Chronic Heart Failure (CHF)

Introduction

Chronic Heart Failure (CHF) is a progressive condition in which the heart is unable to pump blood efficiently to meet the body's needs. It is a widespread condition, affecting millions worldwide, and is commonly associated with hypertension, coronary artery disease, and diabetes.

Causes of CHF

The most common causes of CHF include:

1. Hypertension (High Blood Pressure) – Increased pressure can overwork the heart, leading to heart failure.
2. Coronary Artery Disease (CAD) – Blockages in the heart’s arteries reduce blood supply, weakening the heart muscle.
3. Cardiomyopathy – Diseases of the heart muscle, including genetic, viral, or alcohol-related causes.
4. Valvular Heart Disease – Damage to heart valves can lead to inefficient blood circulation.
5. Diabetes Mellitus – Increased risk due to vascular damage and metabolic stress on the heart.

Symptoms of CHF

CHF symptoms depend on its severity and can be classified based on the New York Heart Association (NYHA) classification:

• Class I: No limitation of physical activity.
• Class II: Mild symptoms with moderate activity.
• Class III: Marked limitation of activity.
• Class IV: Symptoms occur even at rest.

The common symptoms include:

• Shortness of breath (dyspnea) – Worse with exertion or lying down.
• Fatigue and weakness – Due to poor blood circulation.
• Swelling (edema) in legs, ankles, and abdomen – Due to fluid retention.
• Rapid or irregular heartbeat – The heart works harder to compensate.
• Persistent cough or wheezing with white or pink phlegm – Fluid accumulation in lungs.

Diagnosis of CHF

A doctor may use various tests to diagnose CHF, such as:

1. Echocardiogram (Echo) – Assesses heart function and ejection fraction (EF).
2. Electrocardiogram (ECG) – Identifies rhythm abnormalities.
3. Blood tests – Measures BNP (B-type natriuretic peptide), an indicator of heart strain.
4. Chest X-ray – Detects fluid buildup in lungs and heart enlargement.
5. Cardiac MRI or CT scan – Provides detailed images of heart structure.

Treatment of CHF

Management focuses on slowing progression, reducing symptoms, and improving quality of life. Treatment options include:

1. Lifestyle Modifications

• Sodium restriction – Reducing salt intake prevents fluid retention.
• Fluid management – Proper hydration without excess fluid intake.
• Regular exercise – Low-impact activities like walking help maintain health.
• Smoking and alcohol cessation – Prevents further damage to heart muscle.

2. Medications

The following medications help manage CHF and improve survival:

• ACE inhibitors / ARBs – Lower blood pressure, reduce heart workload.
• Beta-blockers – Slow heart rate and improve heart function.
• Diuretics – Reduce fluid buildup and swelling.
• Aldosterone antagonists – Prevent further heart damage.
• SGLT2 inhibitors – New medications beneficial for heart failure patients.

3. Surgical and Device-Based Treatments

• Implantable Cardioverter Defibrillator (ICD) – Prevents life-threatening arrhythmias.
• Cardiac Resynchronization Therapy (CRT) – Coordinates heart contractions.
• Heart transplant – Considered in end-stage CHF.

Prognosis

With early diagnosis, lifestyle changes, and appropriate treatment, many CHF patients can have an improved quality of life. However, CHF is a progressive disease requiring continuous management.

Conclusion

Heart failure is a complex condition, but with proper monitoring and adherence to therapy, many individuals can manage their symptoms effectively and lead fulfilling lives.

Source recommendations

1. American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for the Management of Heart Failure

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/03/29/19/53/2022-AHA-ACC-HFSA-Heart-Failure-Guideline-gl-hf
3. https://pubmed.ncbi.nlm.nih.gov/35363499/
4. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx
5. https://www.sciencedirect.com/science/article/pii/S0735109721083959

2. European Society of Cardiology (ESC) Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://pubmed.ncbi.nlm.nih.gov/34447992/
3. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
4. https://pubmed.ncbi.nlm.nih.gov/22611136/
5. https://academic.oup.com/eurheartj/article/44/37/3627/7246292