Is your heart a little tired? Let's learn about Congestive Heart Failure in a simple way!

Do you sometimes feel like you have trouble breathing even when you walk a short distance or climb stairs? Or do you feel like your legs or ankles are swelling? These could be your heart telling you something. Today we will talk about Congestive Heart Failure , or as some call it, congestive heart failure . Don't worry, if you understand this properly and manage it properly, you can be fine.

What exactly is Congestive Heart Failure?

Simply put, Congestive Heart Failure is when your heart can't pump blood as well as it needs to. Think of your heart as a large distribution center. Every package that comes in (i.e. blood) needs to be delivered to the right place (i.e. organs) on time. But what happens when this center becomes a little weak and can't deliver all the packages on time? The packages pile up, right? That's what happens here too. When the heart can't pump blood properly, the blood backs up and collects in different parts of the body, especially in the lungs, legs, ankles, and stomach . This is what we call (Congestive), which means there is a "collection."

Are there main types of Congestive Heart Failure?

Yes, there are several main types:

• Left-sided heart failure: This is the most common type. This is when the left side of the heart (the left ventricle) is unable to pump blood throughout the body. This can cause blood to pool in the lungs, causing difficulty breathing.
• Right-sided heart failure: This is most often caused by left-sided heart failure. When the right side of the heart can't pump blood from the lungs properly, blood pools in the venous system and causes swelling in areas like the legs, ankles, and abdomen.
• High-output heart failure: This is a rare type. In this condition, the heart pumps blood well, but due to the body's high demand (for example, severe anemia, hyperthyroidism), the heart is unable to meet that demand.

How common is this condition?

Millions of people around the world suffer from this condition. It is especially common among people over the age of 65 , and it is the leading cause of hospitalization in that age group. Therefore, it is very important to be aware of this condition.

What are the symptoms of Congestive Heart Failure?

These symptoms can vary from person to person, and also vary depending on the severity of the condition. However, there are some common symptoms that can be seen:

• Shortness of breath: Feeling like you're going to faint when doing light work, walking a little, or climbing a few stairs. In severe cases, it can be difficult to breathe even when standing still.
• Waking up at night with difficulty breathing: If you suddenly wake up while sleeping and feel like you're suffocating, that's also a symptom of this.
• Chest pain or discomfort: Some people may feel a tightness or heaviness in their chest.
• Heart palpitations: The heart may feel like it is beating loudly, rapidly, or irregularly.
• Feeling extremely tired when active: Feeling too tired to do things that were previously easy.
• Swelling of the legs, ankles, and abdomen: Ankles and toes may swell to the point where it becomes difficult to put on shoes or remove rings.
• Sudden weight gain: If you gain a few kilos in a few days, it may be due to water retention.
• Frequent need to urinate at night.
• A dry, hacking cough that comes on for no reason: This cough can get worse, especially when you are coughing.
• Feeling of fullness or tightness in the stomach.
• Loss of appetite or feeling sick (nausea).

Remember, sometimes these symptoms can be very subtle, or even absent. But that doesn't mean you don't have heart failure. Symptoms can come and go. It's common for the condition to get worse over time. So if you have one or two of these signs, it's wise to see a doctor.

What are the causes of Congestive Heart Failure?

There can be many reasons why the heart may be weak. Some of the main reasons are:

• Coronary artery disease and/or heart attack: Damage to the heart muscle due to blockage of the arteries that supply blood to the heart.
• Cardiomyopathy: This can be due to genetic causes, viral infections, or other causes, causing the heart muscle to weaken or thicken.
• Congenital heart disease: Being born with a heart defect.
• Diabetes: Long-term diabetes can affect the heart.
• Hypertension: Uncontrolled high blood pressure causes the heart to work harder.
• Heartbeat irregularities (Arrhythmia): Irregular heartbeat reduces the efficiency of the heart.
• Kidney disease: When the kidneys do not function properly, the amount of fluid and salt in the body increases, putting pressure on the heart.
• Body mass index (BMI) greater than 30 (obesity).
• Tobacco and illegal drug use.
• Excessive alcohol use.
• Certain medications: For example, some chemotherapy drugs used to treat cancer can be harmful to the heart.

Another thing to know is that left-sided heart failure is the main cause of right-sided heart failure. When the left side is not working properly, blood flows backward through the lungs and affects the right side as well.

