Congestive Heart Failure: Causes, Types, Symptoms, Treatment

Congestive Heart Failure (CHF) is a complex clinical syndrome which develops as a result of the inability of the heart to pump sufficient amounts of blood to various organs and to collect blood from organs. This leads to reduction in blood flow and causes backup or congestion of blood in the veins and fluid buildup in the lungs leading to symptoms like breathlessness, fatigue, fluid retention, and weakness. A neurohormonal response results in an increase in blood pressure, pulmonary congestion, ascites or peripheral edema. 

Key Terms: CHF, Congestive Heart Failure, pulmonary, heart, lung, dysfunction, left, right, blood, pump, valve.

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Causes of Congestive Heart Failure

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The causes of congestive heart failure include: 

• High blood pressure / Hypertension
• Coronary artery disease
• Inflammation of Heart muscles (cardiomyopathy, myocarditis)
• Valve disorders
• Valvular Defects
• Severe lung disorders (pulmonary embolism or blood clot in lungs)
• Anaemia
• Thyroid gland dysfunction
• Kidney failure
• Abnormal heart rhythms
• Type 2 diabetes

Read about: Human Heart

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Types of Congestive Heart Failure

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The types of heart failure are as mentioned below:

Left-sided Heart Failure

The left sided heart failure is the most common and it happens due to abnormal function of the left ventricle of the heart. The left ventricle is unable to pump sufficient blood leading to a backup of blood or congestion of the pulmonary veins (which carry oxygenated blood from lungs to the left ventricle).

Systolic dysfunction

The left ventricle does not contract normally and makes it difficult for the heart to pump blood into the body.

Diastolic dysfunction

In diastolic dysfunction, the heart is unable to fill up with blood due to the stiffness of the left ventricle which cannot relax as a result of being stiff.

Left Sided Heart Failure

Right Sided Heart Failure

Right sided heart failure is a result of the dysfunction of the right ventricle of the heart which is responsible for pumping blood back to the lungs. The right ventricle fails to pump the required amount of blood to lungs and causes congestion in the veins carrying blood to the lungs. This results in leakage of the fluid from the veins to the tissues around it. The fluid buildup is generally in the legs, belly or genital areas.

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Symptoms of Congestive Heart Failure

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Heart failure signs and symptoms include:

• Shortness of breath 
• Tiredness accompanied by weakness
• Edema or Swelling of extremities
• Irregular heartbeat or palpitations
• Nocturnal cough
• Wheezing accompanied by pink mucus
• Swelling of the abdomen
• Rapid weight gain
• Nausea and lack of appetite
• Difficulty in focussing 
• Dizziness
• Chest pain

Symptoms of CHF

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Diagnosis of Congestive Heart Failure

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When a person presents the symptoms of the heart failure mentioned above, the doctor will take a complete medical history of the patient to confirm if he suffers from any other related chronic ailments. Also, the doctor will prescribe the following tests to confirm the severity of heart damage:

• Cardiac Catheterization
• Chest X-ray
• Echocardiogram (echo)
• Ejection fraction (EF)
• Electrocardiogram (EKG or ECG)
• Multigated Acquisition Scan (MUGA scan)
• Stress Test

Based on the test results the doctor will further prescribe lifestyle changes and medications to alleviate the patient’s condition.

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Stages of Congestive Heart Failure

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Congestive heart failure has been classified into four stages as seen in the image below. As the heart slowly starts to weaken, it is unable to meet the metabolic demands of a body, eventually leading to heart failure. 

• Initially, in stage I, there are not many symptoms except some tiredness and breathlessness when doing activities like jogging or climbing stairs. Life is fairly usual and it does not show apparent signs of heart failure. The CHF can be managed in this stage with some lifestyle changes and mild medication. 
• In stage II, the symptoms like shortness of breath, palpitation and fatigue appear when the person is active or exercising but not when he is resting. Careful monitoring is required at this stage and lifestyle adjustments must be done.
• Gradually, in stage III, the person starts experiencing difficulties even when mildly active. Consultation with a doctor becomes necessary at this stage to prevent further damage.
• Eventually in stage IV, as the heart weakens further, the condition worsens and the demand is not met even when the body is at rest. Although nothing can be done at this stage to stop the damage to the heart, medications must be taken to alleviate the discomfort to the patient. 

Four Stages of CHF

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Treatment of Congestive Heart Failure

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The treatment of congestive heart failure is aimed at slowing down the progress of the disease. 

• ACE Inhibitors - Angiotensin Converting Enzyme (ACE) inhibitors are given to dilated the narrowed blood vessels which help in reducing the blood pressure and lowering the hormones that cause damage to the heart. 
• Beta blockers - they reduce the pace of heart beat and also lower the blood pressure.
• Diuretics - They help in removing excess fluid from the body through excretion.
• If the medications are not sufficient, the treatment may also involve surgeries like Angioplasty which involves opening up of the blocked arteries and heart valve repair surgery to rectify the dysfunction of the valves.

Ways to reduce risk of developing heart failure

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Things to Remember

• Congestive heart failure results from inability of the heart to pump adequate amount of blood to meet the metabolic demands of various organs of the body
• The main symptoms of CHF are shortness of breath and edema resulting from water retention.
• Generally, CHF occurs in the left side of the heart and if left untreated it progresses to the right side.
• There is no cure as such for CHF but the progress of the disease can be slowed down by medications and surgeries.
• During initial stage of CHF, minor lifestyle changes can improve the situation

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