Author: Vanessa Mora
Editor: Prachi Patel
Overview
Congestive Heart Failure (CHF) occurs when the heart is not efficiently pumping blood throughout the body, leading to inadequate blood flow to vital organs (Malik et al., 2021). As a result, the kidneys filter less fluid, causing fluid retention in the abdomen, ankles, feet, liver, and lungs (Malik et al., 2021).
There is a high prevalence of congestive heart failure in the entire world, with approximately 5.1 million people in the United States of America alone (Malik et al., 2021). Congestive heart failure is more common in individuals older than 65 years of age through differences in people with different racial backgrounds have been observed as well (Malik et al., 2021). Non-Hispanic black males and females have a prevalence of 4.5% and 3.8% of congestive heart failure respectively whereas, non-Hispanic white males and females have a prevalence of 2.7% and 1.8% respectively (Malik et al., 2021).
What Causes Congestive Heart Failure?
Congestive heart failure is a condition that develops through abnormalities from other diseases that have weakened the heart structure and function resulting in damage to the cardiovascular system, including the heart and surrounding veins and arteries (Figueroa & Peters, 2006). A number of conditions lead to cardiovascular system damage, including heart attacks, coronary artery disease, heart arrhythmia, diabetes, HPV, severe infections, allergic reactions, high blood pressure, and a family history of cardiovascular issues (Hajouli & Ludhwani, 2020). Often, the deteriorated function of the left ventricular myocardium, the thickest muscle of the heart, can cause symptoms of congestive heart failure (Malik et al., 2021).
Symptoms
The most common symptoms of congestive heart failure include the following:
- Difficulty concentrating
- Feeling tired quickly
- Lightheaded/ dizziness
- Lack of appetite
- Nausea
- Persistent cough with white or pink-tinged phlegm
- Rapid weight gain due to fluid retention
- Rapid heartbeat
- Shortness of breath
- Swelling of abdomen, legs, ankles, and feet (Malik et al., 2021).
Risk Factors
Some of the risk factors that increase the likelihood of acquiring congestive heart failure are:
- Alcohol use
- Diabetes and taking medications for diabetes
- High blood pressure
- Heart arrhythmia
- Obesity
- Sleep apnea
- Tobacco use (Varga et al., 2017).
How does my Doctor know I have Congestive Heart Failure?
A physical examination is needed, taking note of the patient’s medical history, potential risk factors, and symptoms (Inamdar & Inamdar, 2016). After, the physician will check the patient’s blood pressure, detect abnormal heart rhythms, examine the veins in the neck, and check for fluid retention in the liver, abdomen, and legs (Malik et al., 2021).
Physicians will also perform a chest X-ray to note for heart defects and swelling (Malik et al., 2021). Additional tests, such as a CT scan, MRI test, echocardiogram (echo), and electrocardiogram (ECG, EKG) may also be used to determine what type of heart failure the patient is experiencing and if there is the presence of any abnormalities in the heart structure (Malik et al., 2021). Moreover, a stress test may be implemented to track the patient’s heart function during physical exercise (Malik et al., 2021).
Treatment
Treatment of congestive heart failure is focused on improving the outcome of the disease, reducing mortality and reducing symptoms and morbidity (Inamdar & Inamdar, 2016). While the mainstay of treatment for congestive heart failure is drug therapy, several strategies could be adopted to ensure individuals with congestive heart failure have a better quality of care (Guidi et al., 2015; Inamdar & Inamdar, 2016). These strategies include:
- Patient education for lifestyle changes
- Educating patients to recognize abnormal signs and symptoms
- Arranging appropriate follow-up care
- Safe transition from the hospital to the patient’s home or different healthcare facility (Inamdar & Inamdar, 2016).
The following are examples of various medications prescribed to patients with congestive heart failure depending on their signs and symptoms:
ACE, ARB or ARNI inhibitors: May be prescribed to lower patient blood pressure, reduce shortness of breath and swelling (Inamdar & Inamdar, 2016).
Anticoagulants (blood thinners): Maybe prescribed if you are a heart failure patient often presenting with rapid and irregular heart rate and to prevent blood clots (Zeitler & Eapen, 2015).
Beta-Blockers: May be prescribed to lower patient blood pressure and to improve heart function (Inamdar & Inamdar, 2016).
Diuretics: May be prescribed to assist with urination and to decrease the buildup of fluid in other parts of the body (Inamdar & Inamdar, 2016).
Cholesterol-lowering drugs (statins): Maybe prescribed if you have high cholesterol or had a history of a heart attack. This class of drugs is used to decrease the risk of further heart disease or progression (Lee et al., 2019)
Vasodilators: May be prescribed to lower patient blood pressure and reduce shortness of breath by widening blood vessels to allow efficient blood flow and prevent muscle from tightening (Levy & Mebazaa, 2014).
If the medications above are not effective, patients may require device therapy, heart surgery, or even a heart transplant if all other measures have been exhausted (Malik et al., 2021; Hajouli & Ludhwani, 2020). Examples of device therapies include an implantable cardioverter-defibrillator (ICD) that prevents unforeseen cardiac death or a ventricular assist device that helps pump blood (Malik et al., 2021).
References
British Heart Foundation. (2020, June 02). Watch: What are ACE inhibitors and what do they do in your body? Retrieved August 30, 2020 from https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/drug-cabinet/ace-inhibitors.
Guidi, G., Pollonini, L., Dacso, C. C., & Iadanza, E. (2015). A multi-layer monitoring system for clinical management of Congestive Heart Failure. BMC Medical Informatics and Decision Making, (15). https://doi.org/10.1186/1472-6947-15-S3-S5.
Hajouli,S., & Ludhwani, D. (2020). Heart Failure and Ejection Fraction. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK553115/.
Inamdar, A., & Inamdar, A. (2016). Heart Failure: Diagnosis, Management and Utilization. Journal of Clinical Medicine, 5(7), 62. DOI: 10.3390/jcm5070062.
Lee, M., Sattar, N., McMurray, J., & Packard, C. J. (2019). Statins in the Prevention and Treatment of Heart Failure: a Review of the Evidence. Current atherosclerosis reports, 21(10), 41. DOI: 10.1007/s11883-019-0800-z.
Levy, P. D., Laribi, S., & Mebazaa, A. (2014). Vasodilators in Acute Heart Failure: Review of the Latest Studies. Current emergency and hospital medicine reports, 2(2), 126–132. DOI: 10.1007/s40138-014-0040-z.
Malik, A., Brito, D., & Chhabra, L. (2020). Congestive Heart Failure (CHF). In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430873/
Savarese, G., & Lund, L. H. (2017). Global Public Health Burden of Heart Failure. Cardiac Failure Review, 03(01), 7-11. DOI: 10.15420/cfr.2016:25:2
Varga, Z., Sabzwari, S. R., & Vargova, V. (2017). Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drugs: An Under-Recognized Public Health Issue. Cureus. DOI: 10.7759/cureus.1144.
Zeitler, E. P., & Eapen, Z. J. (2015). Anticoagulation in Heart Failure: a Review. Journal of atrial fibrillation, 8(1), 1250. DOI: 10.4022/jafib.1250.
