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Causes of Congestive Heart Failure, its Symptoms and Treatment

Causes of Congestive Heart Failure, its Symptoms and Treatment

  • January 25, 2020
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Heart failure is a condition in which the heart cannot pump enough blood to meet the body’s needs. Heart failure does not mean your heart has stopped or will stop working. Rather, it means that your heart cannot pump blood efficiently. This can affect one or both sides of the heart.

This can happen if the heart muscle itself is weaker than usual or if there is a defect in the heart that prevents blood from entering the bloodstream. When the heart does not circulate blood as it should, the kidneys receive less blood and filter out less fluid into the urine. Excessive fluid in circulation builds up in the lungs, liver, around the eyes and sometimes in the legs. This is known as fluid congestion and is therefore referred to by doctors as congestive heart failure.

Older children with heart failure can get tired and have difficulty keeping up with their friends at the playground, while infants with heart failure usually have symptoms during breastfeeding, including sweating, fast breathing, and fatigue. In addition, these babies cannot gain weight. Fluid can also accumulate throughout the body and cause swelling in the legs, feet or around the eyes.

Heart failure affects nearly 6 million Americans. Around 670,000 people experience heart failure every year. In Nigeria, there are more than 100,000 cases of heart failure per year. This is the most common cause of hospitalization for people over 65 years of age.

Certain conditions, such as narrowed arteries in the heart (coronary artery disease) or high blood pressure, gradually make your heart too weak or rigid to fill and pump blood effectively.

Not all conditions that cause heart failure can be reversed, but treatment can improve the signs and symptoms and help you live longer. Lifestyle changes – such as exercise, reducing sodium in your diet, coping with stress and losing weight – can improve your quality of life.

One way to prevent heart failure is to prevent and control conditions that cause it, e.g. coronary artery disease, high blood pressure, diabetes or obesity.

Medicines known as diuretics (water pills), such as furosemide (Lasix), help get rid of excess fluid through increased urination. Sometimes a low salt diet may be needed to rid the body of excess fluids. Medications for blood vessels relaxation (such as captopril, enalapril) can sometimes be used to make the heart pump more easily. Another drug, digoxin, can make the heart contract more.

Stages of Heart Failure

There are four different stages of Heart Failure: A, B, C and D.​1​

When this disease develops, one’s chances of survival are reduced by at least 5 years.

Stage A

People with stage A heart failure do not have heart dysfunction but are at high risk of heart failure due to accompanying conditions such as chronic high blood pressure, diabetes and coronary artery disease.

People with this stage of heart failure have no problems with the structure of their heart or how their heart works. You will also rarely experience symptoms of heart failure, but you may experience symptoms related to your other conditions.

Stage B

At this stage, structural heart disease develops, such as a reduction in the heart’s pumping function, which can cause the left ventricle to enlarge. This can also be the result of a previous heart attack. However, people with stage B heart failure remain asymptomatic.

Stage C

People at this stage show symptoms of heart failure associated with underlying structural heart disease, including fatigue or shortness of breath. These symptoms usually occur due to problems with left ventricular ejection function, or the heart’s pump chamber.

Stage C Heart Failure also includes people who are no longer symptomatic but are currently being treated for previous symptoms, for example, those who have been hospitalized for a long time due to worsening heart failure.

Stage D

In stage D, people have advanced structural heart disease and show significant symptoms even when they are at rest.

This stage is difficult and may require advanced special care, such as mechanical circulatory support, continuous inotropic infusion to strengthen the heart, or heart transplantation.

Types

Left-sided Congestive Heart Failure which occurs when your left ventricle does not pump blood properly to your body is the most common type of Heart Failure. During the course of the disease, fluid can accumulate in the lungs and make breathing difficult.

There are two types of left-sided heart failure:

  • Systolic heart failure: This type of heart failure occurs when the heart muscle does not contract with enough force. It causes less oxygen-rich blood to be pumped throughout the body. It is also known as systolic dysfunction.
  • Diastolic heart failure: This type occurs when the heart contracts normally but the ventricles don’t relax well or become stiff and less blood enters the heart during normal filling. It is also referred to as diastolic dysfunction.