Who is most at risk for this?

Some people are more likely to develop this condition. These risk factors include:

• Over 65 years of age.
• Use of tobacco products, drugs such as cocaine, or alcohol.
• A sedentary lifestyle that is not physically active.
• Frequent consumption of foods high in salt and fat.
• Having high blood pressure.
• Having coronary artery disease.
• Having had a previous heart attack.
• Having a family history of Congestive Heart Failure.

What are the possible complications of Congestive Heart Failure?

If this condition is not treated properly or controlled, further problems can occur.

• Irregular heartbeat.
• Sudden cardiac arrest can even cause death.
• Heart valve problems.
• Fluid accumulation in the lungs (Pulmonary edema).
• Pulmonary hypertension.
• Kidney damage or kidney failure.
• Liver damage.
• Malnutrition.

How do you know if you have Congestive Heart Failure?

If you have these symptoms, when you see a doctor, he or she will first ask you questions.

• Things like what symptoms you have and how long you've had them.
• Other medical conditions you have (such as diabetes, high blood pressure).
• Has anyone in your family ever had heart disease or sudden death?
• Do you use tobacco products, alcohol, or drugs?
• Whether you have previously received chemotherapy or radiation for cancer.
• What medications do you use?

Then the doctor will examine you physically. They will listen to your heart, check your lungs, and check your legs for swelling.

What are the four stages of Congestive Heart Failure?

Because this is a disease that gradually gets worse over time, there are four stages. These stages are called A, B, C, and D. That is, a journey from a low-risk level to a high-risk level.

Stage A (Stage A - Pre-heart failure)

This means that you are at high risk of developing heart failure. This may be because someone in your family has had the disease. Or it may be because you have one or more of these conditions:

• High blood pressure (Hypertension).
• Diabetes.
• Coronary artery disease.
• Metabolic syndrome.
• A history of alcohol use disorder.
• Having rheumatic fever.
• Having a family history of cardiomyopathy.
• Having used medications that can damage the heart (e.g., some anti-cancer drugs).

Stage B (Stage B - Pre-heart failure)

At this stage, your left ventricle (the main chamber that pumps blood throughout the body) is not working properly, or there is some change in its structure (e.g. thickening). But you do not yet have symptoms of heart failure.

Stage C

People in this stage have been officially diagnosed with Congestive Heart Failure. They may also have symptoms now, or they may have previously had symptoms but now have none.

Stage D and Reduced Ejection Fraction (EF)

These people have a very advanced (Advanced) (Heart Failure) condition. Even with treatment, the symptoms are difficult to control. The amount of blood that is ejected from the heart at one time, that is, `(Ejection fraction - EF)`, is very low and may have `(HFrEF - heart failure with reduced ejection fraction)`. This is the final stage of (Heart Failure).

What are the diagnostic tests?

Doctors perform several tests to determine if you have congestive heart failure, what stage it is in, and what exactly is causing it:

• Blood tests: These can detect other conditions that affect the heart (e.g. anemia, kidney disease, thyroid problems) and whether the heart has been damaged (by checking certain enzyme levels).
• Cardiac catheterization: This is done to check for blockages in the coronary arteries of the heart.
• Chest X-ray: This can be used to check for an enlarged heart and fluid buildup in the lungs.
• Echocardiogram (Echo): This is like an ultrasound scan of the heart. It can clearly see many things like the heart's chambers, valves, heart muscle function, and how well it pumps blood (the ``Ejection fraction - EF'').
• MRI (Magnetic Resonance Imaging) of the heart.
• CT (Computed Tomography) scan of the heart.
• Electrocardiogram (EKG or ECG): This helps to see things like the electrical activity of the heart and the rhythm of the heartbeat.
• MUGA scan (Multigated Acquisition Scan): This can also be used to see how well the heart chambers are pumping blood.
• Stress test: An ECG is taken while you are walking on a treadmill or riding a bicycle to see how your heart responds to exercise.
• Genetic testing: Sometimes, especially if there is a family history, these tests are done to look for genetic causes.

How is Congestive Heart Failure treated?

Treatment depends on the type of heart failure you have, its cause, and the stage you are in. Medications and lifestyle changes are an integral part of every treatment plan. Your doctor will talk to you about the best treatment plan for you.

