Congestive heart failure (CHF) is a gradual, chronic illness that impairs the ability of your heart muscle to contract.

Although heart failure is frequently referred to as “heart failure,” CHF refers mainly to the stage when fluid builds up inside the heart and impairs its ability to pump.

Your heart has four chambers. Your heart is divided into two halves: the upper half, which consists of two atria, and the lower half, which consists of two ventricles. The atria take the blood from the rest of your body while the ventricles pump it to your organs and tissues.

CHF develops when your ventricles cannot pump enough blood to the body. Blood and other fluids may eventually back up inside your;

  • Liver 
  • Lungs
  • Abdomen
  • Lower body

Having CHF can be fatal. If you have CHF or know someone who does, get medical help immediately.

Stages of congestive heart failure:

  • Stage I:

Heart failure is not yet seen in Stage I. If you have a history of heart failure in your family or one or more of the following medical conditions, you are at a high risk of getting heart failure.

  • Hypertension.
  • Diabetes.
  • Cardiovascular disease.
  • Metabolic disorder
  • Abuse of alcohol in the past.
  • Rheumatic fever history.
  • Cardiomyopathy in the family history.
  • History of using drugs, such as some cancer medications that can harm your heart muscle.
  • Stage II:

Heart failure is not yet seen in stage II. It indicates that even though you have never experienced heart failure symptoms, your doctor has diagnosed you with systolic left ventricular dysfunction. The majority of a person with Stage II heart failure has an ejection fraction (EF) of 40% or less on echocardiography. (For further information on ejection fraction, see the “Diagnosis” section.) People with heart failure and reduced EF from any cause fall into this category. At this point, CHF can be controlled with lifestyle modifications, cardiac medicines, and close observation.

  • Stage III:

Heart failure has been diagnosed in people with Stage III heart failure who presently exhibit or have previously displayed the signs and symptoms of the disorder.

Heart failure can have a wide range of symptoms. The most typical are;

  • Breathing difficulty
  • Being worn out (fatigue).
  • Less able to work out.
  • Shaky legs
  • Got up repeatedly through the night to use the restroom.
  • Foot, ankle, lower leg, and abdominal swelling (edema). 

Although there is a definite physical activity restriction, you are probably comfortable when you are at rest. Even light exertion can leave you feeling exhausted, with heart palpitations or shortness of breath. Treatment may be challenging. Discuss the potential consequences of heart failure for you with your doctor.

  • Stage IV:

You probably cannot engage in physical activity without experiencing symptoms, even when you are resting. Although there is no cure for CHF, palliative care and quality-of-life solutions are still available. It would help if you discussed the potential advantages and disadvantages with your doctor.

Causes of congestive heart failure:

Other medical disorders that directly impact your cardiovascular system can cause CHF. It is why it’s crucial to have yearly checks to reduce your risk of developing heart health issues, such as;

  • Hypertension:

CHF might develop if your blood pressure is more significant than it should be.

There are numerous distinct causes of hypertension. One of them, which raises artery pressure, is the hardening of your arteries.

  • Cardiovascular disease:

The coronary arteries, tiny arteries that carry blood to the heart, can get blocked by fatty substances like cholesterol. The arteries narrow as a result of this.

Blood flow is restricted in narrower coronary arteries, which might harm your arteries.

  • Valve circumstances:

Your heart’s valves control blood flow by opening and closing to allow blood to enter and exit the chambers.

Incorrectly functioning valves may make your ventricles work harder to pump blood. Having a heart infection or cardiac defect may cause this.

  • Other causes:

There are additional problems that can make you more susceptible to CHF than those that seem unrelated to heart disease.

These consist of;

  • Obesity
  • Thyroid problems
  • Some chemotherapy medications

Additionally, severe infections and allergic responses can cause CHF.

Symptoms of CHF:

You most likely won’t notice any changes in your health in the early stages of CHF. You’ll see slow changes in your body as your illness worsens. 

