CHF exacerbation comes from congestive heart failure (CHF) in which the heart does not pump enough blood to the tissues for diverse reasons.
Congestive heart failure is a preventable disease in most cases but also causes the most economical costs all around the world for the countries’ public health systems. It is common in males above 45 years old and females above 55 years old to suffer from heart failure, especially if other family members have it.
By reading this article, you will get a profound explanation of how the heart itself works, congestive heart failure, and its causes. Also, we are going to discuss its symptoms, diagnosis, and treatments of the disease. The exacerbation of congestive heart failure is also going to be thoroughly explained.
Continue reading this article to obtain the insight you need to know to understand this life-threatening chronic disease and its complexities, directly from a doctor.
What does the heart do?
The heart is an essential organ, mostly made of cardiac muscle cells in charge of pumping blood. This organ is the core of the circulatory system by taking blood to and from peripheral tissues through blood vessels. It has the size of the person’s fist and a cone’s shape with the apex pointing down to the left and forward.
Anatomists divide the heart into four chambers: the right and left atrium and the right and left ventricle. This creates two hearts in terms of functions, the right heart, and the left heart.
The right atrium receives blood without oxygen and takes it to the right ventricle that pumps it to the lungs. The blood gets to the lungs through the pulmonary artery, where it gets oxygen, and then it travels back to the heart. The left atrium receives this blood; goes into the left ventricle where it pumps it again back to the body.
In the end, the right heart is in charge of the pulmonary circulation. The left heart is in command of the systemic circulation. This situation is evident in the differences between them as the right heart manages volumes, and the left heart handles pressures. Leading to the left heart having bigger walls, while the right one has thinner walls, allowing more space for blood.
Some other aspects of the heart are worth noting, and we’ll continue developing them further in the article. For example, it is essential to know about heart valves’ presence to understand some possible causes of heart failure or that there is an electric system on the heart that makes sure it keeps beating automatically. Also, there is a membrane that covers the entirety of the heart to protect it from friction.
How does the heart work?
The heart has cardiac muscle cells that stimulate each other through canals that allow electrolytes to pass, enabling simultaneous contraction. But first, there must be an initial signal that comes from nodes in the heart itself.
Nerves can excite these nodes to make the heart rate faster or slower, depending on the situation. However, they don’t need constant stimulation to send signals to keep the heart pumping blood. When there is a problem with the main node, another one in the chain takes its place, maintaining the heartbeat.
The cardiac muscles’ contraction follows a pattern that creates a cycle that consists of Systole and Diastole. Systole is the contraction itself, the shortening of the cells that creates the energy to pump the blood. Diastole is the relaxation of these cells, equally important. They need to get back to their original form before contracting again. If one of these two fails, the whole circuit fails, disrupting the heart’s pressures and volumes.
Moreover, this mechanism follows a particular sequence as not all the heart muscle contracts or relaxes simultaneously. Starting in the atriums, they contract while diastole is happening in the ventricles, pumping blood into them. Then systole occurs in the ventricles, pumping blood out of the heart while diastole occurs in the atriums and takes more blood.
Between the atriums and ventricles and between ventricles and big arteries (pulmonary and Aorta), there are valves. They are essential since they stop blood returning to the chamber from where it came when diastole or systole happens.
The closure of these valves is what makes the two sounds we usually hear as heartbeats. Sometimes they can fail for various reasons, creating problems for the heart to manage excessive pressures or volumes.
What is congestive heart failure?
Heart failure is when the heart loses its ability to pump blood to the rest of the body properly. It does not necessarily mean the organ does not function anymore but is doing it inefficiently.
Depending on the disease’s degree, it can affect other organs such as the kidneys, brain, and lungs. Besides, this condition has causes that most of the time are manageable, although not totally curable with treatments. So, a close follow-up by a doctor is a must.
Doctors call it congestive heart failure since the heart doesn’t eject the usual amount of blood, so it begins to accumulate. This situation increases the blood above the heart’s capacity to handle, which also raises pressure causing all sorts of problems. The manifestations will depend on what side of the heart is the failure, although it is common to be both.
