Heart failure

Congestive heart failure is a chronic and progressive disease in which the heart muscles are significantly weakened and cannot pump enough blood for the body’s needs.



One speaks of acute heart failure when it occurs for the first time and passes again in the short term.
Chronic heart failure means that the condition has stabilized or worsened.
Heart failure at low cardiac pumping power (cardiac output) at rest occurs due to rheumatic diseases, myocardial diseases, congenital defects and valve damage.

Heart failure with low cardiac pumping power is the result of diseases such as Paget’s disease, anemia, thyrotoxicosis or arteriovenous fistula formation.

Congestive heart failure (CHF) is usually divided into two groups: systolic and diastolic heart failure.

Systolic heart failure – systolic heart failure occurs when the pumping action of the heart becomes less efficient.
It is usually measured as an ‘ejection fraction’ (EF).
EF is calculated by dividing the amount of blood pumped from the left ventricle by the maximum volume of blood that can enter the ventricle when the heart is relaxed (at the end of diastole).
The normal ejection fraction should be greater than 55%, meaning that the ventricle pumps at least 55% of the blood it contains.
If this value is not reached, systolic heart failure is diagnosed.

Diastolic heart failure – sometimes the heart can contract normally, but becomes rigid during diastole (when the heart relaxes and blood enters).
As a result, the heart does not fill completely with blood. This phenomenon is called diastolic heart failure.
It is usually diagnosed by color Doppler sonography.
In diastolic heart failure, the ejection fraction is normal or above 55%.
This condition is more common in patients with hypertension and people over 75 years of age.
Women are more likely than men to suffer from diastolic heart failure.

Causes of congestive heart failure

Cardiac decompensation can be caused by:

  1. diseases that impair the heart’s ability to pump enough oxygenated blood;
  2. Diseases that cause an increased need for oxygen-rich blood.

Older people have a greater risk of heart failure because the heart muscles weaken with age. In addition, the heart wall and the heart valves inside the heart can become hard and rigid with age.
In addition to age, the following disorders can cause decompensation of the heart in young and old people.

  • Coronary artery disease – the coronary arteries are blood vessels that carry blood to the heart. If these arteries narrow due to the formation of atherosclerotic plaques, they can no longer transport enough blood to the heart muscle.
    The result is heart failure.
  • High blood pressure – high blood pressure or hypertension exposes the heart and blood vessels to increased pressure.
    The heart may no longer be able to bear this increased pressure. Therefore, the risk of heart attack, stroke or heart failure increases.
  • Myocarditis – myocarditis is an inflammation of the myocardium, i.e. the heart muscle.
    As a rule, the cause is a viral infection.
    Severe myocarditis can weaken the pumping ability of the heart. The result can be congestive heart failure or a heart attack.
  • Congenital heart disease – it is an abnormality in the structure of the heart that is present from birth.
    A defect may be present in the heart wall or on the valves, it can hinder blood flow to the heart or lead to a malfunction in the blood supply.
  • Cardiomyopathy – cardiomyopathy is characterized by an increase in size and weakness of the heart muscles.
    The condition causes difficulty pumping blood efficiently and can provoke heart failure.
  • Cardiac arrhythmia – the arrhythmia refers to an abnormality of the heartbeat. The heartbeats become irregular. Usually, the cause is abnormal electrical activity. Cardiac arrhythmia can lead to heart failure.
  • Hyperthyroidism – Hyperthyroidism is characterized by increased production of the hormone thyroxine in the thyroid gland. Hyperthyroidism speeds up metabolism and causes an irregular or accelerated heartbeat.
    It can also increase pressure on the heart because it increases the body’s need for blood and oxygen.
  • Other causes – in addition to the diseases mentioned above, cardiac decompensation can also be caused by heart valve disorders, hemochromatosis, amyloidosis, anemia, contact with toxins, cocaine or chemotherapy.

Risk factors of heart failure

Some factors can increase the risk of congestive heart failure.
The main risk factors are:

  1. Age
  2. Smoking and alcohol
  3. Overweight
  4. Lack
  5. Arterial hypertension (high blood pressure)
  6. Diabetes
  7. Family predisposition to heart failure
  8. Metabolic syndrome
  9. Previous heart attacks

Difference between Right and Left Heart Failure

Symptoms of left heart failure

This is the most common type of heart failure that occurs in the human body.
The left side of the heart receives oxygenated blood and pumps it into the body.