The important thing is, (Heart Failure) is not a completely curable disease. As it gets worse, the amount of blood pumped by the heart to the organs decreases, and you move on to the next stage. You can't go back from these stages. Therefore, the main goal of treatment is to stop you from going to the next stage, to delay it, to control the symptoms and improve your quality of life.

Let's see how the treatment changes from stage to stage:

Treatment for stage A:

These people don't have heart failure yet, but the risk is high. That's why they do things to reduce the risk.

• Regular exercise, like walking every day.
• Completely abstaining from tobacco products.
• Treatment of high blood pressure (medication, low-salt diet, active lifestyle).
• Treatment of high cholesterol levels.
• Avoiding alcohol and illegal drugs.
• If you have other health conditions such as coronary artery disease, diabetes, or high blood pressure, you may be prescribed an Angiotensin-converting enzyme inhibitor (ACE-I) or Angiotensin II receptor blocker (ARB).

Treatment for stage B:

These people have a heart problem, but no symptoms.

• All treatments mentioned in Phase A.
• If your `(Ejection fraction - EF)` is 40% or less, `(ACE-I)` or `(ARB)` is the right medicine.
• If you have had a heart attack before and your EF is 40% or less (if you are not already taking it), you should take a medicine called a beta-blocker.
• If you have had a previous heart attack or if your EF is 35% or less, you may need a medication called an Aldosterone antagonist.
• Sometimes, surgery or other interventions may be needed for conditions such as coronary artery disease, heart failure, valve disease (valve repair or replacement), or congenital heart disease.

Treatment for stage C (HFrEF - for those with reduced blood pumping ability):

These people have (Heart Failure) and have/had symptoms.

• Treatments mentioned in stages A and B.
• `(Beta-blocker)` and `(Aldosterone antagonist)` medications.
• A class of drugs called `(Sodium-glucose transport 2 inhibitors - SGLT2i)`.
• A combination drug called ``(Hydralazine/nitrate)`` is used if other treatments do not control symptoms, especially in people of African American descent.
• If the heart rate is greater than 70 beats per minute and symptoms persist, heart rate-lowering medication.
• If symptoms (especially swelling and difficulty breathing) persist, a diuretic (what we call water pills) is given.
• Limiting the amount of salt (sodium) in food.
• Weigh yourself daily. If you gain or lose more than 2 kilograms (4 pounds) in a day or two, inform your doctor immediately.
• You may also need to limit the amount of fluid you drink per day.
• Some people need to have a special pacemaker device installed called ``Cardiac resynchronization therapy - CRT``, or ``biventricular pacemaker``.
• A device called an implantable cardiac defibrillator (ICD) is implanted in people who are at risk of developing life-threatening heart rhythm irregularities.
• Even if symptoms improve with treatment, it is very important to continue treatment to delay the condition from progressing to stage D.

Treatment for stage D:

These people have a serious condition (Heart Failure).

• All of the treatments mentioned in stages A, B, and C. In addition, more advanced treatments are being considered:
• Heart transplant.
• Mechanical devices that support the heart (Ventricular assist devices - VADs)
• Special heart surgeries `(Heart surgery)`.
• Continuous intravenous inotropic drugs (medicines that increase the force of heart contractions).
• Palliative care or hospice care.

Stages C and D (HFpEF - for those with no problem pumping blood from the heart):

In this case, even though the heart's ability to contract (ejection fraction) is normal, there is a problem with the heart filling with blood (diastolic function) resulting in heart failure.

• Treatments mentioned in stages A and B.
• Treating other medical conditions that can cause or worsen heart failure (e.g., atrial fibrillation, high blood pressure, diabetes, obesity, coronary artery disease, chronic lung disease, high cholesterol, kidney disease).
• Diuretics (water pills) to reduce or relieve symptoms.

Don't forget that managing your other medical conditions (diabetes, kidney disease, anemia, high blood pressure, thyroid disease, asthma, chronic lung disease) is very important to controlling this condition (Heart Failure) .

Are there any side effects or complications of the treatment?

Some treatments may have minor side effects.

• Low blood pressure (Hypotension).
• Effects on kidney function (Kidney failure).
• Frequent hospitalizations, especially with intravenous medications (central IVs), increase the risk of infection.

