Congestive heart failure

Systolic congestive heart failure occurs when blood is not effectively pumped through the heart. It can happen when the heart muscle is too weak or another health issue prevents it from circulating efficiently in the blood.

Over time, systeolic congestive heart failure, or heart failure (HF), can result in other organs dysfunction due to inefficient pumping.

Heart Failure four different stages : A, B, C, and D.

As the disease progresses into the next level, the probability of a person living for 5 years or more decreases.

Stage A

People with stage A congestive heart failure do not yet have heart pumping dysfunction but are at high risk of developing HF due to associated conditions, such as chronic high blood pressure, diabetes and coronary artery disease.

People with this stage HF have no problems with the heart structure or the way their heart functions. These will also rarely experience any HF symptoms, but may have other conditions-related symptoms.

Stage B

At this stage, structural heart disease progresses like decreased heart pumping capacity, which can lead to an enlarged left ventricle. It can also be the result of earlier heart attack. Individuals with stage B HF however remain asymptomatic.

Stage C

People at this stage will exhibit symptoms of HF associated with underlying heart disease, including fatigue or breathlessness. These symptoms usually arise because of problems with the left ventricle’s squeezing function, or the heart’s pumping chamber.

Stage C HF also includes people who are no longer showing symptoms but are currently undergoing treatment for previous symptoms (such as those who have spent time exacerbating heart failure in hospital).

Stage D

People will have advanced heart disease at stage D and show significant symptoms even when they are at rest.

This stage is serious and may require advanced specialist treatment such as mechanical circulatory assistance, continuous inotropic infusion to make squeezing of the heart more difficult, cardiac transplantation or hospice care.

Types

The most prevalent form of HF is left side HF. The left side of the heart needs to work harder to move the same blood volume around the body. This can cause a buildup of fluid in the lungs and complicate breathing as it progresses.
These fluids give congestive heart failure its name.

There are two kinds of left-sided HF:

Systolic heart failure: The left ventricle can not contract normally, thus reducing the pumping power of the heart.
Diastolic heart failure: The muscle stiffens within the left ventricle. If the muscle is unable to relax, then the ventricle pressure increases, causing symptoms.
Right-sided HF is less common. It occurs when the right ventricle cannot pump blood to the lungs. This can lead to blood retention in the blood vessels which can cause fluid retention in the lower legs and arms, abdomen and other organs.

At the same time, a person can have both left and right-sided HF. Nonetheless, HF usually starts on the left side and can impact the right side if a person is not being handled effectively.

Outlook and prevention

Symptoms of HF vary from mild to severe, but may get worse over time unless medically treated.

Strategies for lifestyle can reduce the risk of developing HF, and can also slow progress.

People should take the following steps to prevent or slow the progression of HF:

Keep a healthy body weight: excess body weight can put stress on the heart and increase the risk of further heart damage.
Exercise regularly: The AHA recommends each week being given 150 minutes of moderate-intensity exercise. Many people with heart disease should negotiate “prescription” with their physicians for having an individualized exercise.
Manage stress: Meditation, meditation, and relaxation techniques can help a person relieve stress, which can have adverse heart effects.
Eat a heart-healthy diet: Daily intake of food should be low in trans fats, high in whole grains, low in sodium and low in cholesterol. Doctors also recommend limiting their sodium intake to 2,000 milligrams (mg) per day for people with heart failure and drinking 2 liters (l) of fluid. Individuals should consult with their doctor but what should be their consumption of sodium and fluid.

Monitor blood pressure regularly: A doctor may do this during regular check-ups. However, doctors also recommend people use home blood pressure monitors, or sphygmomanometers. There is a range of home blood pressure monitors available online.
Vaccinations: Be sure to stay on top of vaccinations for influenza and pneumococcal pneumonia.
Treat and control risk factors such as hypertension, smoking, alcohol, medications, diabetes The following steps should be taken by people who already have HF to avoid further progress:

  • avoid alcohol
  • limit caffeine and other stimulants
  • get adequate rest
  • track changes in their symptoms and exercise capacity
  • monitor daily weights
  • check blood pressure and heart rate at home
  • Without treatment, HF can be fatal. HF can get worse over time, even with adequate
  • treatment, triggering dysfunction of other organs throughout the body.

Causes


HF is more likely to occur in people with other heart-weakening conditions or lifestyle factors.

Risk factors for HF include:

  • congenital heart anomalies
  • high blood pressure or cholesterol
  • obesity
  • asthma
  • Chronic pulmonary obstructive disorder (COPD) and coronary heart disease
  • cardiovascular conditions, such as valvular heart disease
  • heart infection
  • reduced kidney function
  • a history of heart attacks
  • irregular heart rhythms or arrhythmias
  • abuse of alcohol or illicit drugs
  • smoking
  • older age


Symptoms

Individuals with a history of cardiovascular health issues or several HF risk factors should seek immediate treatment if they experience HF symptoms.

