Congestive heart failure, also called heart failure, is a serious condition that happens when the heart can’t get enough oxygen and blood to support other organs in the body. It doesn’t mean the heart has stopped beating, but rather it has a hard time pumping much needed nutrients our body requires. “When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath,” says the Mayo Clinic. “Certain heart conditions, such as narrowed arteries in the heart (coronary artery disease) or high blood pressure, gradually leave the heart too weak or stiff to fill and pump blood properly.”

Over 6 million Americans have congestive heart failure, according to the Centers for Disease Control and Prevention and “in 2018, heart failure was mentioned on 379,800 death certificates.” John Whyte, MD, MPH, Chief Medical Officer, WebMD tells us, “Congestive Heart failure is quite common,”  It’s the number one reason why people over the age of 65 are hospitalized.  Some people think failure means that all of a sudden the heart stops working like in cardiac arrest.  Heart failure is a process that occurs over several years.”  

The medical community continues to search for improved ways to treat congestive heart failure, but it still remains a common and often fatal health problem. “Congestive heart failure is a domain of active and intensive research in the US and overseas,” Dr. J. Wes Ulm, Harvard and MIT-trained MD, PhD with a background in bioinformatics, gene therapy, genetics, drug discovery, consulting and education explains. “In light of its significant toll and costs – with an estimated prevalence of more than 6 million Americans, and an incidence of close to a million new diagnoses each year – efforts are ongoing to improve its management and to better address its basic physiology, in the form of confronting and reversing the pathological remodeling of heart muscle at the cellular and molecular level. However, CHF is also a classic example of a condition that is usually secondary to other root causes as discussed above. Therefore, the best approach in confronting CHF is to address and prevent the conditions that give it in the first place.”

Read on to learn more about congestive heart failure and signs that indicate you have the condition. As always, please consult your physician for medical advice. 

CHF can have many causes and can be acute or chronic, though in the latter case, it generally involves so-called pathological remodeling. This occurs if the myocardium – the central muscular wall of the heart – undergoes an alteration in its cellular and molecular character which impairs proper function.”

Dr. Whyte explains, “Congestive Heart Failure can make doing your daily activities much more difficult.  You have less energy.  You have trouble breathing.  That makes it hard to live an active lifestyle.  You retain fluid and that makes you gain weight and that affects how you look and feel.”

Dr. Ulm says, “The specific symptoms will depend on the severity of the CHF, which is essentially categorized as one of four different classes (with patients often moving between them at various times), and on the specific causes and comorbidities, i.e. any other diagnoses that may be present. More broadly, heart failure is classified as being systolic (inadequate heart pumping) or diastolic (inadequate heart filling), with the myocardium essentially becoming too weak in the former and too stiff in the latter. As a rule, CHF by its nature tends to limit daily activity since the heart is unable to supply peripheral tissues with their circulation needs, which is most manifest during periods of heightened exertion.”

Dr. Ulm explains, “CHF generally manifests with fatigue, dyspnea (shortness of breath), elevated heart rate (compensating in part for the insufficient circulatory delivery), and swelling in the feet or legs, sometimes alongside less specific symptoms like confusion, trouble sleeping, or having to awake at night to urinate. There can also be weight gain with fluid retention, heart palpitations, or a dry cough present. The leg and ankle swelling result from a process called edema, in which fluid exits into the tissues beneath the skin, in this case essentially from the backup of circulation when the heart is unable to pump blood adequately into the pulmonary artery (from the right ventricle) and the aorta (from the left ventricle). 

Depending on the stage and severity of the CHF, patients may also have fluid accumulation (ascites) in the abdomen. Upon clinical examination at a doctor’s office, a physician or nurse listening through a stethoscope may hear a crackling sound in the lungs and abnormal sounds from the heart, or may notice cool extremities or a purplish discoloration (cyanosis) from inadequate circulation and oxygenation, depending on CHF severity. An echocardiogram procedure will often note a reduction in the ejection fraction (EF), a hallmark of the inadequate cardiac output that defines the disease.”

