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Congestive Heart Failure (CHF): Types, Stages, Symptoms, Causes, Risks, Diagnosis And Treatment

World Heart Day is observed on 29 September every year. The article will focus on congestive heart failure or CHF, which is often referred to as heart failure. A chronic progressive condition, CHF affects your heart muscles, making them unable to pump blood properly. Being more specific, CHF is termed as the stage where your heart has fluid build-up around it.

The condition is caused when the ventricles (which pumps blood to your body's organs and tissues) fail to pump the right amount of blood to the body, resulting in the blood and other fluids getting filled inside your lungs, liver, abdomen and lower body[1] .

Congestive heart failure is life-threatening and requires immediate medical attention.

Types Of Congestive Heart Failure

The most common type of CHF is left-sided which occurs when the left ventricle is unable to pump out blood. This paves way for fluid retention within your lungs and causes breathing difficulty. Left-sided CHF are of two types and they are as follows [2] :

Systolic heart failure: This type of CHF occurs when the left ventricle fails to contract, which in turn reduces the level of force available to push blood into circulation. The reduced force hinders with the proper functioning of your heart.

Diastolic failure: Also termed as diastolic dysfunction, this type of CHF occurs when the muscle in the left ventricle becomes stiff. With the muscle being stiff, your heart will not be able to fill up the required amount of blood into your body.

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Right-sided CHF is the rare type and occurs when the right ventricle has difficulty pumping blood to your lungs. This results with the blood being backed up in the blood vessels and thereby causing fluid retention in your abdomen and other vital organs [3] [4] .

Individuals can develop both left-sided CHF and right-sided CHF at the same time. In most cases, the condition develops on the left side and progresses to the right side.

Stages Of Congestive Heart Failure

CHF is differentiated into four different stages, Class I, Class II, Class III and Class IV [5] .

Class I: It is the first stage of heart failure. There will be no symptoms during this stage.

Class II: The second stage will not cause any issues while the individual is at rest, but physical activities can cause fatigue, palpitations, and shortness of breath.

Class III: You will face difficulty in carrying out even the simplest of physical tasks. Even mild exercise may cause fatigue, palpitations, or shortness of breath.

Class IV: You will be completely unable to do any physical amount of physical activity at all. Symptoms such as fatigue and shortness of breath will be present even while resting.

Symptoms Of Congestive Heart Failure

CHF does not show any signs in its initial stages. If your condition progresses, you will experience gradual changes in your body [6] .

The initial symptoms are as follows:

  • Fatigue
  • Weight gain
  • Swelling in your ankles, feet and legs
  • A constant need to urinate, especially at night

When the condition worsens, the following symptoms can be noticed [7] :

  • Irregular heartbeat
  • Wheezing
  • Coughing
  • Shortness of breath

The following symptoms indicate the presence of a severe heart condition [8] :

  • Rapid breathing
  • Chest pain, which spread to your upper body
  • Fainting
  • Skin that appears blue due to lack of oxygen in your lungs

The symptoms of heart failure in children and infants are different from that of adults, such as the following [7] :

  • Excessive sweating
  • Difficulty breathing
  • Poor feeding

Causes Of Congestive Heart Failure

The condition can develop from other health conditions that affect your cardiovascular system. The causes of CHF are as follows [9] [10] :

  • Hypertension
  • Valve conditions
  • Coronary artery disease

Apart from these, the following can also cause CHF,

  • Diabetes
  • Thyroid disease
  • Obesity
  • Severe infections
  • Allergies

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Diagnosis Of Congestive Heart Failure

The doctor will begin by checking your symptoms and accordingly, will refer you to a heart specialist or cardiologist.

A physical examination will be carried out, which will be comprised of the doctor checking your heartbeat to detect abnormal heart rhythms. Also, your cardiologist may request diagnostic tests to examine your heart's valves, blood vessels, and chambers.

Apart from these, the doctor will recommend the following tests as well[11] :

  • Electrocardiogram
  • Echocardiogram
  • Stress test
  • MRI
  • Blood tests
  • Cardiac catheterisation

Treatment For Congestive Heart Failure

The medical care for CHF will be determined by your doctor depending on your overall health and progression of the condition [12] .

You will be prescribed congestive heart failure drugs such as ACE inhibitors, beta-blockers and diuretics.

If the medications fail to be effective, surgery will be the next option. Your doctor will prescribe angioplasty to open up the blocked arteries. A heart valve repair surgery may be considered too.

