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Congestive Heart Failure: Stages And Types

Systolic congestive heart failure occurs when the heart does not pump blood effectively. There are 4 stages of congestive heart failure.

Congestive heart failure may happen when the heart muscle is too weak or when another health problem prevents it from circulating blood efficiently. Over time, systolic congestive heart failure, or heart failure (HF), can lead to dysfunction of other organs due to inefficient pumping.

This article discusses how HF progresses over time and explains the outlook for people with this condition. It also examine the causes, symptoms, treatment options, and stages.

There are four different stages of systolic heart failure: A, B, C, and D.

When the condition progresses to the next stage, a person's chance of surviving decreases.

People with stage A HF do not yet have dysfunction of the pumping activity of the heart but have a high risk of developing HF due to related conditions, such as chronic high blood pressure, diabetes, and coronary artery disease.

Symptoms

A person usually has no symptoms of HF at this stage but may experience symptoms of their chronic conditions, including:

shortness of breath

difficulty breathing

swelling in the hands, feet, and ankles

Outlook

People with this stage HF have no problems with the structure of the heart or how their heart works. Treatment should focus on managing risk factors.

Structural heart disease develops at this stage, such as reduced pumping function of the heart, which can lead to an enlarged left ventricle. It can also result from a previous heart attack.

Symptoms

Most people at stage B still do not show symptoms of HF.

Outlook

A doctor may prescribe medication at this stage for the management and prevention of future problems. It is common for a doctor to prescribe ACE inhibitors/ARB or ARNI and beta blockers at this stage.

People at this stage will show symptoms of HF linked to underlying structural heart disease, including fatigue or breathlessness. These symptoms usually occur due to problems with the squeezing function of the left ventricle, or the pumping chamber of the heart.

Stage C HF also includes people who no longer show symptoms but are currently undergoing treatment for previous symptoms, such as those who spent time in the hospital with heart failure exacerbation.

Symptoms

Common symptoms include:

fatigue

breathlessness

difficultly breathing

Outlook

A doctor will definitely prescribe medication at this stage for the management and prevention of future problems. It is common for a doctor to prescribe diuretics, ACE inhibitors/ARB/ARNI and beta blockers, mineralocorticoid receptor blockers, or SGLT2 inhibitors at this stage.

A doctor also may consider implantable cardioverter-defibrillators and cardiac resynchronization therapy at this stage.

At stage D, people will have advanced structural heart disease and display significant symptoms, even when they are at rest.

Symptoms

Symptoms may include:

shortness of breath

difficulty breathing

swelling of legs, arms, hands, and ankles

fatigue

nausea

rapid heartbeat

weight gain

lightheadedness

persistent cough

Outlook

This stage is severe and may require advanced specialized treatment. Such as mechanical circulatory support, continuous inotropic infusion to make the heart squeeze harder, cardiac transplant, or hospice care.

The most common type of HF is left-sided HF. The left side of the heart must work harder to move the same volume of blood around the body. This may cause a fluid buildup in the lungs and make breathing difficult as it progresses.

These fluids give congestive heart failure its name.

There are two kinds of left-sided HF.

With systolic heart failure, the left ventricle cannot contract normally, limiting the heart's pumping ability. The stages of HF only refer to systolic heart failure and not the other types.

With diastolic heart failure, the muscle in the left ventricle stiffens. If the muscle cannot relax, the pressure in the ventricle increases, causing symptoms.

Right-sided HF is less common. It occurs when the right ventricle cannot pump blood to the lungs. This can lead to blood backing up in the blood vessels, which may cause fluid retention in the lower legs and arms, abdomen, and other organs.

A person can have left-sided and right-sided HF at the same time. However, HF usually begins on the left side and can affect the right side if a person does not receive effective treatment.

Symptoms of HF range from mild to severe but may get worse over time if not managed medically.

Lifestyle strategies can reduce the risk of developing HF and can also slow its progress.

To prevent or slow the progression of HF, people should take the following steps:

Maintain a healthy body weight: Excess body weight can place strain on the heart and increase the risk of more damage to the heart.

Exercise regularly: The AHA recommends getting 150 minutes of moderate-intensity exercise every week. Individuals with heart failure should talk to their doctors about getting an individualized exercise "prescription."

Manage stress: Meditation, therapy, and relaxation techniques can help a person manage stress, which can have adverse effects on the heart.

Eat a heart-healthy diet: Daily food intake should be low in trans fats, rich in whole grains, and low in sodium and cholesterol. Experts often recommend that people with heart failure limit their sodium intake to 2,000 milligrams (mg) daily. However, individuals should check with their doctor to determine what their sodium and fluid intake should be.