Talk to your doctor about this and be informed.

How to reduce the risk of (Congestive Heart Failure)?

Although we cannot change things like age and family history, we can reduce our risk of developing this condition (Heart Failure) by changing our lifestyle.

• Maintaining a healthy weight that suits you.
• Eating a heart-healthy diet (less salt, sugar, oil, more vegetables and fruits).
• Exercising regularly.
• Managing stress well.
• Complete cessation of the use of tobacco products.
• Not drinking alcohol or drinking it very sparingly.
• Not using illegal drugs.
• If you have other medical conditions that increase your risk (such as high blood pressure, diabetes, high cholesterol), get them properly treated and controlled.

What kind of future can someone with Congestive Heart Failure expect?

With proper treatment, lifestyle changes, and adherence to your doctor's recommendations, many people can live a happy life despite having Congestive Heart Failure. Your future depends on these things:

• It depends on how well your heart muscle works.
• Depending on the nature and severity of your symptoms.
• It depends on how well you respond to the treatment plan.
• It depends on how well you follow your treatment plan (medication, diet, exercise).

Some studies suggest that people with heart failure may live up to 10 years less than those without it. But this varies greatly from person to person. So it's best to be open and honest about your condition with your doctor. Heart failure is a chronic, lifelong condition. It requires lifelong treatment and management.

How do I take care of myself? (Self-care)

When living with Heart Failure, it is very important that you take care of yourself.

• Take your medicine exactly as prescribed by your doctor, at the right time. Don't miss a single day.
• Stay as active as possible. Ask your doctor what exercises are right for you.
• Follow a low-salt diet. Packaged, canned, and fast foods are high in salt.
• Check your weight every day. If you notice any sudden weight gain (e.g., 1-2 kilos in a day or two), tell your doctor .
• If new symptoms appear, or if existing symptoms worsen, notify your doctor immediately.
• Be sure to go to the doctor on scheduled follow-up appointments.
• Because this is a disease that can be fatal, it is a good idea to let your doctor and family know your wishes regarding your medical care (e.g., whether you want life-prolonging treatment/hospitalization). This can be done by filling out an ``advance directive'' or ``living will''. It is wise to prepare this while you are still of sound mind in case you are unable to make these decisions at a later date.

What are the things you can't eat and drink with (Congestive Heart Failure)?

Many people with heart failure need to limit their daily salt intake . Some people may also need to limit their fluid intake (such as water, tea, soup). Your doctor or nutritionist will advise you on this.

When should I see the doctor?

It is very important to tell your doctor if you have any new symptoms or if your existing symptoms of heart failure worsen. Especially if you have any of the following:

• If you have difficulty breathing even when at rest.
• If swelling increases in the legs, ankles, or abdomen.
• If you suddenly gain weight (more than 1-2 kg in a day or two).
• If you constantly feel tired and sleepy.

When should I go to the Emergency Department (ETU) ?

If your heart failure suddenly gets worse (e.g., severe shortness of breath, severe chest pain), you need emergency treatment. Doctors call this acute decompensated heart failure . In this case, you may be given medications and oxygen to help improve your condition. Getting to the hospital quickly without wasting time can be life-saving.

What questions should I ask the doctor?

When you go to see the doctor, don't be afraid to ask questions that are on your mind.

• "What stage of (Congestive Heart Failure) do I have?"
• "What is the best treatment for me at this stage?"
• "What are some safe exercises I can do? How long should I do them?"
• "What changes should I make to my diet?"
• "Are there support groups for people with (Congestive Heart Failure)?"
• "What should I do if my symptoms get worse?"

The most important things to remember (Take-Home Message)

Congestive Heart Failure is nothing to be afraid of, but it's also not something to take lightly. If you have this condition, there are many things you can do to improve your heart health.

• Take your medicine exactly and on time.
• Eat low-salt, heart-healthy foods.
• Stay as active as possible.
• Check your weight daily and be aware of sudden changes.
• Be sure to go to the doctor on the scheduled dates.
• Keep a record of your symptoms and tell your doctor if they get worse.

If you have any questions or concerns about your medication, lifestyle changes, or anything else in your treatment plan, talk openly with your doctor. They are there to help you manage this condition and live the best life possible. Remember, you are not alone!

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