Treatment for a patient with congestive heart failure and shortness of breath may include

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, it can lead to fatigue and breathlessness. Everyday activities that used to be easy may become challenging.

There is usually no cure for heart failure, but with the right treatment, people can often lead enjoyable and productive lives.

According to the Centers for Disease Control and Prevention (CDC), more than 6 million adults in the United States have heart failure.

The condition can be systolic or diastolic, depending on whether it affects the heart’s ability to contract or relax. This article focuses on systolic congestive heart failure, and we cover its causes, symptoms, types, and treatment.

In exploring the characteristics of heart failure, it can help to have a clear understanding of related issues, including:

• Heart attack: This event involves damage to the heart muscle. It can result from the blockage of a coronary artery, which supplies blood to the heart. In this case, the muscle is damaged because too little blood and oxygen are reaching it. The damage can also result from a supply and demand mismatch.
• Systolic heart failure: This means that the heart muscle cannot pump blood around the body properly. It can be caused by a heart attack.
• Cardiac arrest: This happens when the heart and blood circulation both stop, and the person has no pulse.

These stages are:

• Stage A: A person has not yet developed heart failure but has a high risk due to one or more preexisting conditions, such as high blood pressure, coronary artery disease, or diabetes.
• Stage B: A person has not developed heart failure or its symptoms but has received a diagnosis of systolic left ventricular dysfunction.
• Stage C: A person has ongoing or past symptoms of heart failure and currently has structural heart disease.
• Stage D: A person has advanced heart failure that is difficult to manage with standard treatment.

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 diminishes, and the heart does not receive the blood supply that it needs.
• Heart attack: This involves damage to the heart muscle. It can result from a sudden blockage of the coronary arteries that causes scarring and reduces how effectively the heart can pump. The damage may also result from an increased demand for blood flow due to a fixed blockage.
• Nonischemic cardiomyopathy: This disease involves weakness of the heart muscle caused by something other than a blockage in the coronary arteries. Possible causes include genetic conditions, drug side effects, and infections.
• Conditions that overwork the heart: Examples include valve disease, high blood pressure, diabetes, kidney disease, sleep apnea, and heart irregularities present at birth.

The following are risk factors for congestive heart failure:

• diabetes, especially type 2 diabetes
• obesity
• smoking
• anemia
• thyroid problems, including hyperthyroidism and hypothyroidism
• lupus
• myocarditis, which is inflammation of the heart muscle that usually occurs due to a virus and can lead to left-sided heart failure
• heart arrhythmias, or irregularities — 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, in which deposits of proteins accumulate in one or more organ systems

The following are possible symptoms of heart failure:

Congestion in the 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 dry, hacking cough.

Fluid retention: Less blood reaches the kidneys, which can result in water retention and 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 brain and other organs can cause weakness, 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, increasing the release of stress hormones.

Many other conditions can cause similar symptoms, so it is important to see a doctor. 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 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

This 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 because the heart does not pump it away effectively. This issue can cause shortness of breath and a buildup of fluid.

Left-sided heart failure symptoms

• shortness of breath
• trouble breathing
• coughing, especially during physical activity

Left-sided heart failure treatment

• a left ventricular assist device
• angiotensin-converting enzyme (ACE) inhibitors, such as ramipril, captopril, or enalapril
• angiotensin-2 receptor blockers (ARBs), such as candesartan, losartan, or telmisartan
• mineralocorticoid receptor antagonists (MRAs), such as spironolactone or eplerenone
• angiotensin receptor neprilysin inhibitor (ARNIs), such as sacubitril
• sodium glucose co-transporter 2 (SGLT2) inhibitors, such as canagliflozin or dapagliflozin
• a pacemaker
• treatment for valve disease
• opening up blocked arteries

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.

Right-sided heart failure symptoms and signs

• a fluid buildup in the legs
• a fluid buildup in the genital area
• a fluid buildup in the organs of the abdomen
• weight gain
• abdominal fullness of discomfort
• a collection of fluid around the lungs

Right-sided heart failure treatment

• treatment for symptoms
• diuretics, also called water pills, such as furosemide or bumetanide
• treatment for valve disease
• treatment for left-sided heart failure or pulmonary hypertension

Biventricular heart failure

Biventricular heart failure affects both sides of the heart.

Biventricular heart failure symptoms

• shortness of breath
• a fluid buildup in legs
• trouble breathing
• breathlessness at night
• coughing

Biventricular heart failure treatment

• MRAs, such as spironolactone or eplerenone
• diuretics, or water pills, such as furosemide or bumetanide
• ACE inhibitors, such as ramipril, captopril, or enalapril
• ARBs, such as candesartan, losartan, or telmisartan
• ARNIs, such as sacubitril
• beta-blockers, such as metoprolol succinate or carvedilol
• a pacemaker
• SGLT2 inhibitors, such as canagliflozin or dapagliflozin

Diastolic heart failure

Diastolic heart failure occurs when the heart muscle is stiffer than usual and does not relax normally but pumps normally. When the heart is stiff, it does not fill up with blood properly. Doctors refer to this as diastolic dysfunction.

When the heart does not fill up with blood as usual, it causes increased pressure inside the heart, which can lead to a backup of fluid into the lungs.

Diastolic heart failure symptoms

• shortness of breath with physical activity
• shortness of breath while lying down
• swelling in legs
• fatigue

Diastolic heart failure treatment

• MRAs, such as spironolactone or eplerenone
• diuretics, such as furosemide or bumetanide
• ACE inhibitors, such as ramipril, captopril, or enalapril
• ARBs, such as candesartan, losartan, or telmisartan
• ARNIs, such as sacubitril
• a pacemaker

Systolic heart failure

Systolic dysfunction is the heart’s inability to pump efficiently after filling with blood. It often occurs if one or both sides of the heart become weak or enlarged.

