Warning Signs and Symptoms of Congestive Heart Failure

What is Congestive Heart Failure?

Congestive heart failure (CHD) or heart failure is a condition where the heart muscles are weakened or there is a defect in the heart leading to insufficient pumping of blood. Insufficient pumping of blood causes an improper supply of oxygen and nutrients to the different parts of the body. This, in turn, causes excessive tiredness and breathing difficulties in carrying out daily activities such as walking or climbing stairs.

What are the different types of heart failure?

Heart failure can be classified into several types based on the following criteria of:

  1. Based on the time course, heart failure is divided into acute or chronic. 

  • Acute heart failure is described as a sudden onset of signs and symptoms or worsening of the manifestations. 

  • Chronic heart failure is present for three months or more. 

  1. Based on left ventricular ejection fraction, heart failure can be classified into left and right-sided heart failure. 

  • The left-sided heart failure can be further classified into systolic failure and diastolic failure. 

  • The right-sided heart failure occurs due to left-sided heart failure. As the left ventricle fails, it causes increased fluid pressure leading to failure of the right side of the heart. 

The systolic failure occurs as a result of decreased ejection fraction (less than 40%). Ejection fraction is the amount of blood pumped out during each contraction.  In this situation, the left ventricle cannot contract normal, and hence, there is not enough force that leads to inadequate pumping of blood into the circulation. 

The diastolic failure occurs as a result of preserved ejection fraction (50% or more). In this case, the relaxation phase of the heart is not normal due to stiff muscles. Therefore during the resting phase, the heart is filled with an insufficient amount of blood between beats. 

  1. Based on the severity of symptoms

  • Using the New York Heart Association (NYHA) classification criteria, heart failure can be grouped into four classes, based on the limitations to physical activity.

Class Patient symptoms
I No limitation of physical activity.
Ordinary physical activity is not associated with fatigue, palpitation or shortness of breath
II Slight limitation of physical activity.
Comfortable at rest.
Ordinary physical activity causes fatigue, palpitation, or shortness of breath.
III Marked limitation of physical activity.
Comfortable at rest. Vey less physical activity causes fatigue, palpitation and shortness of breath.
IV Feeling of discomfort at rest which increases while carrying out any physical activity.

Is congestive heart failure life-threatening?

Yes, CHD is a serious condition and can be fatal if not treated promptly. It is a progressive disease, meaning that tends to worsen with passing time.

Heart failure is associated with increased risk of death, morbidity and poor quality of life.

At present, there is no cure for CHD and needs to be managed timely with the help of medications and lifestyle changes. 

How common is CHF in India?

There are about 1.3 to 23 million cases of heart failure in India. Compared to the West, Indian patients are diagnosed with heart failure at a younger age. Indians are diagnosed with heart failure in their 50s and 60s whereas the West is affected by the age of 70. Males are more affected by the disease than their female counterparts. 

What are the major risk factors of congestive heart failure?

Many risk factors may contribute to congestive heart failure. These risk factors include smoking, lack of physical activity, and increase food intake of fat and cholesterol.

In the Indian population, heart failure is most likely to increase in these groups:

  • The older population

  • The rise of risk factors such as diabetes and hypertension

  • Increase in coronary artery (blood vessel supplying blood to the heart) disease 

  • Diseases such as rheumatic heart disease and untreated congenital heart disease

  • Increase in lung diseases

What are the causes of congestive heart failure?

Many underlying medical conditions lead to congestive heart failure. These include:

  • Coronary artery disease (ischemic heart disease)

  • A previous heart attack

  • High blood pressure

  • Abnormality of the heart valves (endocarditis or defect at birth)

  • Any heart defects present at birth

  • Heart muscle diseases (cardiomyopathy or myocarditis)

  • Obesity

  • Diabetes

  • Severe lung disease

  • Chronic kidney disease

The less common causes include severe anaemia, arrhythmia, and hyperthyroidism.

What are the warning signs and symptoms?

There are various warning signs and symptoms and it may differ individually.

There are five main warning signs of early heart failure (FACES):

  • Fatigue

  • Activity limitation

  • Congestion

  • Swelling in the legs

  • Shortness of breath

Warning signs of worsening heart failure include:

  • A sudden increase in weight

  • Swelling or pain in the stomach

  • Increased fatigue

  • Swelling in feet or ankles

  • Coughing/wheezing

  • Appetite loss

  • Confused

  • Shortness of breath - upon waking up or lying flat or not related to exercise

Important symptoms:

  • Feeling short of breath while performing some activity or during rest

  • Feeling short of breath while lying down

  • Shortness of breath that awakens a person at night

  • Shortness of breath when bending forward

  • Tiredness/fatigue: feeling tired the whole day or unable to perform daily activities

  • Persistent cough/wheezing: coughing with white or pink blood-tinged phlegm

  • Swelling in the feet, leg, thighs, or ankles

  • Weight gain

  • Lack of appetite

  • Nausea

  • Confused or impaired thinking 

  • Increased heart rate: having rapid or irregular heartbeats

  • Reduced exercise tolerance

  • Nocturia (excessive urination at night)

  • Puffy face in the morning

How is CHD diagnosed?

The doctor can establish a diagnosis of CHD based on the medical history, symptom assessment and physical examination.  He/She might also require the help of various tests such as a chest X-ray, blood tests, electrocardiogram, echocardiogram, MRI, etc to confirm the diagnosis.

How is CHD managed?

CHD needs lifelong management. 

Patients are usually put on medications to improve their life expectancy and reduce their chances of sudden death. 

Surgeries and medical devices are useful in patients to fix the underlying cause and to help the heart function normally.

Lifestyle changes such as low sodium in the diet, fluid regulation, maintaining weight and appropriate exercises play an important role in worsening of symptoms.

 

Dr. Y K Mishra

Head Of Cardiac Sciences And Chief Cardio Vascular Surgeon

Manipal Hospital, Dwarka, Delhi

 

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