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Congestive Heart Failure (CHF): Types, Causes, Symptoms & Treatment

Congestive Heart Failure (CHF)- Medical & Health 

Heart Failure

In heart failure, your heart is unable to pump enough blood to meet the metabolic demands of the body. Any structural or functional cardiac disorder that weakens the ability of your ventricles for maintaining normal blood flow can cause heart failure. The risk of heart failure increases in older and obese people.

Types Of Heart Failure

There are two main types of heart failure, high-output heart failure, and low-output heart failure. Your heart is functioning normally but cannot fulfill your body's requirements due to increased metabolic demand in high-output heart failure. Your heart is not pumping normally and cannot fulfill your body's requirements in low-output heart failure.

There are two subtypes of low-output heart failure, right-sided heart failure, and left-sided heart failure. Right-sided heart failure is caused by primary or secondary pulmonary arterial hypertension. Left-sided heart failure is further subdivided into two types, systolic dysfunction, and diastolic dysfunction.

In systolic dysfunction, the ejection fraction is reduced to less than 40. The normal value of ejection fraction is 60-70%. The ejected volume of blood is less but the ejection fraction is normal (>45%) in diastolic dysfunction.

Symptoms Of Heart Failure

People with right-sided heart failure may have fatigue, increased peripheral venous pressure, anorexia, GI diseases, weight gain, ascites, edema, and enlarged liver and spleen.

People with left-sided heart failure may report shortness of breath, different sounds in the lungs during inhalation, orthopnea, fatigue, anxiety, and Cheyne strokes.

Stages Of Heart Failure

There are four stages of heart failure,

1. Heart failure stage A: There is no structural and functional heart damage reported. But the risk of heart failure is increased.
2. Heart failure stage B: In this stage, the structure of the heart is damaged but no signs and symptoms appear.
3. Heart failure stage C: In this stage, the structure of the heart is damaged and signs and symptoms appear.
4. Heart failure stage D: Stage D is a critical or advanced stage of heart failure requiring spital-based support, a heart transplant, or palliative care.

Causes Of Heart Failure

Heart failure is caused by other underlying conditions such as coronary artery disease, heart attack, diabetes, obesity, arrhythmias, hypertension, atrial fibrillation, congenital heart disease, kidney diseases, and cardiomyopathy.

Diagnosis Of Heart Failure

An echocardiogram is the gold standard test for the diagnosis of heart failure. It produces a video image of your heart by using sound waves. Electrocardiogram (ECG) is another test that records the electrical activity of your heart. CT-scan, MRIs, X-rays, and chest radiographs also help in the accurate diagnosis of heart failure.

Complete blood count, thyroid-stimulating hormone, serum creatinine, BUN, electrolytes, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) can also be used for the diagnosis of heart failure. Coronary angiogram and myocardial biopsy are used for diagnosing heart muscle disease causing heart failure.

Treatment Of Heart Failure

Commonly prescribed drugs for the treatment of heart failure may include diuretics, beta-blockers, ACE inhibitors, angiotensin II receptor blockers, aldosterone antagonists, digoxin and nitrates, and hydralazine.

There are two types of diuretics used for the treatment of heart failure, loop, and thiazide diuretics. Commonly prescribed loop diuretics are bumetanide, furosemide, and torsemide. Most commonly used thiazide diuretics are hydrochlorothiazide, chlorthalidone and metolazone.

Spironolactone and eplerenone are the commonly used aldosterone antagonist. They block the action of aldosterone and mineralocorticoid receptors. Digoxin is proven to be effective for the treatment of heart failure by increasing the concentration of intracellular sodium and calcium during systole.

Nitrates and hydralazine are effective in combination therapy in people who cannot tolerate ACEIs/ARBs. Nitrates decrease preload while hydralazine decreases peripheral vascular resistance and cardiac output.

ACE inhibitors used in heart failure may include captopril, lisinopril, fosinopril, enalapril, Ramipril, perindopril, and trandolapril. The most widely used beta-blockers are propranolol, carvedilol, atenolol, and bisoprolol. Angiotensin II receptor blocker drugs used in heart failure are losartan, valsartan, candesartan, and Irbesartan.