Despite its name, congestive heart failure does not necessarily mean that the heart has stopped working. However, heart failure is a serious condition in which the heart does not pump blood around the body efficiently.
The body relies on the pumping action of the heart to deliver nutrient- and oxygen-rich blood to each of its cells. When the cells do not receive adequate nourishment, the body cannot function properly.
If the heart becomes weakened and cannot supply the cells with sufficient blood, the person will be tired and breathless. Everyday activities that used to be easy can become challenging.
Heart failure is a serious condition, and there is usually no cure. However, with the right treatment, people can still lead an enjoyable and productive life.
According to the National Heart, Lung, and Blood Institute, approximately 5.7 million people in the United States have heart failure.
Heart failure can be systolic or diastolic, depending on whether it affects the heart’s ability to contract or relax, respectively. In this article, we focus on systolic congestive heart failure, including its causes, symptoms, types, and treatment.
The following list provides definitions for common heart problems:
- Heart attack: A heart attack is damage to the heart muscle due to the blockage of a coronary artery, which supplies blood to the heart. The heart muscle sustains damage because blood is not getting to it, so it becomes starved of oxygen.
- Systolic heart failure. Systolic heart failure means that the heart muscle cannot pump blood around the body properly. It is not a heart attack.
- Cardiac arrest. A cardiac arrest is when the heart and blood circulation both stop, and the person has no pulse.
Any condition that damages the heart muscle can cause systolic heart failure. These conditions include:
- Coronary artery disease: The coronary arteries supply the heart muscle with blood. If these become blocked or narrowed, the flow of blood reduces, and the heart does not receive the blood supply that it needs.
- Heart attack: A sudden blockage of the coronary arteries causes scarring in the heart’s tissues and decreases how effectively it can pump.
- Nonischemic cardiomyopathy: This disease involves weakness of the heart muscle due to causes other than blockages in the coronary arteries. Possible causes include genetic conditions, drug side effects, and infections.
- Conditions that overwork the heart: Examples include valve disease, hypertension (high blood pressure), diabetes, kidney disease, and heart abnormalities present at birth.
The following are risk factors for congestive heart failure:
- diabetes, especially type 2 diabetes
- thyroid problems, including hyperthyroidism and hypothyroidism
- myocarditis, or the inflammation of the heart muscle, which usually occurs due to a virus and can lead to left sided heart failure
- heart arrhythmias, or abnormal heart rhythms — a fast heartbeat can weaken the heart, and a slow heartbeat can reduce blood flow, causing heart failure
- atrial fibrillation, an irregular and often rapid heartbeat
- hemochromatosis, a condition in which iron accumulates in the tissues
- amyloidosis, where one or more organ systems accumulate deposits of abnormal proteins
The following are possible symptoms of heart failure:
Congested lungs: Fluid builds up in the lungs and causes shortness of breath, even when a person is resting and particularly when they are lying down. It can also cause a hacking, dry cough.
Fluid retention: Less blood reaches the kidneys, which can result in water retention. Water retention can cause swelling of the ankles, legs, and abdomen. It can also cause weight gain.
Fatigue and dizziness: A reduction in the amount of blood reaching the organs of the body can cause feelings of weakness. A drop in blood flow to the brain can also cause dizziness and confusion.
Irregular and rapid heartbeats: The heart might pump more quickly to try to counteract the lower volume of blood that it pumps out with each contraction. It may also activate stress receptors in the body to increase the release of stress hormones.
Many other conditions can cause similar symptoms, so a person should see their doctor for an accurate diagnosis. People who have received a diagnosis of heart failure should monitor their symptoms carefully and report any sudden changes to their doctor immediately.
There are several different types of heart failure. It may affect just one side of the heart — the oxygenated or deoxygenated side — or both sides.
Types of congestive heart failure include:
Left sided heart failure
Left sided heart failure is the most common form of congestive heart failure. It usually develops as a result of coronary artery disease.
The left side of the heart is responsible for pumping blood to the rest of the body. In people with left sided heart failure, blood backs up into the lungs as the heart does not effectively pump it away. This issue can, in turn, cause shortness of breath and fluid buildup.
Right sided heart failure
The right side of the heart pumps blood to the lungs, where it collects oxygen. Right sided heart failure typically follows left sided heart failure. However, it can sometimes occur due to other conditions, such as lung disease or pulmonary hypertension.
Biventricular heart failure
If heart failure affects only the oxygenated side of the heart, it is called left heart failure. If it involves just the deoxygenated side (which pumps blood to the lungs), it is called right heart failure.
In biventricular heart failure, there are problems with both sides of the heart. Biventricular heart failure can occur with cardiomyopathy.
Diastolic heart failure
Diastolic heart failure occurs when the heart muscle is stiffer than usual but pumps normally. As the heart is stiff, it does not fill up with blood properly because it does not relax normally. Doctors refer to this as diastolic dysfunction.
When the heart does not fill up with blood, this results in increased pressure inside the heart, which can cause a backup of fluid into the lungs.
Systolic heart failure
Systolic dysfunction describes the heart’s inability to pump efficiently after filling with blood. It often occurs if the heart becomes weak or enlarged, which can occur on either side of the heart.