FAQs On Congestive Heart Failure

Q. What is the life expectancy of someone with congestive heart failure?

A. Researchers say that the prognosis for people with the CHF is still bleak, with about 50 per cent having an average life expectancy of fewer than five years. For those with advanced forms of heart failure, nearly 90 per cent die within one year [13] .

Q. Can you die of congestive heart failure?

A. Yes. As CHF is a disease that can be controlled and not cured, individuals with a severe form of CHF can pass away slowly.

Q. What foods should be avoided with congestive heart failure?

A. Avoid convenience foods, Chinese food, and fast foods. Be careful of condiments-ketchup, mayonnaise, mustard, pickles, olives, marinades, tenderizers, soy sauce etc. Do not consume food that has sodium content. Choose fresh foods, including lean meats, fish, poultry, dry and fresh legumes, eggs, milk, yoghurt, plain rice, pasta and oatmeal [14] .

Q. Are swollen legs a sign of heart problems?

A. Yes

Q. Does drinking water help CHF?

A. If you drink too many fluids, you may get symptoms such as swelling, weight gain, and shortness of breath. Limiting how much you drink, discuss with your doctor if you have any doubts [15] .

Q. How to prevent congestive heart failure?

A. Avoid or quit smoking, maintain a well-balanced diet, exercise regularly and watch your weight.

Infographics by Sharan Jayanth

View Article References
  1. [1] Fisher, S. A., Doree, C., Mathur, A., Taggart, D. P., & Martin‐Rendon, E. (2016). Stem cell therapy for chronic ischaemic heart disease and congestive heart failure. Cochrane Database of Systematic Reviews, (12).
  2. [2] Di Biase, L., Mohanty, P., Mohanty, S., Santangeli, P., Trivedi, C., Lakkireddy, D., ... & Casella, M. (2016). Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: results from the AATAC multicenter randomized trial. Circulation, 133(17), 1637-1644.
  3. [3] Masetic, Z., & Subasi, A. (2016). Congestive heart failure detection using random forest classifier. Computer methods and programs in biomedicine, 130, 54-64.
  4. [4] Stein, P. K., & Pu, Y. (2016). -Heart Rate Variability in Congestive Heart Failure. In Heart Rate Variability (HRV) Signal Analysis (pp. 322-343). CRC Press.
  5. [5] Bardy, G. (2016). U.S. Patent No. 9,232,900. Washington, DC: U.S. Patent and Trademark Office.
  6. [6] Dokainish, H., Teo, K., Zhu, J., Roy, A., AlHabib, K. F., ElSayed, A., ... & Orlandini, A. (2017). Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. The Lancet Global Health, 5(7), e665-e672.
  7. [7] Opsha, Y., Kane, R., & Patel, D. (2017). Evaluation of Diuretic Administration in Admitted Congestive Heart Failure Patients via the Emergency Department. Journal of Cardiac Failure, 23(8), S96.
  8. [8] Rickenbacher, P., Kaufmann, B. A., Maeder, M. T., Bernheim, A., Goetschalckx, K., Pfister, O., ... & TIME‐CHF Investigators. (2017). Heart failure with mid‐range ejection fraction: a distinct clinical entity? Insights from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME‐CHF). European journal of heart failure, 19(12), 1586-1596.
  9. [9] Fisher, S. A., Doree, C., Mathur, A., Taggart, D. P., & Martin-Rendon, E. (2018). Cochrane Corner: stem cell therapy for chronic ischaemic heart disease and congestive heart failure.
  10. [10] Consensus Trial Study Group*. (1987). Effects of enalapril on mortality in severe congestive heart failure. New England Journal of Medicine, 316(23), 1429-1435.
  11. [11] Doval, H., Nul, D., Grancelli, H., Perrone, S., Bortman, G., & Curiel, R. (1994). Randomised trial of low-dose amiodarone in severe congestive heart failure. The Lancet, 344(8921), 493-498.
  12. [12] Kadri, A. N., Menon, V., Sammour, Y. M., Gajulapalli, R. D., Meenakshisundaram, C., Nusairat, L., ... & Griffin, B. (2019). Outcomes of patients with severe tricuspid regurgitation and congestive heart failure. Heart, heartjnl-2019.
  13. [13] Buakhamsri, A., Chirakarnjanakorn, S., Sanguanwong, S., Porapakkham, P., & Kanjanavanich, R. (2019). Heart Failure Council of Thailand (HFCT) 2019 heart failure guideline: pharmacologic treatment of chronic heart failure-part I. J Med Assoc Thai, 102, 240-244.
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