Right-sided Congestive Heart Failure occurs when the right ventricle has difficulty pumping blood to the lungs. Blood builds up in the blood vessels and causes fluid retention in the lower limbs, stomach and other vital organs.

Causes of congestive heart failure

You may experience both left-sided and right-sided heart failure at the same time. Usually, the disease starts on the left side and then moves to the right if not treated.

Heart Failure Symptoms

Depending on the stage of your congestive heart failure, you may have no symptoms or symptoms may be from mild to severe. The symptoms can be persistent or come and go. Symptoms can include:

  • Congestion in the Lungs: Reserves of fluid in the lungs can cause shortness of breath when exercising or difficulty breathing at rest or lying flat in bed. Congestion in the lungs can also cause a dry cough or wheezing.
  • Retention of Fluid and Water: Less blood in your kidneys will cause you to retain fluid and water, causing you to gain weight and your ankles, feet and stomach to swell. Symptoms can cause increased urination at night. Swelling in the stomach can cause loss of appetite or nausea.
  • Fatigue, Weakness and Dizziness: Less blood in your main organs and muscles makes you tired and weak. Less blood in the brain can cause dizziness or confusion.
  • Irregular Heartbeat: The heart beats faster to pump enough blood into the body. This can result in a fast or irregular heartbeat.

Chest pain that radiates throughout the upper body can also be a symptom of a heart attack. If you see this or other symptoms that might indicate serious heart disease, see your doctor immediately.

Diagnosis

After you tell your doctor about your symptoms, you may be referred to a cardiologist or heart specialist.

The cardiologist will ask lots of questions about your symptoms and medical history. You will be asked about possible diseases that can cause heart failure (e.g. coronary artery disease, angina pectoris, diabetes, heart valve disease, and high blood pressure). You will be asked if you smoke, use drugs, drink alcohol (and how much you drink), and what drugs you use.

You will also get a complete physical exam. Your cardiologist will listen to your heart and look for signs of heart failure, as well as other conditions that might cause your heart muscle to weaken or tighten.

Image Source: MedicineNet Inc.

Your cardiologist can also order other tests to determine the cause and severity of your heart failure. This includes:

  • Electrocardiogram: Electrocardiogram (ECG or EKG) records your heart’s rhythm. Abnormal heartbeats, such as accelerated heartbeats or irregular rhythms, can indicate that the walls of the heart chambers are thicker than normal. This can be a warning sign of a heart attack.
  • Echocardiogram: Echocardiogram uses sound waves to record the structure and movement of the heart. The test can determine whether you have poor circulation, muscle damage, or heart muscle that is not contracting normally.
  • Magnetic Resonance Imaging (MRI): Magnetic resonance imaging takes a picture of your heart. With still images and moving images, your doctor can determine whether your heart is damaged.
  • Stress test: Stress tests show how well your heart is working at different stress levels. Increasing your heart rate makes it easier for doctors to diagnose the problem.
  • Blood tests: Blood tests can show abnormal blood cells and infection. The cardiologist can also check the level of Brain Natriuretic Peptide (BNP), a hormone that increases with heart failure.
  • Cardiac catheterization: Cardiac catheterization can indicate blockages in the coronary arteries. Your doctor will insert a tube into your vein and thread it from your upper thigh, arm, or wrist.

At the same time, your doctor can take blood samples, examine your coronary arteries with X-rays, and check blood flow and pressure in your heart chamber.

Congestive Heart Failure Causes

Heart failure often arises after other diseases damage or weaken your heart. However, the heart does not have to be weakened to cause heart failure. It can also occur when the heart becomes too rigid.

With heart failure, the ventricles can become stiff and fail to fill properly between heartbeats. In some cases of heart failure, your heart muscle can be damaged and weakened, and the ventricles become so stretched that the heart cannot pump blood efficiently throughout your body.

Over time, the heart can no longer meet the normal requirements for pumping blood throughout the body.

The ejection fraction is an important measure of how well your heart is pumping and is used to classify heart failure and control treatment. In a healthy heart, the ejection fraction is 50 per cent or more – meaning more than half the blood that fills the ventricles is pumped every time the heart beats.