Monitor blood pressure regularly: A doctor can do this at regular check-ups. However, doctors also recommend people use home blood pressure monitors, or sphygmomanometers.

Vaccinations: Be sure to stay on top of vaccinations for influenza and pneumococcal pneumonia.

Risk factors: Treat and manage risk factors such as hypertension, smoking, alcohol, drugs, and diabetes

People who already have HF should take the following steps to prevent further progression:

avoiding alcohol

limiting caffeine and other stimulants

getting adequate rest

tracking changes in their symptoms and exercise capacity

monitoring daily weights

checking blood pressure and heart rate at home

Without treatment, HF can be fatal. Even with adequate treatment, HF may get worse over time, triggering dysfunction of other organs throughout the body.

HF is more likely to occur in people with other conditions or lifestyle factors that weaken the heart.

Risk factors for HF include:

congenital heart anomalies

high blood pressure or cholesterol

obesity

asthma

chronic obstructive pulmonary disease (COPD) and coronary heart disease

cardiovascular conditions, such as valvular heart disease

heart infection

reduced kidney function

a history of heart attacks

irregular heart rhythms or arrhythmias

abuse of alcohol or illicit drugs

smoking

older age

A doctor or cardiologist will perform a physical exam. This involves listening to the heart, checking for fluid retention, and looking at the veins in the neck to see if there is extra fluid present in the heart. They may order other diagnostic tests, including:

Electrocardiogram: This records the heart's electrical rhythm.

Echocardiogram: This is an ultrasound test that can help a doctor determine if a person has a leaky heart valve, a heart muscle that is not squeezing or relaxing properly.

Stress tests: These tests show how the heart performs under different levels of cardiac stress, such as during exercise. Sometimes, they involve using medications that stimulate the heart to beat faster and harder or cause the blood vessels to relax.

Blood tests: A doctor may request these to check for infections, assess kidney function, and levels of brain natriuretic peptide (BNP). BNP is a "stretch" hormone that indicates stretching or increased pressure that occurs with HF.

MRI: This can provide high-resolution images of the heart and can assess for structural changes and scarring.

Cardiac catheterization: This can help a doctor identify blockages in the arteries, one of the most common causes of HF. A doctor may check blood flow and pressure levels in the ventricles at the same time.

Systolic congestive heart failure occurs when the heart does not pump blood effectively. It may happen for a variety of reasons such as a weak heart muscle or underlining health problems.

There are several stages of systolic congestive heart failure and each stage requires a different treatment. Lifestyle changes, medication, and surgery are typical methods of treatment.

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What's The Difference Between Systolic And Diastolic Heart Failure?

In systolic heart failure, the heart cannot effectively contract with each heartbeat. In diastolic heart failure, your heart cannot relax between heartbeats. Both types can lead to right-sided heart failure.

Heart failure occurs when your heart is unable to pump the amount of blood your body needs to keep you healthy. It can occur on the left or right side of the heart or on both sides.

The left side is in charge of pumping oxygen-rich blood into your body, while the right side collects blood that's low in oxygen from your veins and sends it to your lungs to collect oxygen, after which it returns to the left side.

If you have left-sided heart failure, it means your heart is not pumping enough blood out to your body. Your heart may pump less efficiently when you're doing physical activity or feeling stressed.

Two types of heart failure can affect the left side of the heart: systolic and diastolic. The diagnosis depends on how well your heart can pump blood.

If you have systolic heart failure, it means your heart does not contract effectively with each heartbeat. If you have diastolic heart failure, it means your heart isn't able to relax normally between beats.

Both types of left-sided heart failure can lead to right-sided heart failure. Right-sided heart failure happens when the right ventricle functions poorly due to poor contraction or high pressure in the right side of the heart.

When it comes to diagnosing and managing these two types of heart failure, there are some similarities and some differences. Read on to find out what you need to know about systolic and diastolic heart failure.

If you have systolic or diastolic heart failure, you may experience symptoms such as shortness of breath after routine physical activity. Depending on the function of your heart, actions like climbing stairs or walking a short distance may cause these symptoms.

Symptoms of left-sided heart failure can include:

shortness of breath or trouble breathing

fatigue, even after rest

weakness

clear, frothy cough

inability to sleep lying flat

confusion

decrease in the amount of urine

not eating enough

feeling full early

weight gain

lower leg or stomach swelling

However, in the early stages of heart failure, you may not have any symptoms.