Mild symptoms of CHF are;

  • Fatigue 
  • Weight gain
  • Your ankles, feet, and legs will swell
  • Increased urination, particularly during the night

Moderate symptoms of CHF are;

  • Unsteady heartbeat
  • A cough brought on by clogged lungs
  • wheezing 
  • Breathlessness, which could be a sign of pulmonary edema

Severe symptoms of the CHF are;

  • Rapid breathing
  • Fainting 
  • Upper body ache that originates in the chest
  • Your skin appears blue because your lungs aren’t getting enough oxygen.

Upper-body pain from the chest may also indicate a heart attack. Seek quick medical assistance if you encounter this or any other signs that could indicate a severe cardiac issue. 

Symptoms in the children and infants of CHF:

Heart failure in newborns and young children can be challenging to spot. Some signs could be;

  • Poor nutrition
  • Excessive perspiration
  • Having trouble breathing

These signs and symptoms are frequently mistaken for colic or a respiratory infection. Children who experience heart failure may also exhibit poor development and low blood pressure.

When appropriate, you might be able to feel a baby’s rapid heartbeat through their chest wall when they are at rest. 

Early signs of CHF are;

As previously mentioned, congestive heart failure may not exhibit many overt early warning signs. The following are a few early warning indicators to bring up with your doctor;

  • Excess fluid in the legs, ankles, feet, or abdomen of the body
  • Wheeze or coughing
  • Breathing difficulty
  • A rise in weight that has no other explanation
  • Overall weariness
  • Higher heart rate
  • Either a lack of appetite or nausea
  • Feeling perplexed or lost

Diagnosis of CHF:

If your problems are reported to your doctor, they can suggest that you see a cardiologist or an expert in the heart.

The cardiologist will do a physical examination, during which they will use a stethoscope to listen to your heart and look for any irregular cardiac rhythms.

A cardiologist may request specific diagnostic tests to look at your heart’s valves, blood arteries, and chambers to confirm an original diagnosis.

Heart problems can be identified using several tests. Your doctor might suggest a couple of these tests since they each measure a different aspect of your health to gain a complete picture of your current situation. 

  • Blood tests
  • Chest X-ray
  • Cardiac catheterization 
  • Electrocardiogram
  • Echocardiogram 
  • Stress test
  • MRI

Treatment of CHF:

Depending on your overall health and the progression of your condition, you and your doctor may consider several therapies.

Medicines for congestive heart failure:

Several drugs are used to treat CHF, including ACE inhibitors, beta-blockers, and others. 

  • ACE-inhibitor:

To increase blood flow, angiotensin-converting enzyme (ACE) inhibitors are used to widen constricted blood arteries. If you are unable to use ACE inhibitors, vasodilators are an alternative.

One of the following medicines might be prescribed to you;

  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Lisinopril (Zestril)
  • Quinapril (Accupril).
  • Ramipril (Altace)
  • Perindopril (Aceon)
  • Trandolapril (Mavik)
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
  • Moexipril (Univasc)

Due to the presence of nitrosamine, Pfizer voluntarily recalled five batches of the medication Accupril on April 22, 2022. It was discovered that the medicine included quantities of nitrosamine, a recognized carcinogen with the potential to cause cancer, above the FDA-determined Acceptable Daily Intake (ADI). The Pfizer-produced Accupril tablets are not all included in this recall; rather, it only pertains to a select few lot numbers. If you use Accupril tablets, speak with your pharmacist or doctor; they can help determine whether the recall affects your medicine.

Without first seeing a doctor, avoid taking ACE inhibitors with the following drugs since they could have adverse side effects;

  • Potassium supplements and diuretics don’t deplete potassium. These diuretics can potentially increase blood potassium levels, resulting in irregular cardiac rhythms. Triamterene (Dyrenium), eplerenone (Inspra), and spironolactone are a few examples (Aldactone).
  • Nonsteroidal anti-inflammatory medications (NSAIDs) (NSAIDs). Ibuprofen, aspirin, and naproxen are NSAIDs that can lead to salt and water retention. It might lessen the impact of the ACE inhibitor on your blood pressure.
  • Beta-blockers:

Beta-blockers can lower blood pressure, moderate an erratic heart rhythm, and lessen the work the heart needs to accomplish.