The most common symptoms of HF are:

Shortness of breath or breathing difficulty: People with HF may also struggle to breathe due to fluid accumulation in the lungs when lying down, with activity or in rest.
A persistent, unexplained cough: Wheezing and pink, or blood-stained mucus, some people experience.
Swelling in the legs, feet, abdomen, or hands: The swelling can worsen as the day goes on or after exercise.
Weight gain: Rapid increase of weight could be a symptom of congestive heart failure.
Feeling tired: Even well-rested people can experience fatigue.

Changes in memory and thinking: Electrolyte imbalances caused by HF can affect the ability of a person to think clearly.
Nausea: A reduced appetite can accompany this.
A rapid heart rate: This happens because the heart can not pump blood at regular rhythm.
Light-headedness, dizziness, or passing out: due to inadequate blood supply, this may also include tingling or numbness in the extremities.
When fluid builds up, painful swelling, or edema, may occur in people with HF.

Swelling caused by HF can inhibit movement and can result in skin changes and deterioration of the skin. Fluid accumulation can also affect other functions of the organ, making breathing or exercise harder.

Children with HF may experience physical developmental delays, while infants with the condition may struggle with weight gain.

Diagnosis


A doctor or cardiologist will perform a physical exam. This involves listening to the heart, checking for fluid retention, and looking into the veins in the neck to see if the heart contains extra fluid. They may order other diagnostic tests, including:

Electrocardiogram: This records the heart’s electrical rhythm.
Echocardiogram: This is an ultrasonic test that can help a doctor determine if a person has a leaky heart valve, a heart muscle that does not properly squeeze or relax.
Stress tests: These tests show how the heart responds, for example during exercise, under different levels of cardiac stress. These also include using drugs that cause the heart to beat faster and harder, or that relax the blood vessels.

Blood tests: A doctor may ask for these to test for infections, assess kidney function and brain natriuretic peptide (BNP) levels. BNP is a “stretch” hormone that indicates hypertension or increased pressure with HF.
MRI: This can provide images of the heart in high resolution and can assess structural changes and scarring.
Cardiac catheterization: This can help a doctor recognise arterial blockages, one of the most common causes of HF. A doctor can simultaneously check blood flow and ventricle pressure levels.

Treatment

Different medications can help symptoms of and prognosis in HF. These include:

Blood thinners: These lower the risk of blood clots that could break loose and travel to the body, heart, lungs or brain. Blood thinners carry hazards, like increased bleeding.
Angiotensin receptor-neprilysin inhibitors: These help to reduce mortality risk and reduce cardiac congestion.
ACE inhibitors: They open the blood vessels and help to reduce heart failure impacts.
Angiotensin receptor blockers: Both function to relieve blood vessel discomfort.
Anti-platelet drugs: Doctors prescribe these to stop blood clots, as they prevent platelets from binding together in the blood.
Beta-blockers: These medications lower heart rate, pulse force and blood pressure, allowing the heart to “rest.”

Sino-atrial node modulators: These can aid in people who are already taking beta-blockers to further suppress heart rate.
Statins: People use these to reduce levels of low-density lipoprotein (LDL), or “bad” cholesterol and increase high-density lipoprotein (HDL), or “good” cholesterol levels.
Diuretics: Such help the body excrete and remove excess fluid in the urine from the heart and the lungs. These also reduce swelling, and prevent oxygen shortage.
Vasodilators: This reduce the amount of oxygen necessary to dilate the heart. They can also ease chest pain.
People with advanced HF might need more intensive treatment. Medical procedures that may help include the following:

Implantable devices


Those with advanced HF can need more intensive treatment. A surgeon could have a medical device implanted, like:

An implantable defibrillator: These can prevent arrhythmias.
A pacemaker: To help the ventricles contract more frequently, they fix electrical problems in the heart.
Cardiac resynchronization therapy: It helps regulate the heart rhythm and lower the symptoms of arrhythmia.
A left ventricular assist device (LVAD): It helps a heart’s pumping capacity when it can not do this on its own in an efficient way. Patients used short-term LVADs previously but can now use them as part of long-term therapy.

Other procedures

A doctor may recommend other HF-treatment procedures, including:

Percutaneous coronary intervention to open a blocked artery: to help keep the pipe open, the doctor can insert a stent.
Coronary artery bypass surgery: It redirects some of the blood vessels so that the blood can move to supply the heart with oxygen while removing blood vessels that are sick or blocked.
Valve replacement or repair surgery: A doctor may use a mechanical valve or one made from living tissue to replace or repair an inefficient or diseased valve.
Heart transplant: If other therapies are not successful, this could be the only remaining option.
Not everyone with HF is a good transplant candidate, so people often have to wait a long time before they have one.

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