As we know, the right heart is in charge of receiving blood from the body and pumping it to the lungs. If this system fails, the blood will stay behind in the veins that were supposed to bring it to the heart. That blood will increase the pressure inside the blood vessels, leading to it trespassing to the nearby tissues.
Similarly, it happens the same way on the left side of the heart but instead, the pressure increases in the lungs. This situation causes trouble breathing and oxygenating the blood as there is excessive fluid in the lungs’ functional tissue. If the problem persists, this increased pressure will affect the heart’s right side also.
What causes congestive heart failure?
There are several causes of congestive heart failure. We can still divide them into two main groups for better understanding: Systolic dysfunction and diastolic dysfunction.
In the first one, there’s a reduction of the ejection fraction, which is the quantity of blood the heart pumps. This happens because the heart muscles cannot contract with enough force to pump the blood out.
For example, the cardiac cells are not receiving enough oxygen for them to function correctly, so they lack energy. A common cause of this is when the heart vessels have an obstruction, known as coronary artery disease.
Another case is when the pressure the heart has to overthrow to pump out blood is too big. This is true for people with hypertension, where the blood pressure is higher than the average. Or when there are valves issues such as stenosis, they don’t open when they should.
The ejection fraction stays similar in the latter, but the heart has problems relaxing, leading to diastolic dysfunction. Hypertension, if it isn’t treated, causes ventricular hypertrophy, which means the ventricle’s heart walls get thicker than before. This situation exists because the heart tries to compensate for the increase of pressure by getting more and bigger cardiac muscle cells. The problem with this is that they struggle to get oxygen, prompting them to suffer injuries and possibly die. As they die, the heart wall gets thinner and fibrotic, leading to diastolic dysfunction as well.
Another cause of diastolic dysfunction is atrial fibrillation, a problem of the signals that make the heart contract. The cells receive electric signals irregularly, driving them to contract out of time, including when relaxation is supposed to happen. This is a hazardous disease. It can also originate clots that obstruct arteries on the brain.
What are the symptoms of congestive heart failure?
There can be chronic heart failure and acute heart failure, which will determine the symptoms’ onset. It also depends if there is a right heart failure or if there is left heart failure.
When there is right heart failure, the most characteristic sign is the presence of edema, especially on lower limbs, which is the extravasation of fluids from blood vessels into tissues, creating fluid retention in these areas. This happens because the veins’ pressure increases and is higher than the one in the tissues, letting liquid pass.
If the same fluid retention continues to grow, it can reach the abdominal area causing ascites and pain. Ascites are edema in the abdomen, and doctors associate it with hepatic congestion, causing pain in the liver area, amongst other issues.
Other common symptoms include:
- Palpitations: Feeling your heart pumping out of your chest.
When there is left heart failure, the most characteristic symptom is dyspnea, which is difficult to breathe. This is because cardiogenic pulmonary edema occurs when the left heart fails, not allowing the CHF patient to breathe.
The pulmonary congestion makes the oxygenation of the blood harder and toughens the elastic properties of the lungs. Patients often have trouble breathing when they’re resting in bed or even wake up in the middle of the night. They might also struggle to make moderate efforts like walking a few blocks, but this is subjected to its severity.
Other signs and symptoms are coughs with white or pink phlegm, increasing the necessity of urinating at night, and rapid weight gain. Also, if there is a heart attack, chest pain can be present.
It is important to note that if heart failure affects both sides of the heart, symptoms will be of both types.
What causes exacerbation of CHF?
An exacerbation of congestive heart failure is when symptoms like dyspnea or edema increase, setting the person’s life in danger. One of CHF exacerbation’s leading causes is the rise in sodium (salt) ingestion as it increases blood pressure.
This electrolyte is osmotically active, meaning water goes along with it through the body’s membranes. So when people consume foods high on salt, the intestines absorb water proportionally to the salt intake.
The excess of water translates into more blood in the body, which is more blood the heart has to pump. This adds an extra strain that leads to worsening congestive heart failure and symptoms appearing or escalating.
There is also a group of more vulnerable people to the effects of high sodium intake than most. Studies have shown that black and Hispanic people have a genetic difference that makes them more susceptible to hypertension. In the kidneys, they have a slight alteration in sodium transporters, which causes them to excrete less sodium. Since the kidneys are in charge of regulating fluids in the body, including blood, blood pressure can increase.
