An overview of Congestive heart failure

Congestive heart failure or Heart Failure is a health disorder that affect the heart.It occurs when the heart muscle doesn't pump blood as well as it should. When thishappens, blood often backs up and fluid can build up in the lungs, causing shortnessof breath.Certain heart conditions, such as narrowed arteries in the heart (coronaryartery disease) or high blood pressure, gradually leave the heart too weak or stiffto fill and pump blood properly. The chambers of the heart may respond by stretchingto hold more blood to pump through the body or by becoming stiff and thickened. Thishelps to keep the blood moving, but the heart muscle walls may eventually weaken andbecome unable to pump as efficiently. The kidneys may respond by causing the body toretain fluid (water) and salt. If fluid builds up in the arms, legs, ankles, feet,lungs, or other organs, the body becomes congested.

Left-sided heart failure : Fluid may back up in the lungs, causing shortness ofbreath.

Right-sided heart failure : Fluid may back up into the abdomen, legs and feet,causing swelling.

Systolic heart failure (also called heart failure with reduced ejection fraction) :The left ventricle can't contract vigorously, indicating a pumping problem.

Heart failure with preserved ejection fraction : The left ventricle can't relax orfill fully, indicating a filling problem.

Almost six million Americans have heart failure, and more than 870,000 people arediagnosed with heart failure each year. Heart failure (congestive heart failure) isthe leading cause of hospitalization in people older than 65.

Any of the following conditions can damage or weaken your heart and can cause heartfailure. Some of these can be present without your knowing it:

1. Coronary artery disease and heart attack : Coronary artery disease is the mostcommon form of heart disease and the most common cause of heart failure. The diseaseresults from the buildup of fatty deposits in the arteries, which reduces blood flowand can lead to heart attack.

2. High blood pressure : If your blood pressure is high, your heart has to workharder than it should to circulate blood throughout your body. Over time, this extraexertion can make your heart muscle too stiff or too weak to properly pump blood.

3.Faulty heart valves : The valves of the heart keep blood flowing in the properdirection. A damaged valve — due to a heart defect, coronary artery disease or heartinfection — forces the heart to work harder, which can weaken it over time.

4. Damage to the heart muscle : Heart muscle damage can have many causes, includingcertain diseases, infection, heavy alcohol use, and the toxic effect of drugs, suchas cocaine or some drugs used for chemotherapy. Genetic factors also can play arole.

5. Inflammation of the heart muscle (myocarditis) : Myocarditis is most commonlycaused by a virus, including the COVID-19 virus, and can lead to left-sided heartfailure.p>

6. A heart problem that you're born with (congenital heart defect) : If your heartand its chambers or valves haven't formed correctly, the healthy parts of your hearthave to work harder to pump blood, which may lead to heart failure.

7. Abnormal heart rhythms (arrhythmias) : Abnormal heart rhythms may cause your heartto beat too fast, creating extra work for your heart. A slow heartbeat also may leadto heart failure.

8. Other diseases : Long-term diseases — such as diabetes, HIV, an overactive orunderactive thyroid, or a buildup of iron or protein — also may contribute tochronic heart failure.

9. Blood clots in the lungs

10. Severe infections

11. Use of certain medications

12. Viruses that attack the heart muscle

1. Congested lungs : Fluid backup in the lungs can cause shortness of breath withexercise or difficulty breathing at rest or when lying flat in bed. Lung congestioncan also cause a dry, hacking cough or wheezing.

2. Fluid and water retention : Less blood to your kidneys causes fluid and waterretention, resulting in swollen ankles, legs, abdomen (called edema), and weightgain. Symptoms may cause an increased need to urinate during the night. Bloating inyour stomach may cause a loss of appetite or nausea.

3. Dizziness, fatigue, and weakness : Less blood to your major organs and musclesmakes you feel tired and weak. Less blood to the brain can cause dizziness orconfusion.

4. Rapid or irregular heartbeats : The heart beats faster to pump enough blood to thebody. This can cause a rapid or irregular heartbeat.

5.Shortness of breath.