Heart failure can also occur with a normal ejection fraction. This occurs when the heart muscle becomes stiff in conditions such as high blood pressure.

Heart failure can include the left ventricle, the right ventricle, or both sides of your heart. Heart failure usually starts on the left side, especially the left ventricle – the main pumping chamber of your heart.

Heart failure is caused by many diseases that damage the heart muscle, including:

Coronary Artery Disease


Coronary artery disease, a disease that affects the arteries which supply blood and oxygen to the heart, causes a decrease in blood flow to the heart muscle. When the arteries become blocked or narrowed, the heart is hungry for oxygen and nutrients.

Heart Attack

A heart attack occurs when a coronary artery suddenly becomes blocked and blood flow to the heart muscle is interrupted. Heart attacks damage the heart muscle and result in scarred areas that do not function properly.

Cardiomyopathy (Damage to the heart muscle)

Damage to the heart muscle for reasons other than arterial or circulatory disorders, such as Infection or abuse of alcohol or drugs.

Conditions that Overwork the Heart

Diseases such as high blood pressure, thyroid disease, kidney disease, diabetes or heart defects at birth can all result in heart failure. In addition, heart failure can occur when there are several diseases or conditions simultaneously.

Valve Condition

Your heart valve regulates blood flow through your heart by opening and closing so that blood can flow in and out of the ventricles. A valve that doesn’t open and closes properly can force your ventricles to work harder to pump blood. This can be caused by a heart infection or defect.

Myocarditis

Inflammation of the heart muscle that is most often caused by a virus and can lead to left-sided heart failure.

Heart defects with which you were born (congenital heart defects)

If the heart and chambers or valves are not formed properly, healthy parts of the heart must work harder to pump blood through the heart, which in turn can cause heart failure.

Abnormal Heart Rhythm

Abnormal heart rhythms (heart arrhythmias) can make your heart beat too fast, which creates extra work for your heart. A slow heart rate can also cause heart failure.

Other Conditions

Although heart disease can cause Congestive Heart Failure, there are a number of other seemingly independent conditions that can also increase your risk. This includes diabetes, thyroid disease and obesity. Severe infections and allergic reactions can also contribute to heart failure.

Congestive Heart ​*​Failure Treatment

You and your doctor can consider different treatments, depending on your general health and the extent of progression of your condition.

Medications for Heart Failure

There are several drugs that can be used to treat congestive heart failure, including:

Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)

ACE inhibitors open constricted blood vessels to increase blood flow. Vasodilators are another option if you do not tolerate ACE inhibitors.

ACE inhibitors should not be taken with the following medicines without consulting your doctor, because this can cause side effects:

  • Thiazide diuretics (it can further reduce blood pressure)
  • Potassium-containing diuretics such as triamterene (direnium), eplerenone (inspra) and spironolactone (Aldactone) (can cause potassium to accumulate in the blood thereby causing abnormal heart rhythm)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin and naproxen (can cause sodium and water retention and can reduce the effect of ACE inhibitors on your blood pressure).

Always talk with your doctor before taking new medicines.

Beta-blockers

Beta-blockers can lower blood pressure and reduce a rapid heart rate. Beta-blockers must be used with caution with the following medicines because they can cause side effects:

  • Antiarrhythmic drugs such as amiodarone (necterone) can increase cardiovascular effects, including decreased blood pressure and slowing the heart rate.
  • Antihypertensives such as Lisinopril (Zestril), Candesartan (Atacand) and Amlodipin (Norvasc) can also increase the likelihood of cardiovascular effects.
  • The effect of albuterol (AccuNeb) on bronchodilation can be reversed with beta-blockers.
  • Fentora (fentanyl) can cause low blood pressure.
  • Antipsychotics such as thioridazine (melaryl) can also cause low blood pressure.
  • Clonidine (catapress) can cause high blood pressure.

Diuretics

Diuretics reduce the amount of fluid in your body. Congestive Heart Failure can make your body retain more fluid than required.