Another factor that causes the disease’s exacerbation is a social one, which is the failure of treatment adherence. This is when patients are unsuccessful in taking their treatment correctly, and it is actually a widespread issue.
Incorrect use or lack of medication allows the disease to exponentially get worse, making this a pivotal problem to doctors. Sometimes this happens because people get tired of frequently take a large number of pills a day and stop.
Additionally, they don’t communicate with the doctor their discomforts or side effects, which could be taken care of easily. Or, patients don’t have economic resources to continue or even start the treatment in many cases.
Can a child suffer from congestive heart failure?
Yes, children suffer from congestive heart failure, and the reasons vary depending on their age. Interestingly a structural heart disease is not the most common cause of congestive heart disease as one might think.
Usually, we find anemia, arrhythmias, renal problems, or metabolic diseases being a frequent cause of congestive heart failure in children. This is a very serious condition to have at that age as the central nervous system is still developing.
What affects the brain at an early age creates long-lasting life repercussions from poor school performance to brain damage. The way congestive heart failure presents in babies is different from adults, especially since they cannot speak for themselves. But they show clear signs and symptoms that can orientate doctors into making a diagnosis of the disease.
Tachycardia is the main sign that can indicate heart failure. Still, as children’s heartbeat is already fast, sometimes doctors don’t notice it. If there is pulmonary edema, we will see a retraction of the skin between the ribs. This happens because, in order to breathe, the body uses accessory muscles in the ribs to help with their expansion.
A meaningful sign as well is sweating when the infant tries to eat by the effort of breathing and eating. In other cases, the patient does not want to eat and cries more than usual without comfort.
In adolescents, the most common causes are chronic arrhythmias and heart disease; the patient acquires cardiomyopathy. The latter is essentially the dysfunction of cardiac muscle cells for any possible reason. Adolescents present the same symptoms as adults since their anatomies are almost the same already.
What precipitates acute CHF exacerbation?
In acute decompensated heart failure, there is a fast reduction of cardiac output, which exacerbates symptoms and risks. People suffer from exacerbation of acute congestive heart failure because of myocardial infarction, popularly known as a heart attack. This happens because of an obstruction in the blood vessels that provide blood to the heart itself.
Clots from other parts of the body can travel to these and get stuck, causing a sudden blood flow reduction. It can also happen because of an atherosclerotic plaque that forms in those arteries’ walls, reducing blood flow. These are created by an increase of cholesterol in the body above normal levels, getting stuck in blood vessels’ walls.
There is insufficient blood going to the cardiac muscle cells that causes a decline of oxygen and nutrients as well. This leads to cellular death, which produces inflammation and death of other proximate cells to the damage’s epicenter. When this happens, the heart struggles to keep pumping blood, leading to an acute exacerbation of congestive heart failure.
Likewise, arrhythmias can exacerbate congestive heart failure, making it another common reason for the disease’s acute precipitation. They create a contraction of the atriums or ventricles out of time that disturbs the whole cardiac cycle.
Heart failure patients often feel palpitations when arrhythmias are present in the picture, and even chest pains doctors call angina. The arrhythmic contractions lead to a disruption of the ejection fraction and the relaxation of cardiac muscles. The blood’s irregular movement can also create clots as some of them get stuck in one chamber. These patients are risking the chance of a possible stroke or myocardial infarction, making this an emergency if the person doesn’t have treatment.
What procedures and tests diagnose congestive heart failure?
After reporting your symptoms to your doctor, they will perform a careful evaluation of your medical history and physical exam. The latter will involve listening to your heart with a stethoscope to detect abnormal heart rhythms. Another vital sign of CHF’s congestion is the distension of the jugular vein on the neck. And sometimes, they may require a stress test, an analysis that shows how well your heart performs under different conditions.
However, to confirm the diagnosis, your doctor might order other studies necessary to identify your heart’s structural abnormalities. These may involve chest X-ray and MRI. These tests allow doctors to see the size and whether there is fluid build-up around the heart and lungs.
They also may require an echocardiogram, a type of ultrasound that shows the heart’s structure and motion. It helps to determine if you already have poor blood flow or a heart muscle that doesn’t contract normally.
