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Congestive heart failure

Left-sided CHF is the most common type of CHF. It occurs when your left ventricle doesn’t properly
pump blood out to your body. As the condition progresses, fluid can build up in your lungs, which
makes breathing difficult.

There are two kinds of left-sided heart failure:

Systolic heart failure occurs when the left ventricle fails to contract normally. This reduces the
level of force available to push blood into circulation. Without this force, the heart can’t pump
properly.

Diastolic failure, or diastolic dysfunction, happens when the muscle in the left ventricle becomes
stiff. Because it can no longer relax, the heart can’t quite fill with blood between beats.

Right-sided CHF occurs when the right ventricle has difficulty pumping blood to your lungs. Blood
backs up in your blood vessels, which causes fluid retention in your lower extremities, abdomen, and
other vital organs.

It’s possible to have left-sided and right-sided CHF at the same time. Usually, the disease starts in the
left side and then travels to the right when left untreated.

Congestive heart failure stages

Stage Main symptomsOutlook

Class I You don’t experience any symptoms during typical physical activity. CHF at this stage
can be managed through lifestyle changes, heart medications, and monitoring.

Class II You’re likely comfortable at rest, but normal physical activity may cause fatigue,
palpitations, and shortness of breath. CHF at this stage can be managed through lifestyle changes,
heart medications, and careful monitoring.

Class III You’re likely comfortable at rest, but there’s a noticeable limitation of physical activity. Even
mild exercise may cause fatigue, palpitations, or shortness of breath. Treatment can be
complicated. Talk with your doctor about what heart failure at this stage may mean for you.

Class IV You’re likely unable to carry on any amount of physical activity without symptoms, which are
present even at rest. There’s no cure for CHF at this stage, but there are still quality-of-life and
palliative care options. You’ll want to discuss the potential benefits and risks of each with your
doctor.

What are the causes of CHF, and am I at risk?


CHF may result from other health conditions that directly affect your cardiovascular system. This is
why it’s important to get annual checkups to lower your risk for heart health problems, including
high blood pressure (hypertension), coronary artery disease, and valve conditions.

Hypertension

When your blood pressure is higher than normal, it may lead to CHF. Hypertension has many
different causes. Among them is the narrowing of your arteries, which makes it harder for your
blood to flow through them.

Coronary artery disease

Cholesterol and other types of fatty substances can block the coronary arteries, which are the small
arteries that supply blood to the heart. This causes the arteries to become narrow. Narrower
coronary arteries restrict your blood flow and can lead to damage in your arteries.

Valve conditions

Your heart valves regulate blood flow through your heart by opening and closing to let blood in and
out of the chambers. Valves that don’t open and close correctly may force your ventricles to work
harder to pump blood. This can be a result of a heart infection or defect.

Other conditions

While heart-related diseases can lead to CHF, there are other seemingly unrelated conditions that
may increase your risk, too. These include diabetes, thyroid disease, and obesity. Severe infections
and allergic reactions may also contribute to CHF.

What are the symptoms of CHF?

In the early stages of CHF, you most likely won’t notice any changes in your health. If your condition
progresses, you’ll experience gradual changes in your body.

Symptoms you may notice first Symptoms that indicate your condition has worsened Symptoms
that indicate a severe heart condition

fatigue irregular heartbeat chest pain that radiates through the upper body

swelling in your ankles, feet, and legs a cough that develops from congested lungs rapid
breathing
weight gain wheezing skin that appears blue, which is due to lack of oxygen in your lungs

increased need to urinate, especially at night shortness of breath, which may indicate pulmonary
edema fainting

Chest pain that radiates through the upper body can also be a sign of a heart attack. If you
experience this or any other symptoms that may point to a severe heart condition, seek immediate
medical attention.

Symptoms of heart failure in children and infants

It can be difficult to recognize heart failure in infants and young children. Symptoms may include:

poor feeding

excessive sweating

difficulty breathing

These symptoms can easily be misunderstood as colic or a respiratory infection. Poor growth and
low blood pressure can also be signs of heart failure in children. In some cases, you may be able to
feel a resting baby’s rapid heart rate through the chest wall.

How is CHF diagnosed?