Your doctor can recommend:

  • Thiazide diuretics: They cause blood vessels to expand and help the body secrete excess fluid.
  • Loop diuretics: As a result, the kidneys produce more urine. This helps eliminate excess fluid from your body.
  • Potassium-sparing diuretic: They help get rid of fluid and sodium while maintaining potassium.

Surgery

If the drug itself is ineffective, more invasive procedures may be needed. Angioplasty, a procedure for opening blocked arteries, is an option. Your cardiologist may also consider repairing heart valves to help with proper valve opening and closing. Other surgical procedures that may be considered include:

  • Coronary artery bypass surgery: The most common operation for coronary artery disease is bypass surgery. Although surgery is more risky for people with heart failure, new strategies before, during, and after surgery have been developed to reduce risk and improve outcomes.
  • Heart valve surgery: Diseased heart valves can be treated both surgically (traditional heart valve surgery) and non-surgery (balloon valuloplasty).
  • Implanted left ventricular device (LVAD): Implanted left ventricular device is known as a bridge to transplantation for patients who have not yet responded to other treatments and have been hospitalized with severe systolic heart failure. This device helps the heart pump blood throughout your body. Patients with heart failure can move and sometimes go home to wait for a heart transplant. It can also be used as a goal of long-term support for patients who are not transplanted.
  • Heart transplant: A heart transplant is considered if heart failure is so severe that it does not respond to all other therapies, but the patient’s health is otherwise good.

How can I prevent my heart failure from getting worse?

  • Control your blood pressure: With heart failure, hormone release causes blood vessels to contract or narrow. The heart has to work hard to pump blood through contracted vessels. It is important for you to maintain a controlled blood pressure so that your heart can pump more efficiently without additional stress.
  • Keep an eye on your symptoms: Check your fluid staus by weighing every day and check for swelling. Contact your doctor if you experience unexplained weight gain (3 pounds a day or 5 pounds a week) or if you suffer from edema.
  • Maintain fluid balance: Your doctor may ask you to record the amount of fluid you drink or eat and how frequently you use the toilet. Remember, the more fluid in your veins, the harder your heart has to work to pump excess fluid through your body. Limiting fluid intake to less than 2 litres a day can reduce heart rate and prevent symptoms.
  • Limit your salt intake: Sodium is naturally found in many of the foods we eat. This is also added for seasoning or preservation. If you eat a low sodium diet, you should hold less fluid, swell less, and breathe easier.
  • Monitor your weight and lose weight if necessary: Find out how much your dry weight (weight without extra water) or ideal weight is. Your goal should be to maintain your weight within 4 pounds of your dry weight. Weigh at the same time every day, preferably in the morning, with the same clothes, after urinating, but before eating and in the same order of magnitude. Record your weight in a diary or calendar. If you add three pounds a day or five pounds a week, contact your doctor. Your doctor may want to adjust your medication.
  • Watch your symptoms: Contact your doctor if you experience new symptoms or if your symptoms get worse. Don’t wait until your symptoms are so severe that you should get emergency treatment.
  • Take medicine as directed: Medications are used to increase your heart’s ability to pump blood, reduce stress on your heart, reduce the development of heart failure, and prevent fluid retention. Many heart failure medications are used to reduce the release of dangerous hormones. These drugs cause your blood vessels to expand or relax (which lowers your blood pressure).
  • Schedule regular medical appointments: During the follow-up period, the doctor will ensure that you are healthy and that your heart failure does not get worse. Your doctor will ask you to check your weight record and list of medications. If you have questions, write them down and bring them along with you when coming for your appointment. Contact your doctor if you have urgent questions. Tell all your doctors about heart failure, and medications. Also, ask your doctor about new medicines that have been prescribed by other doctors. Keep good notes and carry it with you every time you visit a doctor.