An electrocardiogram, the analysis that records the electrical impulses traveling through the heart, will show abnormalities in your heart’s rhythm. Rapid heartbeat or irregular rhythm could suggest that your heart’s chamber walls are thicker than normal.
In the same way, doctors use blood tests to evaluate renal function (it is common to have kidney problems because of heart failure), cholesterol levels, the presence of anemia, and infections. They can also check B-type natriuretic peptide (BNP’s level), a substance secreted from the heart in response to blood pressure changes. The BNP increases in a CHF patient when this condition develops or worsens.
How do you get rid of fluid in CHF?
CHF can cause your body to retain more fluid than it should. Diuretics, sometimes called water pills, are drugs that reduce the body’s fluid content. They are useful in preload reduction by increasing urinary salt (sodium) excretion and decreasing fluid retention.
By reducing the amount of fluid flowing through the veins and arteries will also help to reduce blood pressure. The main benefit of diuretics is, hence, reducing the heart’s work to pump the blood. The use of this medication helps to improve the cardiac function, relief of the symptoms, and exercise tolerance.
There are several diuretics, and each one works in a different part of your kidney. One of the most common is the Thiazides, as hydrochlorothiazide. These pills cause blood vessels to widen and help to remove extra fluid.
Other potent types of diuretics work in the Henle Loop, a kidney section that absorbs water. An example of this group is furosemide, which reduces sodium, chloride, and potassium reabsorption, leading to higher urine concentration. As a result, water is also drawn into the nephron, and urine volume increases.
Meanwhile, the potassium-sparing diuretics helps get rid of fluids and sodium while still retaining potassium. Examples of this category include triamterene and spironolactone.
As we can see, diuretics can affect blood potassium levels. If you take a thiazide diuretic, your potassium level can drop too low generating hypokalemia. On the other hand, If you’re on a potassium-sparing diuretic, you can have too much potassium in your blood. These scenarios can cause heartbeat problems, so you should take this drug only with a prescription.
How do you manage CHF exacerbation?
Decompensated CHF can be a life-threatening disease, and you should seek immediate medical examination. Doctors will try to stabilize your condition and recover the heart’s function to provide symptomatic relief rapidly. Depending on the severity of the situation, doctors would suggest nonpharmacologic treatments like fluid and dietary sodium restriction.
One of the first steps in managing acute CHF exacerbation is supplementation with oxygen. This therapy delivers oxygen to the lungs through a device in the nose. Besides, they would recommend the use of pharmacologic therapies focused on preload and afterload reduction. Therefore, the usage of vasodilators such as hydralazine, isosorbide dinitrate, or nesiritide combined with diuretics helps relieve the symptoms.
The therapy’s primary goal consists of the inhibition of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system. The RAAS is a series of hormones that raise blood pressure by constricting blood vessels and increasing water reabsorption.
This inhibition helps to produce vasodilation and, therefore, increases cardiac output and decreases myocardial oxygen demand. This effect could be reached by using an ACE inhibitor. ACE is an enzyme in the lungs that induces the formation of the renin-angiotensin-aldosterone system.
Another kind of drug called beta-blockers can also lower the heart rate and reduce the heart’s burden.
Digoxin, a medication that helps strengthen heart contractions, can be an essential part of CHF treatment when other options fail. It is also indicated if you have an abnormal heart rhythm like atrial fibrillation.
Doctors additionally will use anticoagulants in order to decrease blood clot formation and the risk of pulmonary embolism. Finally, If medications aren’t effective, invasive approaches may be required, including pacemakers.
Can surgery be used to treat heart failure?
Although cardiac surgery is riskier for people with heart failure, they have better outcomes. Coronary artery bypass graft surgery is the current surgical treatment of CHF patients when coronary artery disease is the cause. In this procedure, doctors open up the blocked arteries, allowing the heart muscles’ proper blood flow.
Aortic valve stenosis can cause heart failure if the valve cannot open fully. Regurgitation, too, can lead to heart failure since the blood leaks backward into the left ventricle.
In any case, the heart has to pump more strongly to meet the body’s needs for oxygen-rich blood. Doctors may consider heart valve surgery, a procedure that helps your valves to preserve natural anatomy. Recovering the right opening and closing of the valve will improve the heart’s ability to pump correctly.