After reporting your symptoms to your doctor, they may refer you to a heart specialist, or
cardiologist.

Your cardiologist will perform a physical exam, which will involve listening to your heart with a
stethoscope to detect abnormal heart rhythms. To confirm an initial diagnosis, your cardiologist
might order certain diagnostic tests to examine your heart’s valves, blood vessels, and chambers.

There are a variety of tests used to diagnose heart conditions. Because these tests measure different
things, your doctor may recommend a few to get a full picture of your current condition.

Electrocardiogram
An electrocardiogram (EKG or ECG) records your heart’s rhythm. Abnormalities in your heart’s
rhythm, such as a rapid heartbeat or irregular rhythm, could suggest that the walls of your heart’s
chamber are thicker than normal. That could be a warning sign for a heart attack.

Echocardiogram

An echocardiogram uses sound waves to record the heart’s structure and motion. The test can
determine if you already have poor blood flow, muscle damage, or a heart muscle that doesn’t
contract normally.

MRI

An MRI takes pictures of your heart. With both still and moving pictures, this allows your doctor to
see if there’s damage to your heart.

Stress test

Stress tests show how well your heart performs under different levels of stress. Making your heart
work harder makes it easier for your doctor to diagnose problems.

Blood tests

Blood tests can check for abnormal blood cells and infections. They can also check the level of BNP, a
hormone that rises with heart failure.

Cardiac catheterization

Cardiac catheterization can show blockages of the coronary arteries. Your doctor will insert a small
tube into your blood vessel and thread it from your upper thigh (groin area), arm, or wrist.

At the same time, the doctor can take blood samples, use X-rays to view your coronary arteries, and
check blood flow and pressure in your heart chambers.

How is it treated?

You and your doctor may consider different treatments depending on your overall health and how
far your condition has progressed.
Congestive heart failure drugs

There are several medications that can be used to treat CHF, including:

ACE inhibitors

Angiotensin-converting enzyme inhibitors (ACE inhibitors) open up narrowed blood vessels to


improve blood flow. Vasodilators are another option if you cannot tolerate ACE inhibitors.

You may be prescribed one of the following:

benazepril (Lotensin)

captopril (Capoten)

enalapril (Vasotec)

fosinopril (Monopril)

lisinopril (Zestril)

quinapril (Accupril)

ramipril (Altace)

moexipril (Univasc)

perindopril (Aceon)

trandolapril (Mavik)

ACE inhibitors shouldn’t be taken with the following medications without consulting with a doctor,
because they may cause an adverse reaction:

Thiazide diuretics can cause an additional decrease in blood pressure.

Potassium-sparing diuretics, such as triamterene (Dyrenium), eplerenone (Inspra), and


spironolactone (Aldactone), can cause potassium buildup in the blood. This may lead to abnormal
heart rhythms.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, and naproxen, can
cause sodium and water retention. This may reduce the ACE inhibitor’s effect on your blood
pressure.

This is an abbreviated list, so always speak with your doctor before taking any new medications.

Beta-Blockers

Beta-blockers can reduce blood pressure and slow a rapid heart rhythm.

This may be achieved with:

acebutolol (Sectral)

atenolol (Tenormin)

bisoprolol (Zebeta)

carteolol (Cartrol)

esmolol (Brevibloc)

metoprolol (Lopressor)

nadolol (Corgard)

nebivolol (Bystolic)

propranolol (Inderal LA)

Beta-blockers should be taken with caution with the following medications, as they may cause an
adverse reaction:

Antiarrhythmic medications, such as amiodarone (Nexterone), can increase cardiovascular effects,


including reduced blood pressure and slowed heart rate.

Antihypertensive medications, such as lisinopril (Zestril), candesartan (Atacand), and amlodipine


(Norvasc), may also increase the likelihood of cardiovascular effects.
The effects of albuterol (AccuNeb) on bronchodilation may be cancelled out by beta-blockers.

Fentora (Fentanyl) may cause low blood pressure.

Antipsychotics, such as thioridazine (Mellaril), may also cause low blood pressure.

Clonidine (Catapres) may cause high blood pressure.

Some medications may not be listed here. You should always consult your doctor before taking any
new medications.

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