Almost 6 million people in America are prone to cardiac failure. It is one of the leading cause for people above 65 years of age to get hospitalized. Cardiac failure is a chronic condition which develops gradually over the time. After diagnosis, the treatment option to be opted depends on the congestive heart failure stages and prognosis.
Cardiac failure or heart failure does not indicate that the cardiac system has stopped working completely; however, it refers to the condition in which the heat muscles get damaged or weakened due to certain reason and become unable to pump enough blood to the body parts. Due to this medical condition, blood flow through the heart and body slows down, thus increasing the pressure in the cardiac system. As a result, the body is deprived of the essential nutrients and oxygen. The heart chambers may respond and stretch a little or get thickened or stiffed to hold more blood for supplying to other body parts; however, this may eventually weaken the heart muscles and make them disable to pump efficiently. In this condition, the kidneys may start responding by retaining salt and fluid (water) into the body. If the fluid accumulates into the ankles, legs, arms, lungs, feet or other organs, a person may start feeling congested and this condition is defined as congestive heart failure. Once the heart failure is diagnosed, its evaluation becomes crucial. Doctors may ask the patient for the accurate and complete history of the symptoms.
Although this medical emergency is chronic (long-term condition), it may sometimes develop all of a sudden and may become a core reason for various heart problems. Cardiac failure may affect only the left or right side of the cardiac system. These are called left sided or right sided heart failure. In most cases, both sides of the cardiac system are involved.
Conditions during Heart Failure
- Heart muscles are not able to pump enough blood to fulfill the requirement of the body. This condition is referred as systolic heart failure.
- Heart muscles get stiffed and hence it becomes difficult for them to fill up with blood. This condition is refered to as diastolic heart failure.
Any of these conditions make the heart unable to pump the essential amount of oxygenated blood to the body organs. As the pumping capacity of the heart weakens, blood may start backing up into other body parts and the parts such as the arms, gastrointestinal tract, legs, liver and lungs get filled with fluid.
Usually, patients with coronary artery disease (CAD) have greater chances of developing failure in the functioning of the heart. CAD is a condition which refers to narrowing of the arteries or small blood vessels that are responsible for supplying oxygen rich blood to the cardiac system. If high blood pressure is not controlled appropriately, it may also lead to cardiac failure.
Other major causes may be:
- Heart attack or myocardial infarction
- Certain type of infection that impairs the heart muscle
- Congenital heart disease
- Arrhythmias or irregular/abnormal heart beat
- Heart valve disorder (this may occur in valves that are narrowed or leaky)
Congestive Heart Failure Stages
The American Heart Association has categorized this medical emergency into stages by considering the progression of cardiac failure.
Stage A : At this stage, the patient is at high risk of developing this condition.
Stage B: This stage involves a condition in which the left ventricle of the heart is dysfunctional or enlarged due to certain reason, but the patient does not show any symptoms (asymptomatic).
Stage C: Patients may start experiencing inability to workout, severe fatigue, shortness of breath, etc. This is called symptomatic cardiac failure.
Stage D: This can be considered as the last stage. Patients may undergo the symptoms in spite of rest and medical treatment. Mechanical devices, cardiac transplantation, end-of-life care or more aggressive medical treatment may be required.
The patients can be classified on the basis of their physical restrictions.
Class I: No symptoms while performing routine activities, no restrictions of physical activity or workout.
Class II: Symptoms may develop while performing certain routine activities, slight restrictions.
Class III: Symptoms may develop even with less physical activities, marked restrictions.
Class IV: A person may undergo symptoms even while resting, severe restrictions.
Symptoms and Signs
In some cases, patient with heart failure may not experience any problem. Early signs of heart failure may include cough, shortness of breath, or difficulty in taking a deep breath, mostly when lying down. If the patient has usual breathing problems such as emphysema, COPD (chronic obstructive pulmonary disease), or asthma, they should get a clue that they are undergoing an attack or certain heart worsening condition.
Shortness of Breath: A person with congestive cardiac failure may experience dyspne (difficulty in breathing), particularly while being active. Ordinary activities for example, walking, sweeping, doing routine tasks, etc., may be impossible or problematic. Shortness of breath can be relieved by taking rest. When the fluid gets filled into the lungs and starts interfering with the oxygen during blood oxygenation, the patient may experience orthopnea and dysnea. As the fluid deposits in the lungs become very critical, a foamy pink liquid may come out with cough.
Workout Intolerance: It means that a person becomes unable to tolerate physical exertion and sometimes routine activities that he or she may have been performing without any difficulty. The body requires nutrients and oxygen for performing any physical activity and an impaired heart is not able to fulfill the requirements of the body. The ability to workout or even perform some activity at a normal pace may get restricted due to severe fatigue and difficulty in breathing.
Swelling and Fluid Retention: Edema (puffy swelling) in the ankles, feet and legs may occur, especially after prolonged sitting or end of the day after office. Usually, the swelling is more evident on the lower leg or in the ankles at the front, where the tibia (bone in the leg) is near to the skin. Some patients may undergo severe swelling which may spread up till the abdominal wall, scrotum, hips and ultimately, the ascites (abdominal cavity). Patients should keep the track of his/her body weight on a regular basis, as the retention of fluid is often reflected by the increasing difficulty in breathing and amount of weight gain. Heart failure patients should know their dry weight (weight when they do not have pitting edema).
Pitting edema is a condition in which if the puffy area is pressed with finger, it will make an visible indentation for few minutes. This condition is not synonymous with cardiac failure; it may develop due to some other reasons such as kidney or liver failure. Generally, no pitting edema is caused due to heart failure.
Cardiac failure is a serious health problem that usually develops with age. Today, several victims are surviving with various heart diseases and are living a normal life. Some of them are unaware that they are developing a condition like heart failure. Recently, more effective therapies and medications have been evolved that enhance the outlook of this medical condition.
Medications and drugs are the protagonist of therapy with congestive cardiac failure.
- Implantable defibrillators and pacemakers have been modified. They are helpful in controlling the less common, but life-threatening disruption in the heartbeats.
- Novel and sophisticated treatments have proved beneficial for the patients to improve their quality of life and help them to live longer. New clinical trials and therapies are performed on patients under strict scientific and ethical monitoring.
- Certain sophisticated treatments such as use of LVADs, new form of temporary mechanical heart and heart transplants have been proved beneficial for many patients.
Understanding the congestive heart failure stages and prognosis in early days can help the patients to enhance their scope of survival for a long term. The therapies and medications show better result when used in early stages of heart failure.