Another surgical option involves the implantable left ventricular assist device (LVAD). It is a mechanical pump to help the heart’s weak left ventricle pump blood throughout the body. Doctors especially use it in patients who don’t respond to other treatments and suffer from severe systolic heart failure. This device allows you to be mobile and return home while a heart transplant can be done.
Doctors consider heart transplantation in patients with chronic congestive heart failure that do not respond to all other therapies.
What does the end-stage CHF look like?
The American Heart Association and American College of Cardiology classify Heart Failure in a staging system from A-to-D. In the early stages, medication and a healthy lifestyle can help manage the disease. But as progress, the heart becomes weaker and conventional treatment loses efficacy.
Stage A includes patients without structural heart disease or symptoms. These patients suffer diseases such as hypertension, coronary artery disease, or diabetes mellitus, which increases the risk of developing HF.
In contrast, Stage B patients are asymptomatic, but they have structural heart disease like left ventricular hypertrophy. Meanwhile, Stage C, which involves most patients, includes structural heart disease and heart failure symptoms.
End-stage corresponds with stage D, an advanced heart failure. People develop advanced structural heart disease in this stage, which means conventional heart therapies are no longer working.
Patients display significant symptoms even when they are at rest, unable to carry on any physical activity.
The symptoms include:
- Dyspnea: Shortness of breath
- Chronic cough: Typically, it comes with white or pinkish mucus
- Edema: Swelling in both legs from the ankles and could reach the knees
- Nausea or lack of appetite
- High heart rate: It means a heart rate of one hundred heartbeats per minute or more
- Confusion or impaired thinking
Congestive heart failure end-stage is severe. Despite there’s no cure, there are still specific treatments that may improve quality-of-life. Treatments include mechanical circulatory support, continuous inotropic infusion to make the heart squeeze harder, heart transplant, palliative, or hospice care.
What’s the link between COPD and heart failure?
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory illness in which obstruction of the lungs’ airflow happens. It’s typically caused by long-term exposure to irritating particles or gases, most often from cigarette smoke.
COPD and heart problems, specifically heart failure, may present with similar manifestations. Symptoms include breathing difficulties that develop gradually and generally occur after physical activity such as climbing stairs.
Both conditions are dangerous, and while they often occur independently, it is crucial to understand the connections between the two. In spite that there is not a direct link between COPD and left-sided HF, they can exist together and exacerbate one another.
COPD can decrease the concentration of oxygen in the blood. Therefore, this change places additional stress on the heart and worse symptoms of left-sided heart failure. In the same way, left-sided heart failure can increase fluid in the lungs, aggravating COPD symptoms.
On the other hand, severe cases of COPD can directly trigger the development of right-sided heart failure. This happens due to increased blood pressure in the arteries of the lung when oxygen levels decrease.
The higher pressure puts excessive demand on the right ventricle as it works to pump blood through the lungs. As a result, the heart muscle tends to become weak and precipitate right-sided heart failure.
Are there other diseases similar to CHF?
Many kinds of disorders cause cardiac demand increases or impaired heart function, showing CHF’s signs and symptoms. Pulmonary congestion presents the majority of these symptoms, such as dyspnea at rest.
Doctors must differentiate heart failure from pulmonary edema associated with capillary-alveolar membrane injury. Importantly, in HF, a history of an acute cardiac event as a heart attack, even a cardiogenic shock is usually present. Other cardiac causes include arrhythmias (an abnormal heart rhythm), and ventricular dysfunction such as dilated cardiomyopathy.
Noncardiogenic pulmonary edema secondary to altered capillary permeability commonly includes acute respiratory distress syndrome (ARDS) and other infectious causes. Other causes may consist of altitude illness, anaphylaxis, anemia, COPD, pericarditis, and cardiac tamponade due to pericardial effusion.
Pulmonary edema may also be secondary to a decrease in oncotic pressure found with hypoalbuminemia. This can be secondary to lymphatic insufficiency or kidney disease as renal failure.
For example, when there is kidney failure, the proteins’ level in the blood decreases, one very important is albumin. This situation will also cause the water in the blood to leak into tissues where it should not. Therefore, kidney failure will similarly lead to lung congestion or edema and shortness of breath.