It can be done by using;

  • Atenolol (Tenormin)
  • Esmolol (Brevibloc)
  • Metoprolol (Lopressor)
  • Nadolol (Corgard)
  • Bisoprolol (Zebeta)
  • Carvedilol (Coreg)
  • Nebivolol (Bystolic) 

Avoid using the medications listed below when taking beta-blockers because an adverse response could occur;

  • Pharmaceuticals that lower heart rate. These may intensify heart-related side effects, such as reduced heart rate. Amiodarone (Nexterone), verapamil, diltiazem, and digoxin are a few examples.
  • Albuterol (AccuNeb). Beta-blockers may negate the bronchodilation effects of albuterol.
  • Antipsychotics. Some antipsychotic medications, such as thioridazine (Mellaril), can lower some people’s blood pressure.
  • Fentora (Fentanyl). It might result in decreased blood pressure.
  • Clonidine (Catapres). The risk of a sluggish heartbeat may be increased with clonidine.
  • Diuretics:

Diuretics lessen the amount of fluid in your body. Your body may retain more fluid than it should due to CHF.

Your physician might advise;

  • Diuretic loops. These cause the kidneys to generate more urine. It assists in removing extra fluid from your body. Other examples are Torsemide, ethacrynic acid (Edecrin), and furosemide (Demadex).
  • Diuretics save potassium. These assist in retaining potassium while removing fluids and sodium. Examples include spironolactone, eplerenone (Inspra), and triamterene (Dyrenium) (Aldactone).
  • Diuretics with thiazides. These assist the body eliminate any surplus fluid by widening blood arteries. Metolazone (Zaroxolyn), indapamide (Lozol), and hydrochlorothiazide are other examples (Microzide).

Diuretics should be used cautiously in combination with the following medicines as an adverse reaction could occur:

  • ACE blockers. These, including lisinopril (Zestril), benazepril (Lotensin), and captopril, can result in decreased blood pressure (Capoten).
  • Tricyclics. They are tricyclic antidepressants (TCAs) and may reduce blood pressure. Amitriptyline and desipramine are two examples (Norpramin).
  • Anxiolytics. Anti-anxiety medications called anxiolytics may cause blood pressure to drop. Alprazolam (Xanax), chlordiazepoxide (Librium), and diazepam are typical anxiolytics (Valium).
  • Hypnotics. Sedative drugs like zolpidem and triazolam (Halcion) can cause low blood pressure (Ambien).
  • Beta-blockers. Low blood pressure can also be brought on by beta-blockers such as metoprolol (Lopressor) and carvedilol (Coreg).
  • Blockers of calcium channels. Blood pressure can drop as a result of CCBs. Examples include diltiazem and amlodipine (Norvasc) (Cardizem).
  • Nitrates. They may reduce blood pressure, including isosorbide dinitrate (Isordil) and nitroglycerin (Nitrostat).
  • NSAIDs. The liver may become toxic as a result of these drugs.

Only the most frequent medication interactions are included in this condensed list. Before starting any new medication, it is advisable to visit your doctor.

Surgeries and procedures for CHF:

It can be necessary to do more intrusive operations if drugs don’t work as intended.

One method for unblocking blocked arteries is angioplasty.

To assist your valve opening and closing correctly, your cardiologist may potentially recommend heart valve repair surgery.

Prevention tips for CHF:

While some elements are based on our genetics, lifestyle choices can also be important.

You can take several steps to lessen your risk of heart failure or, at the very least, postpone its beginning.

  • Eat a healthy, well-balanced diet
  • Regular exercise
  • Avoid smoking 
  • Control stress
  • Stay hydrated
  • Avoid alcohol
  • Maintain a healthy weight 
  • Other preventive steps (Limit your alcohol consumption, and abstain from using illicit substances. Follow the directions on your prescription medication carefully, and never raise the dosage on your own without consulting your doctor first.

If you have heart damage or are in danger of developing heart failure, you can still follow these guidelines. Ask your doctor about the appropriate level of exercise and any other limits you may have.

Take your medications as directed if you suffer from diabetes, hypertension, or heart disease. Visit your doctor periodically to keep an eye on your health and to report any new symptoms right away)

References:

https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142 

https://www.healthline.com/health/congestive-heart-failure

https://www.webmd.com/heart-disease/guide-heart-failure

https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure