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What Is Heart Failure

What Happens to the Heart in Congestive Heart Failure (Myung Park, MD)

Heart failure doesnât mean the heart has stopped working. Rather, it means that the heart works less efficiently than normal. Due to various possible causes, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart canât pump enough oxygen and nutrients to meet the body’s needs.

The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. The kidneys may respond by causing the body to retain fluid and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested. Congestive heart failure is the term used to describe the condition.

Causes Of Congestive Heart Failure

Congestive heart failure can often develop in a person when their heart has been weakened or damaged by some other conditions.

Though, it is not always the case. Sometimes it can occur if the heart of a person becomes too stiff.

When a persons heart begins to fail, the ventricles of the heart becomes too stiff, which causes them to not fill properly. Or the heart muscles become so weak and damaged that the ventricles dilate and stretch to an extent that the efficiency of blood circulation throughout the body is affected.

There are certain other conditions that contribute towards congestive heart failure in a person. They are:

What Are The Symptoms Of Heart Failure

You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms can include:

  • Congested lungs. Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
  • Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen , and weight gain. Symptoms may cause an increased need to urinate during the night. Bloating in your stomach may cause a loss of appetite or nausea.
  • Dizziness, fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
  • Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a rapid orirregular heartbeat.

If you have heart failure, you may have one or all of these symptoms or you may have none of them. They may or may not indicate a weakened heart.

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How Is Congestive Heart Failure Treated

We assess the current health status of the patient to establish a baseline and develop a long-term health plan with the goal of improving the patients health, says Dr. Jacoby. This may involve the optimization of medicines and therapies, adding new medication or maybe enrollment in one of the clinical trials going on here.

Theres no quick fix, he says. Stabilizing and/or reversing a patients condition often involves long-term collaborative follow-up with a referring cardiologist or physician, Dr. Jacoby says.

In worst-case scenarios, we may offer advanced therapies, which include mechanical solutions, a heart transplant or hospice, Dr. Jacoby says. But first, we work very closely with our partners in cardiology and Interventional Cardiology Program at Yale to see if the patient would benefit from any interventional strategies.

“Yale has the best program in the area for heart transplants and artificial parts, but we want to exhaust all other options to avoid either if we can.

What Exactly Is Heart Disease

Congestive Heart failure: Causes and Types

Heart disease develops when theres a blockage in your hearts blood supply or an interruption of the coronary arteries due to a build-up of fatty deposits. Over time, the lining of the hearts arteries are blocked with fat and can eventually cause heart failure.

There are many factors that up your chances of developing heart disease, particularly the presence of comorbidities, like diabetes, high cholesterol, and elevated blood pressure.

Lifestyle factors also play a role in the development and severity of the disease. Though there is no true cure, there are a few things you can do to help reduce the symptoms and severity of heart disease:

  • Maintaining a healthy weight
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    Precipitating Causes Of Heart Failure

    A previously stable, compensated patient may develop heart failure that is clinically apparent for the first time when the intrinsic process has advanced to a critical point, such as with further narrowing of a stenotic aortic valve or mitral valve. Alternatively, decompensation may occur as a result of the failure or exhaustion of the compensatory mechanisms but without any change in the load on the heart in patients with persistent, severe pressure or volume overload. In particular, consider whether the patient has underlying coronary artery disease or valvular heart disease.

    The most common cause of decompensation in a previously compensated patient with heart failure is inappropriate reduction in the intensity of treatment, such as dietary sodium restriction, physical activity reduction, or drug regimen reduction. Uncontrolled hypertension is the second most common cause of decompensation, followed closely by cardiac arrhythmias . Arrhythmias, particularly ventricular arrhythmias, can be life threatening. Also, patients with one form of underlying heart disease that may be well compensated can develop heart failure when a second form of heart disease ensues. For example, a patient with chronic hypertension and asymptomatic LV hypertrophy may be asymptomatic until an MI develops and precipitates heart failure.

    • Profound anemia
    • Pregnancy
    • Nutritional deficiencies

    Common Signs And Symptoms Of Heart Failure

    It is very important for you to manage your other health conditions, such as diabetes, kidney disease, anemia, high blood pressure, thyroid disease and asthma or chronic lung disease. Some conditions have signs and symptoms that are similar to heart failure. If you have new or worsening non-urgent symptoms, tell your healthcare provider.

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    Pathophysiology Congestive Heart Failure

    Congestive HF results in the activation of multiple compensatory mechanisms in an attempt to increase cardiac output. These frequently work in the short term however, the long-term effects can be detrimental to the heart via negative remodeling. The two primary mechanisms considered the neurohormonal response are activation of the sympathetic nervous system and activation of the renin-angiotensin-aldosterone system. Medical therapy is aimed at reducing the activity of these two systems. A third compensatory response occurs via B-type natriuretic peptide and A-type natriuretic peptide. See the summary image below.

    When the carotid baroreceptors sense a low blood pressure, one response is to activate the SNS. This increases epinephrine and norepinephrine levels, which act to increase heart rate, contractility and afterload via peripheral vasoconstriction. In the short term, this will work to increase cardiac output and relieve HF symptoms however, chronically this has deleterious effects and causes further left ventricular systolic decline. Beta-blockers are the primary therapy to reduce this SNS activation.

    Endothelin has negative effects in regards to remodeling and vasoconstriction however, clinical trials of endothelin inhibitors have never shown a benefit, and thus its role remains unclear.

    Stage D And Reduced E

    Congestive Heart Failure: Osmosis Study Video

    Patients with Stage D HF-rEF have advanced symptoms that do not get better with treatment. This is the final stage of heart failure.

    Stage D treatment

    The usual treatment plan for patients with Stage D heart failure includes:

    • Treatments listed in Stages A, B and C.
    • Evaluation for more advanced treatment options, including:
    • Heart transplant.
    • Research therapies.

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    Black And Hispanic Communities And Congestive Heart Failure

    Black Americans have a higher risk of congestive heart failure than white Americans, according to an article published in October 2018 in Cardiology.

    A 2020 study published in JAMA Cardiology found that non-Hispanic Black Americans ages 35 to 64 had a prevalence of heart failure almost 3 times that of their white counterparts.

    When Should I Get Emergency Care

    Go to the ER or call 911 if you have:

    • New, unexplained, and severe chest pain that comes with shortness of breath, sweating, nausea, or weakness
    • Fast heart rate , especially if you are short of breath
    • Shortness of breath that doesn’t get better if you rest
    • Sudden weakness, or you can’t move your arms or legs
    • Sudden, severe headache
    • Fainting spells

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    What To Do When Experiencing Cardiac Coughing

    If you cough every time you take a deep breath or find yourself getting quickly winded at the end of a long speech, then you understand the frustrations of dealing with a chronic cough. And, while there are treatment options available for those with a cardiac cough, it can take a while to find the most suitable treatment for your unique needs. So, what should you do in the meantime? If you are experiencing cardiac coughing, you first need to note the symptoms and review them with your healthcare provider. However, if you find youre consistently experiencing unmanageable episodes of cardiac coughing, you should seek medical attention immediately. This is especially important if youve already been diagnosed with CHF or chronic obstructive pulmonary disease , as a chronic cough could exacerbate the existing conditions.

    Why Its Important To Know Your Ef

    Heart failure diagnostics, treatment and symptoms

    If you have a heart condition, it is important for you and your doctor to know your EF. Your EF can help your doctor determine the best course of treatment for you. Measuring your EF also helps your healthcare team check how well our treatment is working.

    Ask your doctor how often you should have your EF checked. In general, you should have your EF measured when you are first diagnosed with a heart condition, and as needed when your condition changes.

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    Stages Of Congestive Heart Failure

    Congestive heart failure occurs in four stages.

    Stage 1 Pre-CHF

    People with this stage of congestive heart failure have been diagnosed either because doctors noticed a weakness in the heart, or because the patient has another heart disorder that may lead to congestive heart failure. Usually, these patients show few to no symptoms, and life expectancy is high.

    Stage 2

    People at this stage of congestive heart failure may begin noticing symptoms however, these symptoms do not greatly affect the quality of life. These symptoms may be of congestive heart failure, or they may be of other conditions. Treatment for stage 2 congestive heart failure usually involves reducing stress and workload along with making lifestyle changes.

    Stage 3

    Typical patients with stage 3 congestive heart failure may notice their condition impacting their day to day lives. While exacerbated by other conditions, symptoms of congestive heart failure may prevent them from doing day-to-day tasks.

    Stage 4

    Stage 4 congestive heart failure experience debilitating symptoms which keep them from functioning on a daily basis. Treatment may require medical intervention in the form of surgeries, hospitalization, and medications.

    What Makes Yale Medicines Approach To Treating Congestive Heart Failure Unique

    We have a very patient-focused team at Yale Medicine, says Dr. Jacoby. Every person seen here, we treat as an individual, rather than offering a simple cookie-cutter treatment plan.

    Yale Medicines multidisciplinary team comprises of heart failure cardiologists and cardiac surgeons, dedicated advanced-practice, registered nurses and nurse coordinators, dietitians, exercise physiologists, financial counselors, immunologists specializing in transplants, psychologists, and specialists in palliative care.

    In our multidisciplinary approach, we include the patients desires as well as input from the family, Dr. Jacoby says. We develop a plan for social work support and take into account all of their financial and emotional stresses in addition to their physical treatment needs.

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    Senior Independent Living: Basic Home Care Service

    If you are an older adult with congestive heart failure, Centric Healthcare offers services that will help you to follow your treatment plan, manage your medications and make all dietary and lifestyle changes while you continue to live at home. We can provide the extra medical attention you need in the comfort and privacy of your own space. Were also able to provide assistance with tasks that you may no longer be able to do on your own. We can help you keep up with things around the house, allowing you to focus on getting healthy and feeling better.

    Arrhythmia & Cardiac Arrest

    Heart Failure…The Heart of the Matter

    Another serious complication of CHF that can cause death is arrhythmias, abnormal heart rhythms. The arrhythmia can be an abnormality of rate or regularity. The heart may beat too slow , too fast , or irregularly which may involve extra or missing beats. Some arrhythmias can be mild while others can be life-threatening. Symptoms include palpitations and chest pain. Serious types of arrhythmias can lead to cardiac arrest. The heart will either stop beating or it will not beat efficiently enough to maintain life. If this condition is not treated immediately, it can be fatal within minutes.

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    Sleep Apnea And Heart Failure

    Sleep apnea is a common but potentially serious sleep disorder that affects an estimated 30 million people in the United States, according to an article published in August 2016 in the Journal of Sleep Medicine.

    People who have sleep apnea experience interruptions in breathing that can last 10 seconds or more and occur repeatedly throughout the night, as many as 30 times or more in the span of an hour.

    This chronic disruption of the normal sleep cycle can leave individuals with the condition feeling exhausted and sleepy during the day, and will put them at increased risk for health problems associated with inadequate sleep, including irritability, problems with memory or concentration, anxiety, and depression.

    Sleep apnea is commonly found in people with heart failure.

    Heart failure can cause retention of sodium and water, and doctors suspect that the excess fluid may enter the lungs at night and lead to obstructive apnea. Heart failure also seems to be linked to problems with the respiratory control system, which may be a cause of central sleep apnea, notes the Mayo Clinic.

    This is the leading heart disease organization in the United States. Their online resources on heart failure offer clear explanations of the condition for both patients and family members, as well as links to many other tools and resources. You can also find information on your local AHA office and learn about volunteer opportunities.

    Enlargement Of The Heart

    Another important compensatory mechanism is enlargement of the muscular walls of the ventricles . When the heart must work harder, the hearts walls enlarge and thicken, as biceps muscles enlarge after months of weight training. At first, the enlargement allows the heart to maintain the amount of blood it pumps out . However, the enlarged and/or thickened heart eventually becomes stiff, causing or worsening heart failure. Also, the enlargement can stretch the heart valve openings, causing them to malfunction, which causes more pumping problems.

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    Diagnosis Congestive Heart Failure

    The diagnosis of congestive heart failure is predominantly by history and physical, though echocardiography and cardiac catheterization can be beneficial.

    Physical examination during systolic congestive HF will reveal a S3 heart sound if significant left ventricular dilation is present. A S4 heart sound can be present in diastolic HF. The point of maximal impulse, or PMI, will be laterally displaced and, at times, the S3 can even be palpable. Cardiac murmurs will be present if valvular heart disease is present, contributing to the HF such as aortic stenosis or mitral regurgitation.

    Physical examination in states of right heart failure may reveal elevated jugular venous pressure including hepatojugular reflux, lower extremity pitting edema and ascites. Pleural effusions may be present and more prominent on the right compared to the left.

    Echocardiography is indicated in all patients with a new diagnosis of congestive HF to help determine the etiology. The LV systolic function can be measured, including ejection fraction. Diastolic function assessment can help determine the left heart pressures. The cardiac valves can be interrogated for significant regurgitant or stenotic lesions.

    Symptoms That Occur First

    Congestive Heart Failure
    • Small appearance
    • Puffiness around the eyes

    However, theres a slight problem when a child is suffering from congestive heart failure. The symptoms mentioned above can very likely be mistaken for a repertory infection or colic. This makes it difficult to diagnose congestive heart failure in children and infants when compared to adults.

    If you have any of these symptoms, visit your doctor immediately.

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    Treatment And Medication Options For Congestive Heart Failure

    Heart failure is a chronic condition and there is no cure. However, once youve been diagnosed, there are several things you can do to treat the condition and manage it so that it does not progress. Chief among them are lifestyle changes. These include exercising and maintaining a heart-healthy diet thats low in saturated fat, trans fats, and cholesterol.

    Diagnostic Tests And Procedures

    This animation discusses some of the tests used to diagnose heart failure. These tests may include an electrocardiogram to look at your hearts electrical activity, an echocardiogram to measure how well your heart is working and look at the structure, and a chest X-ray to see if your heart is enlarged or there is fluid in your lungs. Other tests may include blood tests and an exercise, or stress test. .

    Blood tests

    Your doctor may order to check the levels of certain molecules, such as brain natriuretic peptide . These levels rise during heart failure. Blood tests can also show how well your liver and your kidneys are working.

    Tests to measure your ejection fraction

    Your doctor may order an echocardiography or other imaging tests to measure your ejection fraction. Your ejection fraction is the percent of the blood in the lower left chamber of your heart that is pumped out of your heart with each heartbeat. Ejection fraction tells your doctor how well your heart pumps. This helps your doctor diagnose the type of heart failure you have and guide your treatment.

    • If 40% or less of the blood in your left ventricle is pumped out in one beat, you have heart failure with reduced ejection fraction.
    • If 50% or more of the blood in your left ventricle is pumped out in one beat, you have heart failure with preserved ejection fraction.

    If your ejection fraction is somewhere in between , you may be diagnosed with heart failure with borderline ejection fraction.

    Other tests

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