There may be times that your symptoms are mild or you may not have any symptoms atall. This doesn't mean you no longer have heart failure. Symptoms of heart failurecan range from mild to severe and may come and go.

Unfortunately, heart failure usually gets worse over time. As it worsens, you mayhave more or different signs or symptoms. It’s important to let your doctor know ifyou have new symptoms or if your symptoms get worse.

If you have heart failure, you may have one or all of these symptoms or you may havenone of them. They may or may not indicate a weakened heart.

The key to preventing heart failure is to reduce your risk factors. You can controlor eliminate many of the risk factors for heart disease by making healthy lifestylechanges and by taking the medications prescribed by your doctor.

Lifestyle changes you can make to help prevent heart failure include:

1. Reducing and managing stress

2. Maintaining a healthy weight

3. Eating healthy foods

4. Controlling certain conditions, such as high blood pressure and diabetes

5. Staying physically active

6. Don't smoke

Your doctor will ask you many questions about your symptoms and medical history.You’ll be asked about any conditions you have that may cause heart failure (such ascoronary artery disease, angina, diabetes, heart valve disease, and high bloodpressure). You’ll be asked if you smoke, take drugs, drink alcohol (and how much youdrink), and about what drugs you take.You’ll also get a complete physical exam. Yourdoctor will listen to your heart and look for signs of heart failure as well asother illnesses that may have caused your heart muscle to weaken or stiffen.

Your doctor may also order other tests to determine the cause and severity of yourheart failure. These include:

1. Blood tests : Blood tests are used to evaluate kidney and thyroid function as wellas to check cholesterol levels and the presence of anemia. Anemia is a bloodcondition that happens when there is not enough hemoglobin (the substance in redblood cells that enables the blood to transport oxygen through the body) in yourblood.

2. B-type natriuretic peptide (BNP) blood test : BNP is a substance secreted from theheart in response to changes in blood pressure that happen when heart failuredevelops or worsens. BNP blood levels increase when heart failure symptoms worsen,and decrease when the heart failure condition is stable. The BNP level in a personwith heart failure -- even someone whose condition is stable -- may be higher thanin a person with normal heart function. BNP levels do not necessarily correlate withthe severity of heart failure.

3. Chest X-ray : A chest X-ray shows the size of your heart and whether there isfluid build-up around the heart and lungs.

4. Echocardiogram : This test is an ultrasound which shows the heart's movement,structure, and function.

5. Ejection fraction (EF) : is used to measure how well your heart pumps with eachbeat to determine if systolic dysfunction or heart failure with preserved leftventricular function is present. Your doctor can discuss which condition you have.

6. Electrocardiogram (EKG or ECG) : An EKG records the electrical impulses travelingthrough the heart.

7. Cardiac catheterization : This invasive procedure helps determine whether coronaryartery disease is a cause of congestive heart failure.

Stress Test : Noninvasive stress tests provide information about the likelihood ofcoronary artery disease.

Your treatment will depend on the type of heart failure you have and, in part, whatcaused it. Medications and lifestyle behaviors are part of every treatment plan.Your healthcare provider will talk to you about the best treatment plan for you.Treatment is the same, regardless of gender.As heart failure gets worse, your heartmuscle pumps less blood to your organs, and you move toward the next stage of heartfailure. Since you can’t move backward through the heart failure stages, the goal oftreatment is to keep you from moving forward through the stages or to slow down theprogression of your heart failure.

Stage A treatment

1. The usual treatment plan for people with Stage A heart failure includes:

2. Regular exercise, being active, walking every day.

3. Stopping the use of tobacco products.

4. for high blood pressure (medication, low-sodium diet, active lifestyle).

5. Treatment for high cholesterol.

6. Not drinking alcohol or using recreational drugs.

7. Angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II receptorblocker (ARB) if you have coronary artery disease, diabetes, high blood pressure, orother vascular or cardiac conditions.

8. blocker if you have high blood pressure.

