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Heart Failure (Congestive heart failure)

Heart failure, also known as congestive heart failure (CHF), is caused when the heart is unable to pump enough blood to meet the body's needs. Over time, narrowed arteries in the heart (coronary artery disease) or high blood pressure make your heart too weak or stiff to fill and pump efficiently.

Different types of heart failure are

  • Left-sided heart failure: It is the most common form of heart failure in which the heart is unable to pump enough oxygen-rich blood to the body. In this condition fluid may back up in the lungs, causing shortness of breath.
  • Right-sided heart failure: This happens when the heart does not fill with enough blood and sometimes fluid may back up into the abdomen, causing the legs and feet to swell.
  • Systolic heart failure: It indicates a pumping problem in which the left ventricle doesn't contract vigorously.
  • Diastolic heart failure: The left ventricle is unable to relax or fill fully, indicating a filling problem.

The causes of heart failure are

  • Coronary artery disease and heart attack: Coronary artery disease is the most common form of heart disease and is a leading cause of heart failure. Arteries that supply blood to the heart muscle becomes narrow due to plaque buildup as a result the blood moves slowly through narrowed arteries, leaving some areas of the heart muscle weak and deprived of oxygen-rich blood. A heart attack occurs when plaques formed in the arteries rupture causing a blood clot which blocks blood from flowing to the heart muscle, decreasing the heart's pumping ability.
  • High blood pressure (hypertension): It is the force by which the blood is pumped by the heart through the arteries. When the blood pressure is in an elevated state then the heart has to work harder and over time, the heart muscle becomes thicker to compensate for the extra work that it performs. Eventually, the heart muscle becomes stiff or weak to effectively pump blood.
  • Faulty heart valves: A damaged valve, due to a heart defect, coronary artery disease or heart infection, forces the heart to work harder to keep blood flowing thus weakening the heart.
  • Heart defects (congenital heart defects): If the heart and its chambers or valves are not formed properly then the healthy parts of the heart are forced to work harder which can lead to heart failure.
  • Abnormal heart rhythms (heart arrhythmias): Abnormal heart rhythms cause the heart to beat too fast creating extra work for the heart. Over time, the heart may weaken causing heart failure.
  • Myocarditis. It is an inflammation of the heart muscle commonly caused by a virus which can lead to left-sided heart failure.

Symptoms of heart failure are

  • Fatigue and weakness
  • Swelling in your legs, ankles and feet
  • Palpitations
  • Persistent cough or wheezing
  • Swelling of your abdomen
  • Lack of appetite and nausea
  • Decreased alertness
  • Chest pain

Treatments for heart failure are

  • Medications:
    • Angiotensin-converting enzyme (ACE) inhibitors: These drugs help people with heart failure live longer and feel better by helping to widen the blood vessels which lowers blood pressure, improve blood flow and decreases the workload of the heart.
    • Digoxin: This drug increases the strength of the heart muscle contractions and also tends to slow the heartbeat.
    • Beta blockers: These medications slow heart rate and reduce the blood pressure and also limits or reverses some of the damage done to the heart.
    • Diuretics: They lower the amount of sodium and water in the body which in turn helps in lowering the pressure in the arteries and heart.
  • Surgical and other options:
    • Coronary bypass surgery: In this procedure a graft is created to bypass blocked coronary arteries using a vessel from another part of the body. This allows blood to flow around the blocked or narrowed coronary artery.
    • Heart valve repair or replacement: When a faulty heart valve causes heart failure then the faulty valve is repaired or replaced using this procedure.
    • Implantable cardioverter-defibrillator (ICD): It is a small device which is placed under the skin just below the collarbone to send electrical signals to the heart when it goes very fast. It is also helpful in regulating heartbeat.
    • Cardiac resynchronization therapy (CRT) / biventricular pacing: A biventricular pacemaker sends timed electrical impulses to both the left and right ventricles, so that they pump in a more efficient, coordinated manner.
    • Heart pumps (left ventricular assist devices or LVADs): These devices are implanted into the abdomen or chest and attached to a weakened heart to help it pump.
    • Heart transplant: In cases of severe heart failure when surgery and medications don't help, then the diseased heart is replaced with a healthy donor heart. Heart transplants can improve the survival and quality of life of people with severe heart failure.

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