Doctors diagnose heart failure clinically at a patient's bedside. The diagnosis is confirmed based on the results from imaging tests, symptoms, and other lab tests, such as blood tests.

If doctors suspect you have heart failure, they may perform tests that can include:

Echocardiogram (EKG). This test shows the electrical pulse of the heart and can determine if arrythmias are present which can cause heart failure.

Transthoracic echocardiogram (TTE). This ultrasound imaging test assesses the structure of the heart and determines ejection fraction (pumping ability of the heart), chamber size, heart valve function, and more.

Cardiac computed tomography (CCT) scan. This imaging test takes X-ray images of the heart.

Blood tests, such as natriuretic peptide tests. These tests can help determine the amount of stretch on heart walls and can indicate HF. Also blood tests can assess for causes of heart failure such as thyroid dysfunction, anemias, etc.

Electrolyte panel. This can show potassium, sodium, and magnesium levels to determine the cause of your heart issue.

Cardiac catheterization. In this procedure, doctors insert a thin tube into a blood vessel leading to the heart to visualize the coronary arteries (arteries surrounding the heart) and assess for blockages or coronary artery disease which can be intervened upon with percutaneous intervention (such as angioplasty and stenting).

Systolic heart failure diagnosis

Systolic heart failure happens when the left ventricle of your heart cannot contract completely. That means your heart will not pump forcefully enough to move your blood throughout your body in an efficient way.

It's also called heart failure with reduced ejection fraction (HFrEF).

Ejection fraction (EF) is a measurement of how much blood leaves a heart ventricle every time it pumps.

Doctors determine your EF as a percentage with an imaging test such as an echocardiogram. Between 50 and 70 percent EF is the typical range, according to the American Heart Association (AHA). It's still possible to have other types of heart failure, even if your EF is within that range.

If your EF is under 40 percent, you may have reduced ejection fraction or systolic heart failure.

Diastolic heart failure diagnosis

Diastolic heart failure occurs when your left ventricle can no longer relax between heartbeats because the tissues have become stiff. When your heart cannot fully relax, it won't fill up again with blood before the next beat.

This type is also called heart failure with preserved ejection fraction (HFpEF).

For this type, your doctor may order an imaging test on your heart and determine that your EF looks fine.

Your doctor will then consider whether you have other symptoms of heart failure and if there's evidence from other tests that your heart is not functioning properly. If those criteria are met, you may be diagnosed with diastolic heart failure.

This type of heart failure most often affects older people and also affects more females than males. It typically occurs alongside other types of heart disease and other non-heart-related conditions such as cancer and lung disease.

Having high blood pressure, also called hypertension, is one of the most important risk factors. Another important risk factor is untreated sleep apnea.

There are different medications available to treat systolic heart failure. These can include:

beta-blockers (BBs)

angiotensin receptor-neprilysin inhibitors (ARNI)

angiotensin converting enzyme (ACE) inhibitors

angiotensin receptor blockers (ARBs)

mineralocorticoid receptor antagonists (MRAs)

sodium-glucose co-transporter 2 (SGLT2) inhibitors

diuretics

digoxin

hydralazine

isosorbide dinitrate

Standard treatment can involve a combination of these medications, since each class of medication targets a different mechanism of heart failure.

A typical treatment regimen can include: ARNI, ARB, or ACE I along with a beta-blocker and an MRA. Diuretics may also be used for people who continue to have problems with urine retention despite other medical treatments and while following a low salt diet.

There is new evidence that SGLT2, originally a diabetes medication, can reduce the likelihood of death and re-hospitalization. It is now a standard part of heart failure treatment.

A review published in 2017 looked at 57 previous trials involving combination treatments. It found that people who took a combination of ACE inhibitors, BBs, and MRAs had a 56 percent reduced risk of death from systolic heart failure, compared with people who took a placebo.

People who took a combination of ARN inhibitors, BBs, and MRAs had a 63 percent reduced death rate compared with those who took a placebo.

Doctors may treat diastolic heart failure using many of the same medications that are options for systolic heart failure.

In general, the main approaches to treating diastolic heart failure with medication include:

Medications to reduce fluid buildup. Diuretics, sometimes called "fluid pills," help your body get rid of excess fluid.

Medications to control other conditions. Treatment may focus on managing conditions, most importantly, high blood pressure, which can have a big effect on diastolic heart failure.

SGLT2 inhibitors. New evidence suggests there may be a role for SGLT2 inhibitors in diastolic heart failure.