If a doctor suspects heart failure, they will recommend further tests, which may include:
- Blood and urine tests to check the person’s blood count, as well as their liver, thyroid, and kidney function and markers of “stretch” in the heart. The doctor may also want to check the blood for specific chemical markers of heart failure.
- Chest X-ray to show whether the heart has become enlarged. It will also show whether there is fluid in the lungs.
- An EKG (electrocardiogram) to record the electrical activity and rhythms of the heart. The test may also reveal any damage to the heart from a heart attack.
- An echocardiogram, which is an ultrasound scan that checks the pumping action of the heart. The doctor measures the percentage of blood that leaves the person’s left ventricle (the main pumping chamber) with each heartbeat. This measurement is called the ejection fraction.
The doctor may also carry out the following additional tests:
- A stress test to see how the heart responds to stress and determine whether there is a lack of oxygen due to blockages in the coronary arteries. The person may have to use an exercise machine, such as a treadmill, or take a medication that stresses the heart.
- A cardiac MRI or CT scan to examine the ejection fraction and the heart arteries and valves. The results can help a doctor determine whether the person has had a heart attack.
- A B-type natriuretic peptide (BNP) blood test — the release of BNP into the blood occurs if the heart becomes overfilled and is struggling to function properly.
- An angiogram, where a doctor injects dye into the coronary arteries to help detect coronary artery disease or narrowed arteries, which can cause heart failure. An angiogram is an X-ray of the blood vessels around the heart.
Certain lifestyle changes can reduce the risk of heart failure or, at least, slow down its progression. These include:
- giving up smoking, if applicable
- eating a healthful diet that includes plenty of fruit, vegetables, good quality fats, unrefined carbohydrates, and whole grains
- exercising regularly and staying physically active
- maintaining a moderate body weight
- avoiding drinking more alcohol than the national recommended limits
- getting enough good quality sleep
- reducing stress where possible, as mental stress can place a strain on the heart over time
In addition, people who already have heart failure should keep up to date with their vaccinations and have a yearly flu shot.
The damage that heart failure can do to the heart’s pumping action is not always reversible. Nevertheless, current treatments can significantly improve the quality of life of people with this condition by keeping it under control and helping relieve many of the symptoms.
Treatment also focuses on treating any conditions that may be causing the heart failure, which, in turn, lessens the burden on the heart. A doctor or cardiologist will discuss treatment options with the person and suggest the best choices, depending on the individual’s circumstances.
Some common treatments for heart failure include:
Many different medications are available to treat the symptoms of congestive heart failure. They include:
- ACE inhibitors: Angiotensin-converting enzyme inhibiting drugs reduce the heart’s workload by helping the arteries relax and lowering blood pressure. ACE inhibitors boost the performance of the heart and can improve the person’s quality of life.
- ARBs: Angiotensin receptor blockers reduce symptoms of heart failure and prevent blood pressure from rising. They include candesartan, losartan, and valsartan.
- ARNIs: Angiotensin receptor-neprilysin inhibitors reduce strain on the heart to help treat heart failure.
- SGLT2 inhibitors: Also called gliflozins, sodium-glucose cotransporter-2 inhibitor drugs may help prevent and treat heart failure, according to a 2019 study.
- Diuretics: Diuretics help relieve ankle swelling and fluid retention. These drugs also relieve breathlessness resulting from heart failure. Diuretics remove water and salt from the kidneys in the urine. The three main types of diuretics are loop diuretics, thiazide diuretics, and potassium-sparing diuretics.
- Anticoagulants: Anticoagulant drugs thin the blood, making it harder for the blood to clot and helping prevent a stroke. The most common anticoagulant is warfarin. Doctors will monitor a person closely when they are taking this medication.
- Digoxin: A drug called digoxin slows down the heartbeat to treat a fast, irregular heart rhythm and improves the strength with which the heart contracts.
- Beta-blockers. All heart failure patients benefit from taking beta-blockers.
- Antiplatelet drugs. Medications that stop blood platelets from forming clots are called antiplatelets. Aspirin is an antiplatelet drug that can be suitable for people with a very high risk of a heart attack or stroke and a low risk of bleeding or those who have previously had a heart attack or stroke. Current guidelines no longer recommend the widespread use of aspirin to prevent cardiovascular disease.
Not everyone with heart failure responds to drug treatment. In these cases, there are some surgical options:
Coronary artery bypass graft: Doctors commonly recommend this procedure when coronary artery disease is the cause of congestive heart failure.
Heart valve surgery: This procedure repairs a defective valve that makes the heart pump inefficiently.
Implantable left ventricular assist device (LVAD): For hospital inpatients who have not responded to other treatments, an LVAD can help the heart pump blood. Doctors may use it for individuals who are waiting for a transplant.
Heart transplant: If no other treatments or surgeries help, a transplant is the final option. The medical team will only consider a heart transplant if the person is healthy other than the problem with their heart.
Congestive heart failure affects millions of people in the U.S. Doctors cannot always reverse the damage that it does to the heart, but treatments can provide symptom relief and improve a person’s quality of life.
Anyone who experiences symptoms of heart failure should see a doctor for a diagnosis.