Stage B treatment

1. The usual treatment plan for people with Stage B heart failure includes:

2. Treatments listed in Stage A.

3. Angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker(ARB) (if you aren't already taking one).

4. Beta-blocker if you’ve had a heart attack and your EF is 40% or lower (if youaren't already taking one).

5. Aldosterone antagonist if you’ve had a heart attack or if you have diabetes and anEF of 35% or less.

6. surgery or intervention as a treatment for coronary artery blockage, heart attack,valve disease (valve repair or replacement) or congenital heart disease.

Stage C treatment

1. The usual treatment plan for people with Stage C HF-rEF includes:

2. Treatments listed in Stages A and B.

3. blocker.

4. Aldosterone antagonist if a vasodilator medicine (ACE-I, ARB or angiotensinreceptor/neprilysin inhibitor combination) and beta-blocker don't relieve yoursymptoms.

5. nitrate combination if other treatments don't stop your symptoms. Patients who areBlack should take this medication (even if they’re taking other vasodilatormedications) if they have moderate­ to severe symptoms.

6. Medications that slow your heart rate if your heart rate is faster than 70 beatsper minute and you still have symptoms.

7. A diuretic ("water pill") may be prescribed if symptoms continue.

8. Restriction of sodium (salt) in your diet.

9. your weight every day. Tell your healthcare provider if you gain or lose more thanfour pounds.

10. Possible fluid restriction.

11. Possible cardiac resynchronization therapy (biventricular pacemaker).

12. If the treatment causes your symptoms to get better or stop, you still need tocontinue treatment to slow the progression to Stage D.

Stage D treatment

1. The usual treatment plan for people who have Stage D heart failure includestreatments listed in Stages A, B and C. In addition, it includes evaluation for moreadvanced treatment options, including:

2. Heart transplant.

3. Ventricular assist devices.

4. Heart surgery.

5. Continuous infusion of intravenous inotropic drugs.

6. Palliative or hospice care.

7. Research therapies.

Heart failure is a chronic condition that gets worse with time. There are four heartfailure stages (Stage A, B, C and D). The stages range from "high risk of developingheart failure" to "advanced heart failure."

Stage A

Stage A is considered pre-heart failure. It means you’re at high risk of developingheart failure because you have a family history of heart failure or you have one ormore of these medical conditions:

1. Hypertension.

2. Diabetes.

3. Coronary artery disease.

4. Metabolic syndrome.

5. History of alcohol abuse.

6. History of rheumatic fever.

7. Family history of cardiomyopathy.

8. History of taking drugs that can damage your heart muscle, such as some cancerdrugs.

Stage B

Stage B is considered pre-heart failure. It means your healthcare provider has givenyou a diagnosis of systolic left ventricular dysfunction but you’ve never hadsymptoms of heart failure. Most people with Stage B heart failure have anechocardiogram (echo) that shows an ejection fraction (EF) of 40% or less. (See"Diagnosis" section for more about ejection fraction.) This category includes peoplewho have heart failure and reduced EF (HF­-rEF) due to any cause.

Stage C

People with Stage C heart failure have a heart failure diagnosis and currently haveor previously had signs and symptoms of the condition.

There are many possible symptoms of heart failure. The most commonare:

Shortness of breath.

Feeling tired (fatigue).

Less able to exercise.

Weak legs.

Waking up to urinate.

Swollen feet, ankles, lower legs and abdomen (edema).

Stage D and reduced EF

People who have Stage D HF-rEF have advanced symptoms that don’t get better withtreatment. This is the final stage of heart failure.

Complications of heart failure depend on the severity of heart disease, your overallhealth and other factors such as your age. Possible complications can include:

1. Kidney damage or failure. Heart failure can reduce the blood flow to your kidneys,which can eventually cause kidney failure if left untreated. Kidney damage fromheart failure can require dialysis for treatment.

2. Heart valve problems. The valves of the heart, which keep blood flowing in theright direction, may not work properly if your heart is enlarged or if the pressurein your heart is very high due to heart failure.

3. Heart rhythm problems : Heart rhythm problems may lead to or increase your risk ofheart failure.

4. Liver damage : Heart failure can cause fluid buildup that puts too much pressureon the liver. This fluid backup can lead to scarring, which makes it more difficultfor your liver to work properly.