Risk Factors

One risk factor can be enough to cause heart failure, but a combination of factors also increases the risk. Risk factors are:

  • High blood pressure: Your heart works harder than it should when your blood pressure is high.
  • Coronary artery disease: Narrowed arteries can limit the supply of oxygen to your heart and cause weakening of the heart muscle.
  • Heart attack: A heart attack is a form of heart disease that occurs suddenly. Damage to the heart muscle due to a heart attack can cause your heart to not pump properly.
  • Diabetes: Diabetes increases the risk of high blood pressure and coronary artery disease.
  • Some medications for diabetes: Diabetes medications such as rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure in some people. If you take this medicine, do not stop taking it on your own. Rather, talk to your doctor about whether you should make changes.
  • Certain medications: Some medications can cause heart failure or heart problems. Medications that can increase the risk of heart problems include nonsteroidal anti-inflammatory drugs (NSAIDs); some anesthesia drugs; some antiarrhythmic drugs; certain drugs used to treat high blood pressure, cancer, blood disorders, neurological disorders, psychiatric disorders, lung disorders, urological disorders, inflammation and infection problems; and over-the-counter medicines and other drugs. If you have questions about the medicines you are taking, talk to your doctor whether they recommend changes. Don’t just stop taking medicine on your own.
  • Sleep apnea: The inability to breathe properly at night causes low blood oxygen levels and an increased risk of irregular heartbeat. Both problems can weaken the heart.
  • Uneven heartbeat: This abnormal rhythm, especially if it is very frequent and fast, can weaken the heart muscle and cause heart failure.
  • Congenital heart condition: Some people who experience heart failure are born with structural heart defects.
  • Valvular heart disease: People with valvular heart disease have a higher risk of heart failure.
  • Virus: Viral infections can damage the heart muscle.
  • Alcohol: Too much alcohol can weaken the heart muscle and cause heart failure.
  • Tobacco: Tobacco use can increase the risk of heart failure.
  • Obesity: Obese people are at higher risk of heart failure.

What to do If You have Congestive Heart Failure

  • Eat healthy Food: Limit your of salt intake to less than 2000 milligrams (2 grams) a day. Eat high fiber foods. Limit foods that are high in fat, cholesterol, and sugar. Reduce your daily calorie intake to lose weight when needed.
  • Exercise regularly: A regular cardiovascular exercise program prescribed by a doctor will help you increase strength and feel better. It can also reduce the development of heart failure.
  • Don’t overwork yourself: Plan your activities and schedule periods of rest throughout the day. Some activities, such as tensing or pulling heavy objects and shovels, can make heart failure and its symptoms worse.
  • Prevent respiratory infections: Ask your doctor about the flu and pneumonia vaccines to prevent respiratory tract infections.
  • Take medicine as directed: Don’t stop taking your medication without first contacting your doctor.
  • Seek psychological support if necessary: Heart failure can make it difficult for your entire family. If you have questions, ask your doctor or nurse. If you need emotional support, social workers, psychologists, pastors, and heart failure support groups are on the phone. Ask your doctor or nurse to point you in the right direction.

How to Prevent Congestive Heart Failure

Some factors are based on our genetics, but lifestyle can also play a role. There are several things you can do to reduce the risk of heart failure or at least delay the onset.

Avoid or stop smoking

If you smoke and haven’t stopped, ask your doctor to recommend products and services that can help you. If you live with a smoker, have them smoke outside the room.

Maintain a balanced diet

A healthy diet rich in vegetables, fruits and whole grains is good for the heart. Dairy products must be low in fat or fat-free. You also need protein in your food. Salt added sugar, solid fat and refined grains should be avoided.

Exercise Regularly

Just one hour of moderate aerobic exercise can improve your heart health. Walking, cycling and swimming are good forms of exercise.

If you haven’t exercised for a while, start with only 15 minutes a day and improve your abilities. If you don’t feel motivated to exercise alone, you can register for private training at a local gym.

Watch your weight

Being too heavy can be difficult for your heart. Maintain a balanced diet and regular exercise. If you don’t have a healthy weight, talk to your doctor about how to proceed. You can also consult a nutritionist or dietitian.

Be careful​†​

Drink moderate alcohol and stay away from illegal drugs. When taking over-the-counter medicines, follow the instructions carefully and never increase the dose without medical supervision.​2​

If you are at high risk of having heart failure or have suffered heart failure, you can take the above steps. Ask your doctor how safe your physical activity is and whether you have other restrictions.

If you use drugs for high blood pressure, heart disease or diabetes, use as directed. Visit your doctor regularly to monitor your condition and report new symptoms immediately.

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