Below are the symptoms of left heart failure, which may signal the development of this chronic disease:

  1. Fatigue
  2. Shortness of breath
  3. Palpitations
  4. Weakness
  5. Cough with reddish mucus sputum
  6. Reduction of urine production
  7. Shortness of breath when lying flat, you have to sleep with your head over your heart elevated.
  8. Difficult breathing
  9. Sudden shortness of breath during the night
  10. Fluid backlog in the lungs, leading to respiratory failure
  11. Fast and/or irregular heartbeat
  12. Weight gain

Symptoms of right heart failure

In this disease, the heart chambers do not contract properly, so not enough blood is pumped into the body.
This disorder is relatively rare compared to left heart failure.
The causes of right heart failure are hypertension, pulmonary embolism, etc.

Signs and symptoms of right heart failure

  • Swollen feet and ankles
  • Swollen abdomen
  • Swollen legs
  • Fluid retention in the body
  • Frequent urination, especially at night
  • Hepatomegaly
  • Jaundice (jaundice)
  • Protruding cervical veins
  • Fatigue
  • Fainting
  • Shortness of breath
  • Palpitations and irregular heartbeat
  • Chest pain
  • Inability to concentrate
  • Weakness

In infants, the symptoms are:

  1. Weight loss
  2. Malnutrition
  3. Slow development

Diagnosis of heart failure

The doctor performs a physical examination to determine the patient’s condition. Then he orders instrumental examinations to determine the severity of the disease.
Diagnostic examinations are:
– X-ray of the chest.
– Electrocardiogram (ECG) – to detect coronary disease.
– Echocardiogram (color Doppler examination of the heart).

Risks and complications

In the last stages, there are various complications.

  1. Kidney disorders, the kidneys are not able to excrete mineral salts and water.
  2. Liver disease, this organ can no longer process toxins, so they remain in the body.
  3. Lung disease such as pulmonary edema.
  4. Intestinal problems, for example, malabsorption disorders.

NYHA Classification

To determine the most appropriate therapy, doctors evaluate the stage of heart failure according to the functional classification by the New York Heart Association (NYHA). This method takes into account the symptoms in everyday life and the quality of life of the patient.

Class I (light)
No restriction of physical capacity. Ordinary physical activity does not cause excessive fatigue, palpitations or dyspnea (shortness of breath).

Class II (light)
Slight limitation of physical capacity. Freedom from symptoms at rest, but with everyday physical exertion fatigue, dyspnea or palpitations occur.

Class III (moderate)
Significant limitation of physical capacity. Freedom from symptoms at rest, but routine activities cause fatigue, dyspnea or palpitations.

Class IV (heavy)
The patient is not able to perform physical activities without discomfort.
The symptoms of heart failure are also felt at rest.
Any physical activity aggravates the symptoms.

Source: American Heart Association

Pregnant women who reach NYHA Class 3 or 4 have an increased risk of death. Bed rest can be observed from the 20th week of pregnancy to avoid complications, but in some cases therapeutic abortion is unavoidable.

Treatment of heart failure

The therapy depends on the underlying disease, but the most important thing is to avoid worsening.

It is imperative that arterial pressure, if it is too high, be lowered and arrhythmia prevented.
In the case of heart valve disease (for example, aortic stenosis), surgery must be performed.
Regular but not excessive physical exercise, quitting smoking and reducing body weight is recommended.

Drug therapy
Medications taken to treat heart failure include:

  1. Beta-blockers such as nebivolol (Nebilet) to lower blood pressure.
  2. Vasodilators (nitroglycerin), which reduce overload on the heart and increase the elasticity of the heart.
  3. Digitalis such as digoxin (Lenoxin), which serves to increase cardiac strength and promotes diuresis. This prevents pulmonary edema.

Of the natural remedies, one can drink hawthorn tea, which is a vasodilator (vasodilator) and lowers blood pressure. However, hawthorn should not be taken together with beta-blockers or digitalis, as it is a contraindication.

Prognosis of congestive heart failure

The aging process is a prognostically negative factor in this disease.
The life expectancy of older people depends on the nature of the underlying heart disease.

The prognosis varies and depends on the clinical appearance of the individual.
About 50% of people living with this condition have a life expectancy of 3-5 years.
Complications (such as pulmonary edema) indicate that congestive heart failure has progressed and percentage life expectancy is decreasing in people over the age of 50.
In women, statistics have shown that a third died in the first 5 years after diagnosis.
In stage 4 heart failure, the complications (such as irregular heartbeat) can be fatal.

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