​CHF can affect either both sides of the heart or just one side. The three types of CHF are biventricular, left-sided, and right-sided heart failure. In left-sided heart failure, the left ventricle becomes enlarged (hypertrophy) and becomes dilated together with the left atrium in order to compensate for the increased pressure.

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Right-sided heart failure usually happens after left-sided heart failure. Pooling of blood in the left heart chambers causes an increase in pressure, impairing the normal blood drainage from the lungs to the left atrium. The pressure in the pulmonary veins increases, causing the right ventricle to compensate by pumping more vigorously.

In time, the cardiac muscles of the right chambers wear down, causing right-sided heart failure. Failure of both sides of the heart is called biventricular heart failure.

Congestion is one of the common features of heart failure, thus the term “congestive heart failure” is still used by many medical professionals.

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Signs and Symptoms of Heart Failure

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• Dyspnea (shortness of breath) upon exertion or lying down

• Jugular vein distention (JVD)

• Fatigue and reduced ability to exercise

• Peripheral edema (swelling of limbs, ankles, and feet)

• Pulmonary edema

• Ascites (swelling of the abdominal cavity)

• Irregular and/or rapid heartbeat

• Cough and wheezing – may come with white or blood-tinged sputum

• Nausea and lack of appetite

• Decreased level of alertness and concentration

• Increased urinary frequency at night

• Chest pain if the HF is caused by myocardial infarction (heart attack)

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Causes of Heart Failure

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1. Myocardial Infarction (heart attack) and Coronary Artery Disease (CAD). These are the most common causes of heart failure. Fat buildup on the arterial walls leads to the reduction of blood flow, resulting to cardiac arrest.

2. Hypertension. Having a high blood pressure causes the heart to work harder than normal in order to facilitate the blood circulation throughout the body. This makes the cardiac muscles stiffer and/or weaker, leading to heart failure.

3. Alcohol, tobacco, and drug abuse. The toxic effects of alcohol, nicotine, and drugs (e.g. cocaine) may lead to the damage of the cardiac muscles known as cardiomyopathy.

4. Congenital heart defects. Faulty heart chambers or valves at birth can directly affect the functionality of the heart.

5. Other heart conditions. Viral infections such as COVID-19 may cause inflammation of the cardiac muscles known as myocarditis.

6. Chronic diseases. HIV, diabetes, arrythmias, and thyroid problems may lead to heart failure.

7. Certain medications. Non-steroidal inflammatory drugs (NSAIDS), several anaesthesia drugs, chemotherapy agents, and some antihypertensives puts a person at a higher risk for heart problems which may eventually lead to heart failure.

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Complications of Heart Failure

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1. Kidney damage. A reduction of blood flow from the heart to the kidneys may result to reduce capacity of the kidneys to remove toxic waste. If left untreated, this may lead to kidney failure which may require the patient to undergo dialysis.

2. Liver damage. Fluid build up may result to an increased pressure to the liver. If left untreated, this may result to liver damage known as scarring.

3. Other cardiac issues. Heart failure may result to faulty heart valves and arrythmias if there is an increased pressure in the heart or enlargement of the heart.

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Diagnostic Tests for Heart Failure

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1. Physical examination – crackles heard upon auscultation, signs of edema upon inspection

2. Blood tests – CBC, biochemistry, N-terminal pro-B-type natriuretic peptide (NT-proBNP)

3. Imaging – Chest X-Ray, Echocardiogram, CT scan, MRI, coronary angiogram (insertion of a catheter and injecting a dye for visualization)

4. Electrocardiogram

5. Stress test – letting the patient walk on a treadmill while attached to an ECG machine

6. Myocardial biopsy – insertion of a biopsy cord in a vein in the neck or groin to take heart muscle tissue samples

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Treatment for Heart Failure

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1. Medications. Several medications are used in combination to treat heart failure. These include:

2. Angiotensin-converting enzyme (ACE) inhibitors – promotes vasodilation of the blood vessels, lowering the pressure and improving the blood flow (e.g. lisinopril and enalapril).

3. Beta blockers – reduces heart rate and blood pressure (e.g. bisoprolol and carvedilol).

4. Angiotensin II receptor blockers – similar to ACE inhibitors and can be used if the patient does not tolerate ACE inhibitors (e.g. losartan and valsartan).

5. Digitalis or digoxin – improves the contraction of heart muscles, regulate heart rhy and reduces heartbeat.

6. Inotropes – to improve the function of the heart to pump blood in severe heart failure.

7. Diuretics – to facilitate elimination of excess fluid in the body through urination (e.g. furosemide and spironolactone).

8. Inotropes. These are intravenous medications used in people with severe heart failure in the hospital to improve heart pumping function and maintain blood pressure.

• Surgical interventions. These include coronary bypass surgery, heart valve repair or replacement, and heart transplant. It may also involve the insertion of medical devices such as implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and ventricular assist devices (VADs).

• Lifestyle changes. A crucial part of the treatment plan for a patient with heart failure is to change several habits that are linked to the disease. These include smoking cessation, blood pressure control, diabetes management, dietary changes, stress management, exercise and increase in physical activity.