Systolic heart failure symptoms

• general weakness
• cough
• fatigue
• swelling
• bluish lips and fingers

Systolic heart failure treatment

• MRAs, such as spironolactone or eplerenone
• diuretics, such as furosemide or bumetanide
• ACE inhibitors, such as ramipril, captopril, or enalapril
• ARBs, such as candesartan, losartan, or telmisartan
• ARNIs, such as sacubitril
• SGLT2 inhibitors, such as canagliflozin or dapagliflozin
• beta-blockers, such as metoprolol succinate or carvedilol
• a pacemaker

If a doctor suspects heart failure, they will recommend further tests, which may include:

• Blood and urine tests: The aim is to check the person’s blood count, as well as their liver, thyroid, and kidney function and any indications of “stretch” in the heart. The doctor may also want to check the blood for specific chemical markers of heart failure.
• Chest X-ray: The aim is to show whether the heart has become enlarged. It will also show whether there is fluid in the lungs.
• An electrocardiogram: The aim is to record the electrical activity and rhythms of the heart. It may also reveal any damage from a heart attack.
• An echocardiogram: This is an ultrasound scan that shows the pumping action of the heart. The doctor measures the amount of blood that leaves the left ventricle, the main pumping chamber, with each heartbeat. This measurement is called the ejection fraction.

The doctor may also do additional tests, such as:

• A stress test: The aim is to see how the heart responds to stress and determine whether there is a lack of oxygen due to blockages in the coronary arteries. A 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: The aim is to measure the ejection fraction and examine the heart’s arteries and valves. The results can help the doctor determine whether the person has had a heart attack.
• A PET scan: A doctor can examine the heart muscle and look for signs of rare causes of heart problems, such as sarcoidosis.
• 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:An angiogram is an X-ray of the blood vessels around the heart. A doctor injects dye into the coronary arteries to help detect coronary artery disease or narrowed arteries, which can cause heart failure.

Certain lifestyle changes can reduce the risk of heart failure or slow its progression. These include:

• giving up smoking, if applicable
• having a healthy diet that includes plenty of fruit, vegetables, quality fats, unrefined carbohydrates, and whole grains
• exercising regularly
• maintaining a moderate weight
• not drinking more alcohol than recommended
• getting enough quality sleep
• reducing stress when possible, as stress can strain the heart over time

In addition, people with heart failure should keep up to date with vaccinations, including the yearly flu shot.

Damage that affects the heart’s pumping action is not always reversible. Nevertheless, treatments can significantly improve the quality of life by keeping heart failure under control and helping to relieve many of the symptoms.

Doctors also focus on treating the cause of heart failure. This will reduce the burden on the heart. The doctor, who may be a cardiologist, will present the treatment options and make recommendations that suit each person’s circumstances.

Some common treatments for heart failure include:

Medications

Many medications can treat the symptoms of congestive heart failure. They include:

• ACE inhibitors: These reduce the heart’s workload by helping the arteries relax and lowering blood pressure.
• MRAs: These block hormones produced by the adrenal glands that could damage the heart.
• ARBs: These reduce symptoms of heart failure and prevent blood pressure from rising. They include candesartan, losartan, and valsartan.
• ARNIs: These reduce strain on the heart.
• SGLT2 inhibitors: Also called gliflozins, these may help prevent and treat heart failure, according to a 2019 study.
• Diuretics: These help relieve ankle swelling, fluid retention, and breathlessness resulting from heart failure. Diuretics help the body remove water and salt. The two main types are loop and thiazide diuretics.
• Anticoagulants: These thin the blood, making it harder for the blood to clot and helping to prevent a stroke. Doctors closely monitor people who are taking these medications.
• Digoxin: This drug slows the heartbeat and improves the strength of heart contractions.
• Beta-blockers: Anyone with heart failure may benefit from taking beta-blockers.
• Antiplatelet drugs: These stop blood platelets from forming. Aspirin is an example, and it might be suitable for people with a very high risk of a heart attack or stroke and a low risk of bleeding — or for people who have had a heart attack or stroke. Current guidelines no longer recommend the widespread use of aspirin to prevent cardiovascular disease.

Surgery

Not everyone with heart failure responds to drug treatments. 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.

Percutaneous coronary intervention: Sometimes called PCI, this is a nonsurgical procedure to place a stent in the heart to open up the blood vessels.

Pacemaker: This is a small device placed under the skin in the chest to help correct an irregular heartbeat.

Cardiac ablation: This procedure can help correct a heart rhythm problem. A catheter is inserted into the arteries or veins.

Heart valve surgery: This procedure repairs a defective valve that makes the heart pump inefficiently.

Implantable left ventricular assist device: For hospital inpatients who have not responded to other treatments, this can help the heart pump blood. Doctors may recommend them for people who are waiting for a transplant.

Heart transplant: If no other treatments or surgeries help, a transplant is an option. Medical teams only consider a transplant for a person who is healthy beyond the problem affecting their heart.

The life expectancy of someone with congestive heart failure depends on the type of heart failure, the cause, the stage of the disease, and how effective treatment is.

When heart failure results from cardiomyopathy or coronary artery disease, a person typically has a less positive outlook than someone with heart failure in its earliest stage.

Congestive heart failure affects millions of people in the U.S. Doctors cannot always reverse the damage involved, but treatments can provide symptom relief and improve the quality of life.

Anyone who experiences symptoms of heart failure should see a doctor for a diagnosis.

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