Heart failure, also known as congestive heart failure (CHF), is a condition where the heart cannot pump blood efficiently to meet the body’s needs. This can result from any structural or functional issue in the heart’s ability to fill or eject blood.

The four leading causes of heart failure—ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD), hypertensive heart disease, and rheumatic heart disease (RHD)—account for nearly two-thirds of all cases.

Types of Heart Failure

1. Left-Sided Heart Failure HFrEF (Heart Failure with Reduced Ejection Fraction): Left ventricle cannot contract normally (EF ≤ 40%).
   HFpEF (Heart Failure with Preserved Ejection Fraction): Left ventricle cannot relax properly (EF ≥ 50%).
2. Right-Sided Heart Failure Occurs when the right ventricle fails to pump blood to the lungs efficiently, causing fluid buildup in the legs and abdomen.
3. Biventricular Heart Failure Both sides of the heart are affected, leading to mixed symptoms.
4. Congestive Heart Failure (CHF) Often used interchangeably with heart failure, CHF involves fluid buildup in lungs, limbs, and other organs.

Classification Based on Onset

• Acute Heart Failure: Sudden and severe; needs immediate medical attention.
• Chronic Heart Failure: A long-term, progressive condition that worsens over time.

Causes of Heart Failure
Common Causes:

• Ischemic Heart Disease (IHD)
• Hypertension
• Valvular Heart Disease
• Cardiomyopathies (dilated, restrictive, hypertrophic)
• Obesity & Diabetes
• Inflammatory/Infectious Conditions
• Peripartum Cardiomyopathy
• Arrhythmias and Tachycardia
• Thyrotoxicosis
• Stress-induced Cardiomyopathy (Takotsubo)

Symptoms of Heart Failure
Most Common:

• Shortness of breath (especially on exertion or while lying down)
• Fatigue
• Swollen ankles, feet, or abdomen
• Rapid or irregular heartbeat
• Persistent cough or wheezing

Less Common:

• Loss of appetite
• Weight changes
• Confusion or impaired memory
• Frequent urination at night
• Dizziness or fainting

Risk Factors for Heart Failure
Modifiable Risk Factors:

• High blood pressure
• Diabetes
• High cholesterol
• Smoking and alcohol
• Obesity
• Sedentary lifestyle
• Unhealthy diet

Non-Modifiable Risk Factors:

• Age (especially > 65 years)
• Family history of heart disease
• Gender (men more prone to HFrEF, women to HFpEF)
• Race (higher prevalence in Black populations)

How is Heart Failure Diagnosed?

• Clinical Evaluation: Medical history and physical examination
• Lab Tests: CBC, renal & liver profiles, BNP, troponin
• Imaging: ECG, echocardiogram, chest X-ray, cardiac MRI, CT scan
• Advanced Testing: Cardiac catheterization, genetic testing

Treatment Options for Heart Failure

1. Lifestyle Modifications

• Low-sodium, heart-healthy diet
• Regular physical activity
• Smoking and alcohol cessation
• Weight control and stress management

2. Medications

• ACE inhibitors, beta-blockers, diuretics, aldosterone antagonists
• Digitalis, anticoagulants, vasodilators

3. Device Therapy

• Implantable Cardioverter Defibrillator (ICD)
• Cardiac Resynchronization Therapy (CRT)
• Ventricular Assist Devices (VAD)
• Pacemakers

4. Surgical Interventions

• Valve repair or replacement
• Coronary artery bypass surgery
• Heart transplantation (in advanced cases)

Complications of Heart Failure

• Arrhythmias and sudden cardiac arrest
• Kidney and liver dysfunction
• Cardiac cachexia (muscle wasting)
• Blood clots (thromboembolism)
• Recurrent hospitalizations
• Poor quality of life and depression

Preventing Heart Failure

• Control blood pressure, diabetes, and cholesterol
• Maintain a healthy diet and active lifestyle
• Avoid smoking and excessive alcohol use
• Regular health check-ups, especially if at risk

Difference Between Heart Attack and Heart Failure
Parameter Heart Attack Heart Failure Definition Blockage in coronary arteries Heart unable to pump efficiently Onset Sudden Gradual or sudden

Symptoms Chest pain, arm/jaw discomfort Shortness of breath, fatigue, swelling Causes Coronary artery blockage IHD, hypertension, RHD, COPD Treatment Immediate reperfusion, medications Medications, lifestyle changes, surgeries