Stages of Congestive Heart Failure - Clinical Manifestations, Causes, Diagnosis, and Treatment

Introduction

Congestive heart failure may also be referred to as heart failure. Congestive heart failure is a life-threatening condition. The heart does not pump an efficient amount of blood to the rest of the body, including the brain. Even though the name suggests that the heart is failing or the heart is not working, congestive heart failure refers to the weakness of the heart to contract adequately.

An underlying mechanical problem in the heart results in the heart not being able to meet the demands of the body. The heart tries its best by beating faster or contracting more rapidly and, assembling the bodily needs, turns very weak. Due to this weakening of the heart, the blood returns to the heart more quickly than pumping blood. Hence, the blood in the heart gets congested or backed up, or accumulated. When this happens, vital organs of the body, including the brain, are devoid of blood and oxygen, resulting in organ failure or organ damage.

What Are the Clinical Manifestations of Congestive Heart Failure?

Congestive heart failure is a condition that does not have clear-cut and definitive signs in each patient. There are multiple possible clinical manifestations experienced by patients suffering from heart failure.

Mentioned below are the expected signs and symptoms that may be seen in an individual going through congestive heart failure.

• Shortness of breath.

• Fatigue.

• Weakness in legs.

• Swelling of the ankles and feet.

• Weight gain.

• Increased urinary output.

• Dry cough.

• Bloated.

• Loss of appetite.

• Nausea.

• Hard abdomen.

• Decreased ability to perform exercises.

• Swelling of the stomach.

What Are the Causes of Congestive Heart Failure?

There is a risk of cardiovascular changes as one grows older. Several conditions, if left untreated, may slowly but surely lead to congestive heart failure. There is no established cause for the development of this cardiac anomaly as of today, and thus various causes have been identified for congestive heart failure.

Mentioned below are a few causes of congestive heart failure.

• Coronary artery disease.

• Cardiomyopathy.

• Congenital heart disease or heart disease at birth.

• High blood pressure is called hypertension.

• Arrhythmia or abnormal heart rhythm.

• Heart attack.

• Kidney disorders.

• Obesity and being overweight.

• Excess use of tobacco and tobacco-related products.

• Chemotherapy.

• Recreational drugs and certain medications.

• Uncontrolled diabetes mellitus.

• High levels of cholesterol.

• Family history of congestive heart failure.

• Smoking.

• Excessive intake of alcohol.

• Radiation therapy.

What Are the Different Stages of Congestive Heart Failure?

Congestive heart failure is a disease that does not become worse in a fraction of a second. Instead, congestive heart failure is a chronic condition and develops in four stages, namely- stage A, stage B, stage C, and stage D. The first stage indicates a high risk of congestive heart failure, whereas the last stage is parallel to the advancement of heart failure.

• Stage A or pre-heart failure stage, develops mainly due to a familial tendency of this condition along with comorbidities such as diabetes, coronary artery disease, rheumatic fever, cardiomyopathy, and hypertension.

• Stage B gives a clear diagnosis of malfunctioning of the left ventricle of the heart, even if the patient does not have a family history of any cardiac disease.

• Stage C comprises all the signs and symptoms of congestive heart failure.

• Stage D, or advanced congestive heart failure, is when the patient does not have a chance to recover even after accurate treatment and thus is the final stage of the heart’s life.

How to Diagnose Congestive Heart Failure?

There is no standard or single test to diagnose a case of congestive heart failure. Instead, the healthcare provider will conduct several exams, post a thorough medical history examination and physical evaluation, and then subject the patient to multiple diagnostic tools.

• The electrocardiogram is a simple test that provides critical information about the heart’s rhythm.

• Chest x-ray and radiographs of other chest structures to check for any related damage.

• B-type natriuretic peptide or BNP test is a hormonal test that marks the seriousness of congestive heart failure. It also gives some idea about the prognosis for the same.

• A portable device that measures the electrical impulses in the heart, such as a Holter monitor, may be worn.

• A treadmill test or TMT puts the heart through controlled levels of exercise and exertion to check the heart's performance. In recent years, a drug that induces the same effect of training and effort has been ingested and replaced by the treadmill test.

• Cardiac catheterization.

• Echocardiography.

• Magnetic resonance imaging of the heart.

• A complete blood picture.

How to Treat Congestive Heart Failure?

There is no specific treatment for congestive heart failure. The main aim of managing this condition is to relieve the patient from the clinical signs and symptoms experienced. This will slow down the underlying damage. The authentic line of treatment is decided by multidisciplinary doctors and depends strongly on the stage and cause of congestive heart failure.

Some of the treatment modalities and management plans are mentioned below.

• Prevention is better than cure. Prevent an unhealthy lifestyle and stick to a heart-smart lifestyle to avoid an episode of congestive heart failure or any other cardiovascular disease.

• Medications such as vasodilators can be prescribed.

• Diuretics help in fluid retention in the body.

• Aldosterone inhibitors improve the life of the heart by enhancing heart functioning.

• Digitalis glycosides strengthen the muscles of the heart.

• Tranquilizers help in reducing anxiety in cardiovascular patients.

• Bypass surgery may be required in case the coronary arteries are heavily blocked.

• Heart valve replacement can also be suggested if there is extended damage to the heart vessels.

• Patients with congestive heart failure are ideal candidates for placement in a pacemaker.

• Implantable loop recorder.

• The last resort to treat congestive heart failure is a heart transplant which has a success rate of approximately 75 % to 89 %.

Conclusion

Congestive heart failure is when the heart turns weak because it cannot meet the body's demands. It is a chronic disease of the heart and develops in four stages. This condition can be avoided by leading a heart-healthy diet and indulging oneself in a heart-smart lifestyle. With proper care and treatment modalities, congestive heart disease will not stop a patient from living everyday life. Patients must regularly follow up with the cardiologist post-treatment. Being active and taking medications on time is the key to returning to ordinary life.