Dr. Whyte says, “There are numerous causes for heart failure.  This includes high blood pressure, kidney disease, and thyroid disease.  If you’ve had a heart attack, that weakens your heart and blood vessels which can cause heart failure. Excess use of alcohol doesn’t just affect the liver — it also affects the heart and that can cause heart failure.” 

According to Dr. Ulm, “Common risk factors for CHF include untreated heart valve disease or congenital cardiac conditions (present at birth or becoming evident later, such as cardiomyopathy), a history of heart attacks or other severe heart disease, poorly controlled hypertension (high blood pressure) or diabetes, and some heart arrhythmias such as inadequately treated atrial fibrillation. Patients with significant obesity or kidney issues, alcoholics, smokers, and recreational drug users are also at increased risk. Some medications can likewise have toxic side effects elevating heart failure risk, and thyrotoxicosis – in which the blood is flooded with excess thyroid hormone, for example from hyperthyroidism or a release after thyroiditis (thyroid inflammation) – can also give rise to CHF. 

There are, furthermore, some rare cases that can be caused by infections such as a severe viral myocarditis, in which the heart muscle itself is infected and inflamed, or a condition known as Chagas disease seen most commonly in Brazil. There is, in addition, mounting concern from recent studies amid the pandemic that some forms of COVID-19 infection may contribute to the risk of myocarditis and heart failure, though research is ongoing for this.”

Dr. Whyte states, “Complications of congestive heart failure are liver damage, kidney damage, etc. Because heart failure affects how well the heart pumps oxygenated blood to the body, other organs often suffer damage.  In heart failure, the kidneys, liver, and lungs are often damaged. Some people develop sleep apnea when they have heart failure.  Others might experience anemia, or low blood count.” 6254a4d1642c605c54bf1cab17d50f1e

Dr. Ulm states, “If left untreated, heart failure can progress to Class IV CHF, in which perfusion from the heart is reduced to the extent that downstream tissues risk injury from inadequate circulation of oxygen and nutrients, and which is associated with elevated morbidity and mortality. In such cases, the pathological remodeling of the heart’s myocardium has advanced to result in significant dysfunction and impaired pumping action. Physical activity is substantially restricted even at rest, and management and recuperation are difficult.”

Dr. Ulm shares, “Preventive measures for congestive heart failure overlap for the most part with those you’ve probably heard in warding off heart disease in general, for example cessation of smoking and other tobacco use, minimizing alcohol and recreational drugs, partaking in regular exercise, maintaining a healthy body weight, and dietary adjustments to improve fruit and vegetable intake while controlling salt, sugar, and excess saturated fat. It’s important to get regular medical checkups to detect and treat potential issues such as hypertension and, if diagnosed with CHF, to make sure to take the prescribed medications such as diuretics, ACE inhibitors, and beta-blockers. Such regimens essentially help to rest the heart and reduce the burden of adequately perfusing the body, while research suggests they may also help to halt and reverse the pathological remodeling of the myocardium that gives rise to CHF in the first place.

It’s likewise important to keep stress under control and well-managed. This can be easier said than done especially for us in the US; Gallup and other organizations have found that Americans regularly suffer some of the highest stress levels of any developed country. This no doubt also contributes to the relatively higher rates of obesity, substance abuse, and other contributors to CHF that we encounter in the United States, as well as the comparatively dismal life expectancy – among the lowest for advanced nations, even before the COVID pandemic – for which the USA’s significant prevalence of CHF is itself likewise a culprit. But stress management is key to averting CHF and a host of other health issues, which have in many cases been linked to chronic elevation of blood cortisol, a stress hormone produced by the adrenal glands. Deep breathing, yoga, exercise, and broader lifestyle changes are integral to this.”

Wes Ulm, MD, PhD, is a physician-researcher, musician (J. Wes Ulm and Kant’s Konundrum) ,and novelist, and earned a dual MD/PhD degree from Harvard Medical School and MIT. He is part of the Heroes of the COVID Crisis series in relation to his ongoing efforts in the drug discovery and public health arena.