Heart failure can mimic other diseases. In elderly patients, fatigue and confusion can sometimes be the first symptoms of heart failure, which correlates to a decrease in cardiac output.
Moreover, constipation is a common complaint among patients with heart failure. It can manifest a decline in intestinal transit secondary to poor blood flow. In very severe cardiogenic shock cases, an individual can present severe abdominal pain mimicking bowel obstruction, perforation, or infections due to a possible infarction.
How can you prevent heart failure from worsening?
One way to prevent heart failure is to control the conditions that cause or exacerbate this illness. Among these causes, there are coronary artery disease, high blood pressure, diabetes, or obesity.
However, there are several lifestyle changes you should follow to prevent further damage, such as avoiding smoking and drinking alcohol. Follow a diet rich in vegetables, fruits, and whole grains and limit salt consumption (sodium). And at least one hour of moderate aerobic exercise per week can improve your heart health.
Be aware of your blood pressure, and make sure to keep it low. In heart failure, the release of hormones causes the blood vessels to constrict or tighten. The heart must work hard to pump blood through the smaller vessels.
You must also check for changes in your fluid status by weighing yourself daily and checking for swelling. Your goal is to keep your weight within 4 pounds of your dry weight, which means your weight without extra fluid.
Importantly, if you gain three pounds in one day or five pounds in one week, call your doctor. They may also ask you to record the number of fluids you drink or eat. Remember, the more fluid you carry in your blood vessels, the harder your heart must pump excess fluid.
Another thing to be aware of is hypotension. This drop-in arterial pressure can be asymptomatic or symptomatic, depending on each individual.
Hypotension signs and symptoms include dizziness, loss of consciousness, blurred vision, nausea, pale skin, and palpitations. It is of particular relevance for HF patients since almost all HF drugs cause lower blood pressure (BP). However, hypotension may also occur because of severe reductions in cardiac output. In patients with HF and reduced ejection fraction, low BP is not a sign of good possible outcomes in the long run.
How can you improve your quality of life with heart failure?
With the right care, a heart failure patient may enjoy a great life. The outcome will depend on how well the heart muscle is functioning and how well you respond to your treatment.
That is why you might see your doctor monitor your condition and take your medications as told. It is essential to know what their use is and how often you take them.
Even when you don’t have any symptoms, your medications make your heart pump more efficiently. Never stop taking your medications without discussing it with your doctor.
A regular cardiovascular exercise program decreases heart failure progression. It will help you improve your quality of life and your strength and ability to go about your day-to-day activities independently. For your safety, remember to discuss the addition of exercise with your health care provider first.
It could help plan your activities. Choose which things to do each day and balance your day, including rest periods. Be active at a time when you feel rested, such as in the mornings or after naps.
Furthermore, it is also very important to remember taking care of your emotional health. Living with this condition can stir up a set of feelings like fear and anxiety. If you feel stressed, depressed, or unusually worried, ask your doctor or nurse for emotional support. Social workers, psychologists, and heart failure support groups can help.
What is the role of arrhythmias in heart failure?
Cardiac arrhythmias are irregular heartbeats or abnormal heart rhythms due to unusual electrical impulse origination and propagation. Life-threatening rhythms are common in different cardiac diseases, especially in ischemic cardiomyopathy. In fact, arrhythmias have a close relation with Heart failure and can contribute to the disease’s progression.
The most significant of all rhythms associated with heart failure are ventricular arrhythmias because they are very severe and could prompt death. This is due to a combination of structural factors such as ventricular dilatation and myocardial hypertrophy. Other changes, like the presence of stress hormones and electrolyte imbalance, can contribute to the appearance of sudden death.
The number of patients that have and then die because of HF and cardiac arrhythmia is high in the elderly population aged ≥ 65 years. This is why opportune and proper treatment of elderly patients become increasingly important.
Are you having symptoms of a CHF exacerbation?
This tool is a congestive heart failure symptoms checker. It gathers the most important signs, symptoms, and risk factors for this condition. Therefore, it would help anybody who uses it to determine the likelihood of having congestive heart failure. Besides, what is more is that this tool is free and would only take a few minutes to complete.