Congestive Heart Failure: Symptoms, Stages & Treatment
What's The Connection Between Atrial Fibrillation And Heart Failure?
Atrial fibrillation (AFib) and heart failure commonly occur together. Having either of these conditions increases your risk of developing the other.
AFib is a type of arrhythmia, an abnormality in the way your heart beats. The upper chambers of the heart of people with AFib beat irregularly and, often, too quickly. This rapid beating can cause the lower chambers to beat too quickly and out of sync trying to keep up.
Heart failure occurs when your heart is unable to pump enough blood to adequately supply your bodily tissues with oxygen. It may be caused by chronic damage to the heart over many years or by a sudden injury.
The relationship between AFIb and heart failure seems to be bidirectional, meaning that people with either condition are at an elevated risk of developing the other.
It's important to seek prompt medical attention if you believe you have either condition or if you have a previous diagnosis and your symptoms get worse. Both conditions can lead to life threatening complications if not properly monitored and treated.
Read on to learn more about the connection between these two conditions.
A large amount of research suggests that AFib and heart failure are strongly associated with each other. Each condition might lead to changes to your heart that increase your risk of developing the other condition. Both also share some risk factors.
In a 2023 2023 study, researchers examined the correlation between heart failure and AFib using data from over a million people with each condition. The researchers found that:
One of the major limitations of this study was that 98.6% of the participants were of European ancestry.
How AFib might contribute to the development of heart failure
It's thought that AFib and heart failure might contribute to a cycle of events that each contributes to the other.
Chronic atrial fibrillation can lead to cellular stress that triggers a cascade of inflammatory molecules. This inflammation can potentially lead to structural changes and the development of scar tissue in the upper left chamber of your heart called your left atrium. This process is called atrial fibrosis.
Reduced atrial function over time can increase pressure and impair the ability of the lower chamber of your heart, called the left ventricle, to pump blood. This may contribute to the development of heart failure over time.
AFib with a rapid ventricular response (elevated heart rates greater than 100 beats per minute at rest) can result in overworking the left ventricle with sudden weakening of the left ventricular pumping function. The medical term for this is tachycardia-mediated cardiomyopathy.
Additionally, AFib and reduced left ventricular function commonly co-occur, with the combination being associated with a worse outlook than in people with only one of those conditions.
Shared risk factors
AFib may occur in a quarter of people with heart failure.
Heart failure might lead to several changes to your heart that might contribute to the development of AFIb, such as:
A hallmark feature of heart failure is a disruption in calcium levels inside the heart muscle, which may also predispose you to atrial fibrillation.
Here's a brief look at the symptoms of AFib and heart failure.
AFib symptoms
AFib symptoms can include:
Heart failure symptoms
Some of the most common symptoms of heart failure include:
If you've previously been diagnosed with heart failure, it's important to attend all your scheduled follow-up sessions. It's also important to see your doctor if you notice changes in your symptoms.
AFib often doesn't cause symptoms, and you might not know you have it unless you've received an electrocardiogram (EKG) for another reason. It's important to follow your doctor's instructions with how often you should have a follow-up appointment.
Medical emergency
It's important to seek immediate emergency medical if you sudden or severe symptoms of heart failure or serious AFib symptoms, such as:
Managing AFib and heart failure at the same time can be a challenge. The major treatment goals are to:
What is the top trigger for AFib?
Common triggers for atrial fibrillation include alcohol consumption, stress, untreated obstructive sleep apnea, obesity, caffeine, anxiety, and lack of sleep.
What is the life expectancy with AFib and heart failure?
In a large Danish study, a diagnosis of heart failure before AFib was associated with a higher increased risk of death compared to AFib diagnosed before heart failure. In the studied group, the 10-year mortality rates were 81.8% and 76.8%, respectively.
Can heart failure caused by AFib be reversed?
Heart failure might be reversible or significantly improved with procedures or medications to manage AFib.
What is the most common cause of death in people with atrial fibrillation?
Heart failure is the most common cause of death in people with AFib.
People with AFib seem to be at an increased risk of developing heart failure. The opposite also seems to be true. Each condition may lead to changes to your heart that increase your risk of the other.
If you have either condition, it's important to attend all your scheduled follow-up appointments for regular monitoring and treatment. Keeping your heart condition under control can help prevent complications that may be life threatening.
What Is Congestive Heart Failure?
Imagine experiencing shortness of breath during everyday activities, like walking to the kitchen to make a sandwich.
Your legs are swelling.
Then, you notice you've had to start propping yourself upright with pillows to sleep at night.
These symptoms on their own can be concerning, but then you get the diagnosis: congestive heart failure.
Those can be scary words to hear. However, most people will develop some form of heart failure as they get older.
But getting on board with being healthy at a young age and understanding the signs of heart failure can pay off down the road.
Here, University of Michigan Health Frankel Cardiovascular Center cardiologist and advanced heart failure specialist Abbas Bitar, M.D., tells you what you need to know.
What is congestive heart failure?
Bitar: The American Heart Association defines heart failure as a complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood.
Simply, heart failure is a condition where the heart doesn't pump blood as well as it should.
This happens when the heart's structure or function is damaged, making it harder to fill with blood or push it out to the body.
