Congestive heart failure is a serious medical condition that occurs when the heart cannot supply enough oxygen and blood to support other organs in the body. This does not mean that the heart has stopped beating, but it struggles to pump the nutrients required by our body. When this occurs, blood can accumulate and fluid can build up in the lungs, leading to shortness of breath. Conditions such as coronary artery disease and high blood pressure can leave the heart too weak or stiff to function correctly.
According to the Centers for Disease Control and Prevention, over 6 million Americans have congestive heart failure, and in 2018, heart failure was mentioned on 379,800 death certificates. Dr. John Whyte, Chief Medical Officer of WebMD, explains that congestive heart failure is quite common, and it is the primary reason why people over the age of 65 are hospitalized. It is a gradual process that can occur over several years, not a sudden event like cardiac arrest.
Although the medical community continues to seek improved ways to treat congestive heart failure, it remains a prevalent and often fatal health problem. Dr. J. Wes Ulm, a Harvard and MIT-trained MD, PhD with a background in bioinformatics, gene therapy, genetics, drug discovery, consulting, and education, explains that congestive heart failure is an area of active and intensive research in the US and abroad. Since it has a substantial impact and cost, efforts are underway to enhance its management and address its basic physiology by reversing the pathological remodeling of heart muscle at the cellular and molecular levels. However, since congestive heart failure is usually secondary to other root causes, the best approach is to address and prevent the conditions that contribute to its development in the first place.
1) Essential Information on Congestive Heart Failure: What You Need to Know
Congestive heart failure (CHF) can be either acute or chronic and may have multiple causes. However, in the chronic form, it usually involves pathological remodeling, which happens when the myocardium, the central muscular wall of the heart, undergoes changes in its cellular and molecular makeup that can impair its normal function.
2) The Impact of Congestive Heart Failure on Daily Living
According to Dr. Whyte, congestive heart failure can significantly impact daily activities. It can reduce energy levels, cause breathing difficulties, and make it challenging to maintain an active lifestyle. Fluid retention can lead to weight gain and negatively impact physical appearance and overall well-being.
Dr. Ulm explains that the specific symptoms of congestive heart failure can vary based on its severity, which falls under one of four different classes that patients can move between over time, as well as any other coexisting conditions. Broadly speaking, heart failure is classified as either systolic, which occurs when the heart cannot pump blood adequately, or diastolic, which occurs when the heart cannot fill with enough blood due to stiffness. Regardless of the type, congestive heart failure tends to limit daily activities since the heart cannot supply peripheral tissues with adequate circulation, which becomes more pronounced during periods of physical exertion.
3) Recognizing the Symptoms of Congestive Heart Failure
Dr. Ulm highlights that congestive heart failure (CHF) typically presents with several symptoms, including fatigue, dyspnea (shortness of breath), elevated heart rate, and swelling in the feet or legs. Other non-specific symptoms may include confusion, insomnia, and nocturia (waking up at night to urinate). Weight gain with fluid retention, heart palpitations, or a dry cough may also occur.
Leg and ankle swelling, known as edema, is a common symptom resulting from the backup of circulation when the heart cannot pump blood adequately into the pulmonary artery or the aorta. Depending on the stage and severity of CHF, fluid accumulation (ascites) in the abdomen may also occur. During a clinical examination, a physician or nurse may detect abnormal sounds from the heart and a crackling sound in the lungs while listening through a stethoscope. Cool extremities or a bluish discoloration (cyanosis) from inadequate circulation and oxygenation may also be observed, depending on CHF severity. An echocardiogram often indicates a reduction in the ejection fraction (EF), which is a hallmark of the inadequate cardiac output that characterizes the disease.
4) Factors That Increase the Risk of Congestive Heart Failure
Dr. Whyte notes that congestive heart failure (CHF) can have many causes, including high blood pressure, kidney disease, and thyroid disease. A heart attack weakens the heart and blood vessels, which can lead to CHF. Excessive alcohol consumption can also impact the heart and cause CHF, in addition to affecting the liver.
According to Dr. Ulm, several common risk factors for CHF include untreated heart valve disease, congenital cardiac conditions, a history of heart attacks or other severe heart disease, poorly controlled hypertension, poorly controlled diabetes, and certain heart arrhythmias. Individuals with significant obesity or kidney problems, as well as alcoholics, smokers, and recreational drug users, are also at increased risk. Some medications may also have toxic side effects that increase the risk of heart failure, and thyrotoxicosis, a condition in which the blood contains excessive thyroid hormone, can also lead to CHF.
In rare cases, infections such as severe viral myocarditis, which causes inflammation of the heart muscle, or Chagas disease, primarily found in Brazil, can also cause CHF. Additionally, there is growing concern that certain forms of COVID-19 infection may contribute to the risk of myocarditis and heart failure, although research is still ongoing in this area.
5) Possible Complications Arising from Congestive Heart Failure
According to Dr. Whyte, congestive heart failure can lead to complications such as liver and kidney damage. The condition impairs the heart's ability to pump oxygenated blood to the body, often leading to damage in other organs. Heart failure frequently causes damage to the kidneys, liver, and lungs. In some cases, people with heart failure may also develop sleep apnea, anemia, or low blood count.
Dr. Ulm warns that if left untreated, heart failure can progress to Class IV CHF, which is associated with high morbidity and mortality rates. In such cases, the heart's ability to pump blood is significantly compromised, leading to reduced perfusion to downstream tissues and risking injury due to inadequate circulation of oxygen and nutrients. This type of heart failure indicates advanced pathological remodeling of the heart's myocardium, resulting in significant dysfunction and impaired pumping action. Physical activity is substantially limited, even at rest, and management and recovery become challenging.
6) Ways to Mitigate the Risk of Congestive Heart Failure
Dr. Ulm suggests that preventive measures to reduce the risk of congestive heart failure largely overlap with strategies for preventing heart disease in general. These measures include quitting smoking and other tobacco use, minimizing alcohol and recreational drug consumption, engaging in regular exercise, maintaining a healthy body weight, and adjusting one's diet to increase fruit and vegetable intake while controlling salt, sugar, and excess saturated fat.
Regular medical checkups are also critical for identifying and treating potential health problems, such as hypertension. For individuals diagnosed with congestive heart failure, it is crucial to follow prescribed treatment regimens that may include diuretics, ACE inhibitors, and beta-blockers. These medications help to ease the heart's workload, reduce the burden of adequately perfusing the body, and may also help to halt or reverse the pathological remodeling of the heart muscle that leads to CHF.
Additionally, managing stress is vital to preventing CHF and a range of other health issues. Chronic elevation of blood cortisol, a stress hormone produced by the adrenal glands, has been linked to a variety of health problems. To manage stress, individuals can practice deep breathing, yoga, exercise, and other lifestyle changes.
Dr. Ulm is a physician-researcher, musician (J. Wes Ulm and Kant's Konundrum), and novelist with a dual MD/PhD degree from Harvard Medical School and MIT. He is part of the Heroes of the COVID Crisis series in recognition of his ongoing efforts in drug discovery and public health.