Radiological Findings in Congestive Heart Failure

What Is Congestive Heart Failure?

Congestive heart failure (CHF) is a progressive disease in which the heart cannot pump blood efficiently. The heart comprises four chambers; two atria make up the upper chamber and two ventricles, the lower chambers. The ventricles pump blood from the heart to the rest of the body, and the atria collect the blood circulated from the body. CHF occurs when the ventricles cannot efficiently pump blood from the heart to the rest of the body, resulting in fluid accumulation in the lower extremities, lungs, abdomen, and liver. CHF could be fatal if not diagnosed and treated early. However, proper treatment, lifestyle changes, and medications could prevent any complications and significantly improve the quality of life. Patients with severe conditions may need surgical intervention.

What Are the Causes of Congestive Heart Failure?

Many medical conditions could weaken or damage the heart. They are as mentioned below:

• Coronary Artery Disease: The arteries supplying the heart (coronary arteries) may become obstructed entirely or partially, resulting in depletion of oxygen-rich blood to the heart, causing extensive damage to the heart muscles.

• Heart Attack: When the blood flow to the heart is completely obliterated, it results in a heart attack. A heart attack could also result in scar tissue, thus compromising its function.

• Cardiomyopathy: It is an acquired or hereditary disorder affecting the heart muscles. It could be due to drug abuse, alcohol consumption, or certain infections.

• Valvular Disease: The heart has few valves that check the inflow and outflow of blood. Damage to these valves could strain the heart and weaken it.

• Myocarditis: Inflammation of the muscles of the heart is myocarditis. It is usually caused by a viral infection such as the COVID-19 virus.

• Congenital Heart Defects: Congenital heart defects refers to heart diseases that are present from birth. If not treated early, they could also result in congestive heart failure.

• Arrhythmias: Abnormal heartbeat could result in the irregular working of the heart, thus weakening it over time.

• Risk Factors: Certain risk factors associated with heart failure are diabetes, hypertension, high cholesterol, smoking, alcohol abuse, obesity, and certain medications.

What Are the Types of Heart Failure?

Heart failure can be broadly classified into left-sided and right-sided heart failure. Further, it can also be classified based on the quantity of blood pumped with every heartbeat (ejection fraction). The classification is as follows:

What Are the Symptoms of Congestive Heart Failure?

Heart failure can be a long-standing (chronic) condition or sudden onset (acute). In addition, the patients may exhibit the following symptoms:

• Shortness of breath, whether at rest or while doing any activity.

• Swollen ankles, feet, abdomen, or legs.

• Irregular heartbeat.

• Fatigue.

• Weakness.

• A sudden increase in body weight.

• Wheezing or a constant cough with bloody mucus.

• Chest pain.

• Fainting.

• Reduced alertness.

• Bluish discoloration of the skin due to lack of oxygen.

• Frequent urination at night.

What Are the Stages of Congestive Heart Failure?

What Is the Pathophysiology of Congestive Heart Failure?

The sequences in the heart failure are described below:

What Are the Ways to Diagnose Congestive Heart Failure?

Various tests can be used to diagnose the health of the heart. They are described below:

• Physical Examination and History of the Patient: A detailed physical examination, medical history, family history, and personal history could help ascertain the risk factors and the predisposition for heart failure.

• Blood Test: Blood tests can determine any risk factors that adversely affect the heart. High serum cholesterol levels could result in blocked coronary arteries. Another blood marker for heart failure is B-type natriuretic peptide (BNP). When heart failure occurs, there is a change in blood pressure which prompts the heart to release BNP.

• Radiological Imaging: Various radiological imaging tests such as X-rays, electrocardiograms, computed tomography (CT), and magnetic resonance imaging (MRI) are also used to diagnose heart failure.

What Are the Radiological Findings of Congestive Heart Failure?

The radiological tests conducted and their findings are as mentioned below:

Chest X-Ray

A chest X-ray can be used to view both the heart and lungs. The chest X-ray can assess the size of the heart and the fluid accumulation in the lungs.

Based on the progression of CHF, 3 phases have been described, which are as follows:

- Phase 1: Vascular Phase

• This represents the first phase of CHF and signifies pulmonary venous hypertension.

• Cardiomegaly (enlarged heart) is evident.

• Prominent upper pulmonary vessels, in contrast to lower blood vessels, are evident in healthy individuals.

• Hilar level sees an increase in the artery to bronchus ratio, which appears as white round densities.

• The pulmonary artery is more prominent in diameter than the bronchi (>1).

• Hilar haziness and fullness: Pulmonary veins are enlarged, and fluid is seen collecting around the vessels.

• Vascular redistribution is not seen in supine X-rays (X-ray taken while lying on the back).

- Phase 2: Interstitial Phase

• Kerley lines (they are horizontal lines extending from the base of the lung to the pleural surface).

• They occur due to interstitial edema and amplified lymphatic drainage.

• The bronchial wall thickening appears as a white rim around the bronchioles, which appear dark.

• Thickening of the fissures between the lobes of the lungs.

- Phase 3: Alveolar Phase

• Cotton wool appearance.

• Prominent pulmonary edema.

• The alveolar infiltrates are distributed more in the central and basal regions.

• Pleural effusion (congestion due to fluid accumulation).

• Enlarged pulmonary veins.

Echocardiogram

• An echocardiogram is an initial test conducted on suspected or confirmed heart failure patients.

• This procedure uses sound waves to assess the structure and function of the heart.

• It can show the structure of the heart, ventricular functioning, valves, and blood supply through the heart.

• It can also help to quantify the blood pumped in every heartbeat (ejection fraction).

Computed Tomography (CT)

• CT is not generally recommended to diagnose heart failure. However, it can reveal any congenital or valvular diseases if present.

• Thickening of the septal lines will be evident.

• Ground-glass opacity appearance (suggesting alveolar edema and the possibility of consolidation).

Magnetic Resonance Imaging (MRI)

• MRI is also used to assess any valvular abnormalities or congenital abnormalities.

• It can assess the left ventricular volume and the ejection fraction.

• Highly accurate in determining ventricular systolic function.

• MRI helps establish the etiology of cardiac failure.

Stress Test

• The stress test is used to assess the working condition of the heart both at rest and while doing physical activity.

• A stress test is usually indicated in high-risk patients more prone to developing coronary artery disease.

• An abnormal stress test indicates the need for further diagnostic procedures, such as angiography.

Coronary Angiogram

• A coronary angiogram is an imaging procedure used to assess the blood flow through the heart.

• It is considered a gold standard for detecting blockages in the coronary arteries.

Conclusion:

Congestive heart failure is one of the most common heart disorders affecting adults. Though congestive heart failure can prove fatal, early diagnosis can help prevent any severe complications. Medications and simple lifestyle changes can easily manage the initial stages of congestive heart failure. However, severe cases may require surgical interventions. Considering the various advanced diagnostic aids, CHF should be managed effectively, thereby helping patients with better quality of life.