Congestive Heart Failure (CHF) Overview

Congestive heart failure (CHF) occurs when the heart muscle, due to weakness or stiffening, fails to pump blood effectively, leading to inadequate circulation. Consequently, blood accumulates in various parts of the body, such as the liver, abdomen, lower legs, and lungs, as the heart struggles to meet the body's circulatory demands. CHF often starts on the left side, where the left ventricle, the heart's primary pumping chamber, is located.

Types of Congestive Heart Failure

There are four main types of CHF:

1. Left-Sided Heart Failure: Causes fluid buildup in the lungs.
2. Right-Sided Heart Failure: Leads to fluid accumulation in the abdomen, legs, and feet.
3. Systolic Heart Failure: The left ventricle cannot contract forcefully enough.
4. Diastolic Heart Failure: The left ventricle cannot fully relax, leading to filling issues.

CHF can be classified as either chronic or acute.

Causes of Congestive Heart Failure

Various factors can lead to CHF, including an unhealthy lifestyle, congenital defects, coronary artery disease, diabetes, and hypertension.

Coronary Artery Disease

The most common cause of CHF is coronary artery disease, characterized by the buildup of fatty deposits (plaque) in the arteries supplying blood to the heart muscle, known as atherosclerosis.

Heart Attack

A heart attack can occur if a plaque ruptures, forming a blood clot that blocks blood flow to a part of the heart, causing permanent damage and weakening the heart muscle.

Hypertension

High blood pressure forces the heart to work harder to circulate blood, causing the heart muscle to thicken and eventually weaken.

Faulty Heart Valves

Damaged heart valves can cause blood to back up, making the heart work harder. Valve damage can result from congenital defects, heart infections, or coronary artery disease.

Cardiomyopathy

Damage to the heart muscle (cardiomyopathy) can be caused by infections (like myocarditis), alcohol or drug abuse, chemotherapy, or genetic factors.

Congenital Heart Defects

Some infants are born with heart defects that impair the proper function of the valves or chambers, leading to CHF.

Other causes include heart arrhythmias, infections, allergic reactions, certain medications, and blood clots in the lungs.

Symptoms of Congestive Heart Failure

Symptoms of CHF include:

• Abdominal swelling (ascites)
• Swelling in the legs, ankles, and feet (edema)
• Fatigue and weakness
• Reduced exercise capacity
• Increased nighttime urination
• Persistent coughing or wheezing
• Pink-tinged phlegm
• Rapid or irregular heartbeat
• Shortness of breath, especially with exertion
• Chest pain (if CHF is due to a heart attack)

Diagnosis of Congestive Heart Failure

To diagnose CHF, a comprehensive medical examination is conducted, along with the following tests:

• Blood tests
• Chest X-rays
• Electrocardiogram (EKG or ECG)
• Echocardiogram
• Stress test
• CT or MRI scan
• Coronary angiogram
• Myocardial biopsy (in some cases)

Treatment of Congestive Heart Failure

CHF treatment is essential to prevent complications such as kidney failure and death. Treatment options include medications and surgery.

Medications

Medications commonly used to treat CHF include:

• Beta blockers
• Diuretics
• Digoxin (digitalis)
• Aldosterone antagonists
• Inotropes
• Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers

Surgical Treatments

When medications are insufficient, surgical options may be considered, including:

• Coronary bypass surgery
• Heart valve repair or replacement
• Implantation of cardioverter-defibrillators (ICDs)
• Cardiac resynchronization therapy (CRT)
• Ventricular assistive device (VAD) implantation

In severe cases, a total artificial heart (TAH) or heart transplant may be necessary.

‍