Chronic heart failure

Chronic Heart Failure

Chronic heart failure (CHF) is a condition in which the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs. It is a long-term condition that typically develops over time as the heart becomes weaker or stiffer.

Pathophysiology

Chronic heart failure can result from any condition that reduces the efficiency of the heart muscle, through damage or overloading. The most common causes include coronary artery disease, hypertension, valvular heart disease, and cardiomyopathy.

The heart's inability to pump effectively leads to a cascade of compensatory mechanisms, including:

• Activation of the renin-angiotensin-aldosterone system (RAAS)
• Sympathetic nervous system activation
• Ventricular remodeling

These mechanisms initially help maintain cardiac output but eventually contribute to further cardiac dysfunction and symptoms.

Symptoms

Patients with chronic heart failure may experience a variety of symptoms, including:

• Dyspnea (shortness of breath)
• Fatigue
• Edema (swelling, particularly in the legs and ankles)
• Orthopnea (difficulty breathing when lying flat)
• Paroxysmal nocturnal dyspnea

Diagnosis

The diagnosis of chronic heart failure is based on a combination of clinical evaluation, imaging, and laboratory tests. Key diagnostic tools include:

• Echocardiography: To assess heart structure and function
• Electrocardiogram (ECG): To detect arrhythmias or ischemia
• B-type natriuretic peptide (BNP) or NT-proBNP levels: Biomarkers that can indicate heart failure
• Chest X-ray: To check for pulmonary congestion or cardiomegaly

Management

Management of chronic heart failure involves lifestyle modifications, pharmacotherapy, and in some cases, surgical interventions.

Lifestyle Modifications

• Sodium restriction
• Fluid management
• Regular physical activity
• Smoking cessation

Pharmacotherapy

• ACE inhibitors or angiotensin II receptor blockers (ARBs)
• Beta-blockers
• Diuretics
• Aldosterone antagonists
• SGLT2 inhibitors

Surgical and Device Therapy

• Implantable cardioverter-defibrillator (ICD)
• Cardiac resynchronization therapy (CRT)
• Heart transplantation

Prognosis

The prognosis of chronic heart failure varies depending on the underlying cause, severity, and response to treatment. It is a progressive condition, and early intervention can improve quality of life and outcomes.

See Also

• Acute heart failure
• Cardiomyopathy
• Coronary artery disease

References

• McMurray, J. J. V., et al. (2012). "ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012." European Heart Journal.
• Yancy, C. W., et al. (2013). "2013 ACCF/AHA Guideline for the Management of Heart Failure." Journal of the American College of Cardiology.