Chronic Heart Failure

Chronic heart failure, otherwise known as congestive heart failure or heart failure, is an ongoing inability of the heart to pump enough blood through the body to ensure a sufficient supply of oxygen. The causes of the condition vary, but some of the most common risk factors include old age, diabetes, high blood pressure and being overweight. Chronic heart failure is most common in men.

The condition’s name is potentially confusing; the term “heart failure” does not mean that the heart has stopped or is failing completely, but that it is weaker than is normal in a healthy person. In some cases, the condition can be mild, causing symptoms that may only be noticeable when exercising, in others, the condition may be more severe, causing symptoms that may be life-threatening, even while at rest. 1

The most common symptoms of chronic heart failure include shortness of breath, tiredness, swelling of the legs and ankles, chest pain and a cough. It most commonly affects older people and people with other heart conditions and is typically treated with a combination of lifestyle and diet changes, and medications. Chronic heart failure is typically a long-term condition that gradually worsens over time. This is the feature that differentiates it from acute heart failure, which develops very suddenly. It cannot typically be cured, but symptoms can be managed effectively.

The condition affects the lower chambers of the heart, known as the right and left ventricles. The left ventricle pumps blood around the body, supplying it with oxygen. Chronic heart failure occurs when the heart cannot adapt to the body’s changing need for oxygen, for example when exercising or climbing the stairs. 1

There are different types of chronic heart failure, classified according to how the heart reacts when it pumps. The two main types are: 1 2

• Heart failure with reduced ejection fraction: Also called systolic heart failure or HFrEF, this type occurs when the heart is too weak and doesn’t squeeze normally.
• Heart failure with preserved ejection fraction: Also called diastolic heart failure or HFpEF, this type occurs when the heart is too stiff and doesn’t fill with blood normally.

It is also possible to be affected by a combination of these two types. Moreover, each type of chronic heart failure can affect the left ventricle, right ventricle or both simultaneously.

The symptoms of chronic heart failure generally depend on the type of the condition being experienced and its location, i.e. which ventricle is involved. 2

The main symptom of left-sided chronic heart failure is shortness of breath, which will generally become worse with activity or when lying flat. A cough may also present. If the condition is affecting the right-side of the heart, edema, a buildup of fluid causing swelling of the legs and ankles, is the most commonly experienced symptom.

Other symptoms, which may present regardless of which side of the heart is affected, may include: 1 2

• Tiredness
• Dizziness or lightheadedness
• Nausea
• Loss of appetite
• Constipation
• Weakness, commonly of the legs
• Rapid heart rate, even when resting, or an irregular heartbeat
• Chest pain or angina

Doctors generally classify a person’s heart failure according to the severity of the symptoms being experienced. The New York Heart Association (NYHA) Functional Classification system is the commonly used grading system. People are sorted into four categories: 3

• I: Physical activity is not limited by symptoms.
• II: Physical activity is slightly limited. Rest is comfortable.
• III Physical activity is markedly limited. Rest is comfortable.
• IV: Unable to carry out physical activity without discomfort. Symptoms are present while resting.

People experiencing possible symptoms of chronic heart failure should consult a doctor. In addition, the free Ada app can be used to carry out a symptom assessment.

Chronic heart failure has no single cause; it is most accurately thought of as a complication of a variety of other conditions, each affecting the ability of the heart to pump blood around the body effectively.

One of the most common conditions that causes chronic heart failure is coronary artery disease. CHD leads to a narrowing of the coronary arteries that supply the heart with blood and oxygen, depriving it of the oxygen it needs to function effectively. Although chronic heart failure is a common complication of CHD, it does not occur in all cases.

Read more about Coronary Artery Disease (CHD) »

Hypertension, or high blood pressure, is another common cause. The condition places extra strain on the heart, which can, over time, cause chronic heart failure to develop.

Read more about Hypertension »

Other possible causes of chronic heart failure include: 2 4

• Cardiomyopathy, i.e. diseases of the heart muscle
• Arrhythmia, an abnormal heart rhythm
• Diseases of the heart valve
• Congenital heart conditions
• Viral infections of the heart muscle, such as myocarditis
• Medicines and chemicals including some chemotherapy drugs and cocaine
• Excessive alcohol consumption
• Anemia
• Thyroid gland disease

Diagnosis is typically based on a person’s medical history, a physical examination and a series of tests. Tests are used by doctors to identify the underlying cause of the chronic heart failure and may include: 1 2

• Echocardiogram (ultrasound): This test uses high-frequency sound waves to provide doctors with an insight into the different functions of the heart. It is considered the most important tool in the diagnosis of heart failure.
• Electrocardiogram (ECG): Used to test and record the heart’s rhythm and electrical activity.
• Chest X-ray: Able to give doctors a picture of the heart. Can also reveal if there is a buildup of fluid.
• Brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP): A blood test to measure BNP or NT-proBNP protein levels, both of which tend to be elevated in people with heart failure.