Cardiac rehabilitation program

Doctors may also recommend adopting a heart-healthy lifestyle as part of a cardiac rehabilitation program.

Recommendations can include:

treating other health conditions like blood pressure, heart rate, and anemia

performing regular physical activity, depending on how serious your heart failure is

reducing salt intake

getting quality sleep, including treating any sleep disorders such as sleep apnea

achieving and maintaining a moderate weight

avoiding or limiting alcohol intake

if you smoke, considering quitting

reducing or managing stress

Implanted devices

For some people with left-sided heart failure, a device that is surgically implanted improves heart function. Types of devices can include:

Implantable cardioverter defibrillator (ICD). If you have systolic heart failure, this device gives your heart a shock when your left ventricle beats too fast. This helps your heart beat properly again.

Cardiac resynchronization therapy (CRT). This is a special pacemaker that aids in making the ventricles of your heart contract in a coordinated and organized fashion.

Left ventricular assist device (LVAD). This pump-like device is often called a "bridge to transplant." It helps the left ventricle do its job when it's no longer working well, and it can help you while you wait to get a heart transplant.

Surgery

In some cases, surgery may be recommended to treat left-sided heart failure. The two main types of surgery can include:

Corrective surgery. If a physical heart problem is causing heart failure or making it worse, you may get surgery to fix it. Examples include a coronary artery bypass, which reroutes blood around a blocked artery, or a valve replacement surgery, which corrects a valve that is not working properly.

Transplant. If heart failure progresses to a very serious state, you might need a new heart from a donor. After this surgery, you'll have to take medication so your body does not reject the new heart.

Systolic and diastolic heart failure both affect the left side of the heart. The left side of the heart is in charge of pumping oxygen-rich blood to the body. Having left-ventricle heart failure means that your heart is not able to efficiently pump all the blood that your body needs.

This can cause symptoms such as shortness of breath, fatigue, and weakness.

Doctors can diagnose left-ventricle heart failure as systolic, which means the heart is unable to contract well during heartbeats, or diastolic, which means the heart is unable to relax between heartbeats.

Both types of heart failure have treatment options, ranging from medication and adopting a heart-healthy lifestyle to implanted devices, surgery, and transplantation.

A primary care doctor provides overall healthcare and is your main point of contact for health concerns. They can refer you to a cardiologist, who specializes in heart disease.

A cardiologist may order tests to monitor your condition and recommend medication, certain procedures, surgery, or lifestyle changes. Both doctors often work with nurses and physician assistants.

A cardiac surgeon may perform coronary bypass surgery, heart valve repair, or other operations to treat underlying causes of heart failure. They may implant a device to help your heart work. Rarely, they may do a heart transplant. Their team may include nurses and physician assistants.

Cardiac rehabilitation includes lifestyle education, physical exercises, and psychosocial support. It can help strengthen your heart, improve your well-being, and reduce your risk of future heart problems. Your team may include nurses, occupational therapists, and physical therapists.

A balanced diet protects your heart and may help you lose weight. A registered dietitian can help you develop a sustainable, heart-healthy diet. You may need to adjust your intake of calories, saturated fat, sodium, or fluids.

Tobacco, alcohol, and other drugs can damage your heart and blood vessels. A smoking cessation or substance use counselor can help you stop using these substances if you find it hard to quit. They may prescribe medication and counseling.

Heart disease raises the risk of anxiety, depression, and post-traumatic stress disorder (PTSD), which can affect heart health.

A psychologist, clinical social worker, or licensed counselor may help treat mental health conditions with psychotherapy. A psychiatrist can prescribe medication if needed. Social workers can connect you with support services and assist with legal, financial, and insurance concerns.

Palliative care doctors and nurses provide care to ease heart failure symptoms and treatment side effects, such as fatigue and nausea. A palliative care social worker helps you and your family plan for the future. Palliative care may improve quality of life at any stage of heart failure.

It's common to have questions about medications, especially when they're first prescribed to you. Your pharmacist can help explain medication dosing and timing as well as check for interactions with other prescription drugs, foods, or supplements.

Heart Failure

NT-proBNP Level May Influence HF Risk Among Blacks vs Whites, Men vs Women

Maggie L. Shaw April 27th 2022

In this new subanalysis of data from the Atherosclerosis Risk in the Communities study, investigators assessed the risk of incident heart failure (HF) or death by race and sex, as influenced by N-terminal pro–B-type natriuretic peptide (NT-proBNP) concentration, prompted by growing interest in its use as a predictive biomarker for HF.

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