Congestive refers to fluid buildup in organs which results in symptoms such as shortness of breath and swelling in the legs, ankles or feet, among others.
Heart failure is a broad condition, and patients can have vastly different experiences.
How is congestive heart failure measured?
Bitar: There are multiple ways to measure or classify heart failure.
To start, left ventricular ejection fraction, which is the percentage of blood the left ventricle pumps out with each beat, is most commonly used to classify patients into one of three categories:
Ejection fraction provides vital insight into the strength and function of the heart.
The American College of Cardiology and American Heart Association also determined four main stages of heart failure:
It's important to remember that heart failure is a clinical diagnosis, so it relies on a patient's history, a physical examination and an imaging component to fulfill a clinical suspicion of heart failure.
Finally, there are also four classes identified by the AHA to monitor symptoms and clinical course:
For the most part, stages don't change but classes can vary based on the individual clinical course.
What are the signs of congestive heart failure?
Bitar: The most common symptoms are:
In clinic, we often ask patients how many pillows they use to prop up their heads at night.
Many are surprised by this question, but it helps us assess fluid levels in the body.
The human body functions similarly to a bottle containing liquid. When a bottle with a small amount of fluid is tipped on its side, the liquid remains at the bottom and doesn't reach the top.
However, if the bottle contains a large amount of fluid, the liquid rises to the top. In the human body, excess fluid can accumulate in the lungs, leading to breathing difficulties.
Some patients may also have an irregular heartbeat or chest pain.
These aren't typical heart failure symptoms but result from the main issue.
For example. When excess fluid builds up, it increases pressure in the heart, which can lead to chest pain similar to angina.
What causes congestive heart failure?
Bitar: The most common causes of heart failure are coronary artery disease and hypertension, or high blood pressure.
There are other metabolic causes too, such as thyroid issues, that can affect the heart muscle.
Ultimately, there are two components which can heighten your chances of heart failure:
Age is also a factor: More than 20% of Americans over the age of 40 have some form of heart failure and over 80% of people diagnosed with heart failure are aged 65 years or older.
How long can you live with congestive heart failure?
Bitar: There is no unifying answer for how long someone can live with heart failure.
How well someone responds to treatment and the cause of their heart failure will play a role in their prognosis.
Statistically, patients with advanced heart failure who continue to experience Class 3 or 4 symptoms despite treatment have poor survival rates.
Their risk of mortality can be as high as 50% within one year.
On the other hand, those who respond well to treatment and are not limited with heart failure symptoms can experience survival rates in line with those that do not have heart failure at all.
So, it's a pretty wide spectrum.
How do you treat congestive heart failure?
Bitar: Treatment often starts with managing blood pressure and reducing the congestion that may cause swelling or shortness of breath.
Patients with symptoms of fluid buildup are put on a diuretic, or "water pill", to remove excess fluid from the body and prevent symptoms.
The main classes of medicines are:
Each has been shown to reduce the risk of dying and being hospitalized due to heart failure from anywhere between 15-20%.
None of these medications are risk free, and your health care provider will work with you to manage any side effects, such as sodium retention.
For the smaller subset of patients with advanced heart failure and refractory symptoms, treatments go beyond medication.
Around 10-15% of patients with more advanced symptoms may need other treatments.
This is when you get into heart pumps, like left ventricular assist devices, and heart transplants.
Can heart failure be reversed?
Bitar: It all comes down to the cause of the heart failure.
If someone experiences a heart attack that leads to a scar on their heart muscle, they may not be able to recover from that.
However, if the heart failure is because someone has high blood pressure and then it is controlled by treatment, many of those patients' heart muscles can recover.
The drugs we mentioned in the last question have been shown to reduce the risk of death and hospitalization.
What I tell patients in clinic is, 'You do have heart failure. We can put you on treatment, and then time will tell how you respond.
As a doctor, what do you want patients to know most about congestive heart failure?
Bitar: Heart failure is more common than people realize, but, for most, it's not a terminal condition.
Many patients do well with medical treatment. For those who don't, there are options to help extend and improve their lives.
While there's no cure, identifying and managing risk factors, like high blood pressure and coronary artery disease, early on is crucial.
The key is early diagnosis and intervention, as there's a lot we can do to help to improve patient's quality of life and longevity.
If you care about heart disease, please read studies about a big cause of heart failure, and common blood test could advance heart failure treatment.
For more information about heart health, please see recent studies about a new way to repair human heart, and results showing drinking coffee may help reduce heart failure risk.
Written by Rachel Zeichman.
Source: Michigan Medicine.
Chronic Heart Failure
Heart failure (HF) often called congestive heart failure (CHF) is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography and blood tests. Treatment commonly consists of lifestyle measures (such as smoking cessation, light exercise including breathing protocols, decreased salt intake and other dietary changes) and medications, and sometimes devices or even surgery.
Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy. The term "heart failure" is sometimes incorrectly used to describe other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest, which can cause heart failure but are not equivalent to heart failure.
Heart failure is a common, costly, disabling, and potentially deadly condition. In developed countries, around 2% of adults suffer from heart failure, but in those over the age of 65, this increases to 6–10%.
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