In some cases, other tests, including urine tests and MRI scans, may also be used.

Once diagnosed, people with chronic heart failure will work closely with their doctors to create a treatment plan that works for them. In most cases, this plan will include a variety of lifestyle and dietary changes, as well as medications.

Lifestyle and dietary changes that are often recommended for people with chronic heart failure include: 1 5

• Stopping smoking: People who smoke should stop. Doctors are able to advise on the best methods of doing this.
• Limiting alcohol intake: If a person’s condition was caused by alcohol consumption, they should stop. Doctors are able to advise on the best methods of doing this.
• Losing weight: If a person is overweight, they should lose weight. This can lessen the strain placed on the heart.
• Taking regular exercise: Exercise can help to reduce symptoms such as shortness of breath and fatigue. Before beginning a new exercise regimen, however, a person should consult their doctor about how to do this in a safe way.
• Limiting salt intake: Salt can cause the retention of excess fluid in the body. By managing the amount of salt in one’s diet, therefore, chronic heart failure can be managed. A doctor will advise on how much salt should be consumed.
• Weighing yourself daily: It is important for people who have been diagnosed with chronic heart failure to weigh themselves daily. If a person’s weight increases by around 2 kg (roughly 4 lb) over a period of 1 to 3 days, they should contact a doctor. This is a sign of fluid retention and may require intervention.

People with severe chronic heart failure may be asked to limit the amount of fluid, including water, they consume. Doctors will advise on exactly how much fluid to drink and how to do this in a safe way.

The type of medications prescribed will depend on the type of chronic heart failure being experienced, its underlying causes and its severity. In many cases, a combination of medications will be necessary; this combination may need to be altered over time, depending on whether hypertension and left ventricular ejection fraction has been controlled and, importantly, whether the affected person is still displaying symptoms.

Some of the most common medications prescribed to help manage chronic heart failure include: 2

• Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors can help to prevent a buildup of fluid and may be able to slow the progression of heart failure.
• Beta blockers: Usually taken in combination with ACE inhibitors, this type of medication can help to protect the heart and slow the progression of heart failure.
• Diuretics (water tablets): This type of medication helps the kidneys to pass extra urine, helping to ease excess fluid retention.
• Mineralocorticoid/aldosterone receptor antagonists (MRAs): This type of medication also helps to prevent excess fluid retention.

Doctors will advise on how and when to take medications. Reading the enclosed instruction leaflet is also recommended.

In some cases, alternative treatment methods may be recommended by doctors. Often, these methods will be used to treat the underlying cause of chronic heart failure.

Devices, such as implantable cardioverter defibrillators (ICDs) and pacemakers, may be fitted in some people. In some severe cases, surgery to replace or fix the affected heart valve may be recommended. In rare cases, a heart transplant or the implantation of a left ventricular assist device may be necessary.

A number of measures can be taken to help lessen the risk of developing chronic heart failure. These include:

• Taking regular exercise, such as walking or swimming
• Maintaining a healthy weight
• Maintaining a healthy and nutritious diet with plenty of vegetables and lean meats
• Limiting alcohol intake
• Stopping smoking

It is also important to address any underlying risk factors, such as high blood pressure and anemia. Doctors are able to advise on how best to manage these conditions.

• Cardiac failure
• Chronic congestive heart failure
• Congestive heart failure

Q: What is the difference between acute and chronic heart failure?
A: Chronic heart failure is generally a condition that develops gradually over time, whereas acute heart failure, in most cases, occurs very suddenly and should be considered a medical emergency requiring immediate intervention. The two types of the condition share symptoms, such as shortness of breath, fluid buildup and chest pain, but the pace of their development differs.

Read more about Acute Heart Failure »

Q: What is the relationship between sleep apnea and chronic heart failure?
A: Sleep apnea, as well as other sleep-related disorders, often occur in people with chronic heart failure. 6 Such conditions can place extra strain on the heart during sleep, which can cause heart failure to worsen and may worsen the prognosis for some people. People who have sleep apnea and chronic heart failure should inform their doctor, who will be able to recommend a variety of treatment options.

Q: Is chronic heart failure hereditary?
A: While it may not be accurate to say that chronic heart failure is hereditary, a number of the risk-factors that can lead to the condition can be hereditary. These include coronary heart disease and high blood pressure. 7 8 As well as a genetic link, it is often the case that family members also share lifestyle and environmental factors which can lead to chronic heart failure.

Q: What is the life expectancy for chronic heart failure?
A: With prompt and proper treatment, the life expectancy for a person with chronic heart failure can be improved. The prognosis for the condition also greatly depends on the severity of the underlying cause. Chronic heart failure, however, is a serious condition, with, only around 15 percent of people surviving for over 10 years after an occurrence, according to one study. 9