Congestive Heart Failure

Congestive heart failure occurs when your heart can't pump enough oxygen-rich blood to meet your body's needs. The condition is termed "congestive" because poorly pumped blood can back up and congest in the lungs, liver, abdomen, and lower extremities.

Causes

Congestive heart failure often develops after other conditions such as narrowed arteries (coronary artery disease) or high blood pressure have damaged or weakened your heart. Over time, the weakened heart can no longer keep up with the demands placed on it to pump blood throughout your body. Your heart’s ventricles, its main pumping chambers, may become stiff and fail to fill properly between beats, or stretch and dilate to the point that blood no longer pumps efficiently.

 

Symptoms

Congestive heart failure can be chronic (persistent and ongoing) or acute (sudden onset).

Chronic (long-term) heart failure symptoms:

  • Rapid or irregular heartbeat (palpitations)
  • Fatigue, weakness, difficulty with exercise 
  • Shortness of breath (dyspnea) when you exert yourself or when you lie down
  • Swelling (edema) in your legs, ankles and feet
  • Abdominal swelling
  • Persistent cough or wheezing with white or blood-tinged phlegm
  • Sudden weight gain from fluid retention
  • Lack of appetite and nausea
  • Difficulty concentrating or decreased alertness

Acute (sudden onset) heart failure symptoms:

  • Similar to chronic symptoms, but more severe with sudden startup or abrupt worsening 
  • Sudden fluid buildup
  • Rapid or irregular heartbeat
  • Sudden, severe shortness of breath and coughing up pink, foamy mucus
  • Angina symptoms (chest pain) if your heart failure is caused by a heart attack 

Treatments

The best way to prevent congestive heart failure is to control risk factors and conditions that cause heart failure symptoms, such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity. Lifestyle changes can significantly improve your heart health.

Medication Management
A number of effective medications exist to relieve heart failure symptoms and increase survival from congestive heart failure. Your doctor may also prescribe medications to lower blood pressure, improve circulation and prevent blocked arteries as well as blood thinners to prevent blood clots.

  • ACE inhibitors and ARBs: ACE (angiotensin-converting enzyme) inhibitors lower blood pressure, improve blood flow and decrease your heart's workload. ARBs (angiotensin receptor blockers) provide some of the benefits of ACE inhibitors without the potential side effect of a persistent cough.
  • Beta blockers: These lower blood pressure, slow the heart rate, and lessen the risk of abnormal heart rhythms (arrhythmia).
  • Digoxin: This drug, also known as digitalis, strengthens heart contractions and slows your heartbeat.
  • Diuretics: These prevent fluid from collecting in your body and decrease fluid in your lungs, making breathing easier.
    Aldosterone antagonists. These medications help your heart work better, reverse scarring of the heart, and can prolong your life if you have severe congestive heart failure.
  • Inotropes: These intravenous medications are administered to patients suffering severe heart failure symptoms to improve heart-pumping function and maintain blood pressure.

Percutaneous Coronary Intervention (PCI)
If the causes of congestive heart failure include coronary artery disease, then PCI procedures (angioplasty and stent placement) may be necessary. These procedures restore and improve blood flow to the heart muscle.

Angioplasty
Your cardiologist uses a technique, called cardiac catheterization, where a long, thin tube (catheter) is inserted into an artery of your groin, wrist, or arm and snaked to the site of the arterial blockage or narrowing near your heart. A wire tipped with a deflated balloon is passed through the catheter to the site and then inflated and deflated to compress the plaque deposits against your artery walls and restore proper blood flow. At this point the cardiologist may choose to place a stent in the artery.

Stent placement
A tiny stainless steel mesh tube called a stent is mounted on a balloon and guided through the catheter to the plaque-filled site after angioplasty has reopened the artery. The balloon is then inflated, which expands the stent into the inner layer of the artery. The stent acts as a scaffold to hold the artery open, helping to improve blood flow and relieve symptoms caused by a blockage. Some stents slowly release medication to help keep the artery open as well.

Benefits
In most cases, a PCI procedure greatly increases blood flow through the previously narrowed or blocked coronary artery. Your chest pain should decrease, and you may have a better ability to exercise. Successful angioplasty can also eliminate the need for an invasive surgical procedure called coronary artery bypass graft.

However, keep in mind that angioplasty and stenting don't cure heart disease. You'll need to continue healthy lifestyle habits and may need medications to ensure that your artery doesn't re-narrow.

Risks
Angioplasty with stent placement is a less invasive way to open clogged arteries than open-heart bypass surgery, but the procedure still carries some risks. The most common include:

  • Bleeding: You may bleed at the site in your leg or arm where a catheter was inserted. This usually results in a simple bruise, but sometimes serious bleeding occurs that may require additional surgical procedures.
  • Re-narrowing of your artery (restenosis): With angioplasty alone — i.e., without stent placement — restenosis can happen in about a third of cases. Stents were developed to reduce restenosis. Bare-metal stents reduce the chance of restenosis to less than 20 percent, and drug-releasing stents reduce the risk to less than 10 percent.
  • Blood clots: Clots can form in stents after angioplasty; these clots can cause a heart attack. Certain medications can decrease the chance of clots.

The following complications of angioplasty are considerably less common:

  • Heart attack
  • Coronary artery damage (may require emergency bypass surgery)
  • Kidney problems
  • Stroke
  • Abnormal heart rhythms (usually short-lived)


Cardiac Resynchronization Therapy (CRT)
Implantation of devices such as biventricular pacemakers or implantable cardioverter defibrillators (ICD) can correct abnormalities in your heart’s rhythm. A biventricular pacemaker sends specifically timed electrical impulses to your heart's lower chambers that synchronize your heartbeat and help your heart to pump more efficiently. An implantable cardioverter defibrillator continuously monitors the heartbeat. If an abnormally rapid and potentially dangerous heart rhythms is detected, the ICD delivers electrical impulses to terminate the arrhythmias and allow the normal heartbeat to resume. 

Benefits
In most cases, a CRT procedure offers the following advantages:

  • Helps heart pump more effectively
  • Increases how much blood your lower heart chamber (left ventricle) is pumping
  • Treats slow heartbeats (bradycardia)
  • Improves quality of life
  • Decreases heart failure symptoms
  • Lowers risk of hospital admissions
  • Improves your exercise tolerance
  • Lowers your risk of death due to congestive heart failure

Risks
Implanting a CRT device is generally a minor procedure, but it may still involve some risks, including:

  • Swelling, bruising or bleeding
  • Allergic reaction to anesthesia
  • Damage to blood vessels near the CRT device
  • Infection where the CRT device was implanted
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