Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscle. While often referred to as heart failure, CHF specifically refers to the stage in which fluid builds up within the lungs and body due to the weakened heart muscle. As blood flow out of the heart slows, blood returning to the heart through the veins back up, causing congestion in the body’s tissues. Eventually, blood and other fluids can back up inside of your lungs, abdomen, liver and lower body.
In the early stages of congestive heart failure, you might not experience any symptoms, but as it goes untreated, you will experience changes in your body.
Symptoms you may first notice:
- Swelling in your ankles, feet and legs
- Weight gain
- Increased need to urinate, especially at night
Symptoms that indicate your condition has worsened:
- Irregular heartbeat
- A cough that develops from congested lungs
- Shortness of breath, which may indicate pulmonary edema.
- Decreased appetite due to “feeling full”
Symptoms that indicate a severe heart condition:
- Chest pain through the upper body
- Rapid breathing
- Skin that appears blue due to lack of oxygen in the lungs.
If you are experiencing any of these symptoms, visit your primary care doctor immediately.
Congestive heart failure may result from conditions that directly affect your cardiovascular system including hypertension (high blood pressure), coronary artery disease and valve conditions. You can also be at risk if you have diabetes, thyroid disease and obesity.
Heart failure is a long-term, chronic condition that gets worse over time. There are four stages of heart failure:
Stage A: Considered pre-heart failure. You are at high risk of developing heart failure because you have one or more of the conditions below:
- Coronary artery disease
- History of alcohol abuse
- Family history of heart failure
People at this stage have no problems with the structure of their heart yet from congestive heart failure. They may experience little to no symptoms and if they do, it is usually from one of the conditions above.
Stage B: The structure of the heart starts to be affected at this stage including reduced pumping of the heart and enlarged ventricles. This could also be from a previous heart attack. Oftentimes, you are still asymptomatic at this stage.
Stage C: At this stage, you will start showing symptoms of heart failure due to the structural heart disease. These symptoms may include fatigue or breathlessness and usually occur because of a squeezing function of the left ventricle or the pumping of the chamber of the heart.
Stage D: This stage is severe, and people will have advanced structural heart disease and display symptoms, even while they are at rest. At this stage, you will need specialized treatment.
There are a few of types of heart failure you need to know:
- Left-sided heart failure: The most common type of heart failure is left-sided heart failure. The left side of the heart must work harder to move the same amount of blood around the body. This may cause a fluid buildup in the lungs and make breathing challenging as it progresses. These fluids give congestive heart failure its’ name. There are two types of left-sided heart failure.
- Heart failure with reduced ejection fraction (HFrEF), also called systolic failure: The left ventricle loses its ability to contract normally. The heart cannot pump with enough force to push enough blood into circulation.
- Heart failure with preserved ejection fraction (HFpEF), also called diastolic failure (or diastolic dysfunction): The left ventricle loses its ability to relax normally (because the muscle has become stiff). The heart cannot properly fill with blood during the resting period between each beat.
- Right-side heart failure: The heart’s pumping action moves “used” blood that returns to the heart through the veins through the right atrium into the right ventricle. The right ventricle then pumps the blood back out of the heart into the lungs to be replenished with oxygen. Right-sided or right ventricular heart failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure is transferred back through the lungs, ultimately damaging the heart’s right side. When the right side loses pumping power, blood backs up in the body’s veins. This usually causes swelling or congestion in the legs, ankles and swelling within the abdomen such as the GI tract and liver (causing ascites).
Treatment for congestive heart failure depends on the severity of your condition. Some of the recommended treatments are:
- Self-care – Quitting smoking, physical exercise, weight-loss, or a low-sodium diet.
- Medications – Beta blockers, ACE inhibitors, blood pressure support, dietary supplements, diuretics and others.
- Devices– Implantable cardioverter defibrillator, cardiac resynchronization therapy, left ventricular assist device (LVAD).
- Surgical Procedures – Percutaneous coronary intervention (PCI, also referred to as angioplasty), coronary artery bypass, valve replacement and, in advanced cases, either a heart transplant or LVAD.
Although it can be difficult living with a chronic condition like congestive heart failure, many people learn to manage the symptoms – and enjoy full lives. People who report greater levels of improvement and emotional well-being often build new habits around eating better, tracking and managing their symptoms and exercising.
For best long-term success and maintaining a good quality of life, it is important to see a heart failure specialist.
Article written by:
Dr. Christina Dunbar-Matos
Medical Director, Advanced Heart Failure Therapies Program
Dr. Mark Slaughter
Surgical Director – Heart Transplant & Ventricular Assist Devices
Professor & Chair – Dept. of Cardiovascular & Thoracic Surgery
For additional resources about congestive heart failure, visit, www.heart.org.