid weight gain of 2-3+ lbs in one day or 5+ lbs in one week
Fatigue- feeling a lack of physical or mental energy

CHF can occur for many different reasons. Some factors that can lead to congestive heart failure include:

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

It is important to remember that “CHF” is a term describing a set of symptoms occurring from a backup of fluid from the heart. Your provider will investigate why it is occurring.

CHF is often diagnosed simply by a history and physical exam

Fluid in lungs can be seen on a chest x-ray

Labs – blood tests to screen for conditions that might be contributing to CHF

Echocardiogram – painless, noninvasive study that uses ultrasound waves to evaluate heart structure and function in real time

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

Diuretics – help your body eliminate extra fluid, a common symptom of heart failure.
Beta-blockers – lower blood pressure and heart rate, reducing the workload on the heart.
ACE inhibitors and ARBs – help widen blood vessels to lower blood pressure, and increase the amount of blood the heart pumps. 
Entresto – valsartan (an ARB) plus sacubitril, which helps up-regulate your body’s natural mechanisms to get rid of extra fluid. Spironolactone – helps lower blood pressure and remove extra fluid
SGLT2 inhibitors – help your body rid fluid by peeing off sugar, which also helps lower A1c and reduces cardiovascular risks.
Nitrates – relax the coronary arteries, increasing blood flow to the heart
Hydralazine – helps widen blood vessels, lowering blood pressure. Sometimes used in combination with a nitrate (BiDil)

Additional options for therapy include ivabradine, vericiguat, or digoxinIn some instances, the cause of heart failure may be reversible through one of the following: 

Cardiac catheterization with angioplasty and Stenting to correct a blockage from coronary artery disease (CAD).

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 measures to help manage heart failure include:

Weighing daily to detect fluid build up
Eating less than 2000 mg of sodium a day

Limiting fluid intake to 1.5-2 liters daily (48-64 oz)

Exercising

Losing weight

Controlling diabetes

Limiting alcohol intake, and

Quitting smoking

Congestive Heart Failure

Basic Facts

Causes and Risk Factors

Diagnosis

Treatment Approaches