The new congestive heart failure: It’s treatable

By Bradley D. Berry, M.D., International Heart Institute of Montana

[4 MIN READ]

In this article:

• What is congestive heart failure (CHF), and what are its causes and risks?

• The possible effect of COVID-19 on someone with heart disease.

• Providence cardiologist Dr. Bradley Berry explains advances in treatments for CHF.

There was a time when a diagnosis of congestive heart failure meant that a physician would merely try to ease a patient’s symptoms. No more. Now, through the early recognition of heart failure and swift treatment, we can not only treat the symptoms, but we can also slow the disease – and even reverse it.

Congestive heart failure (CHF) is a clinical syndrome in which the body inappropriately retains sodium and, consequently, water. This condition is generally due to a weakening heart muscle.

Some sobering facts

In the United States:

• It’s estimated that 450,000 new cases of CHF are diagnosed annually.
• There are 4.6 million Americans currently diagnosed and living with CHF.
• CHF is the single largest volume diagnosis in the Medicare-age population in this country.
• The disease is the most likely diagnosis that leads to readmission to the hospital after initial treatment.

Causes of a weakening heart

Despite the ominous-sounding name, congestive heart failure doesn’t mean sudden death or that the heart suddenly stops working. CHF can be a gradual disease. As the heart muscle weakens, the heart has to work harder to adequately meet the demands of the body.

The heart generally weakens in response to:

• An injury such as a heart attack
• Long-standing high blood pressure
• Abnormal heart values

Watch for these symptoms

As the heart muscle loses strength, it often cannot handle the buildup of fluid, which can leak into the lungs, abdomen, feet, and legs. People with CHF can experience shortness of breath with exertion while lying down or even while doing simple daily activities. People may awaken at night breathless and require pillows to prop themselves up to avoid trouble breathing.

Patients also can experience fatigue, cough with or without exertion, and feet or leg swelling. Keep in mind that all symptoms of heart failure are not exclusive to the disease and could be caused by another condition. The most important first step is to discuss any new or concerning symptoms with your health care provider to determine their cause.

Risk factors and diagnosis

Common risk factors for developing congestive heart failure include:

• Coronary artery disease
• Heart attack
• High blood pressure
• A history of heart murmurs or heart valve disease
• An enlarged heart
• Obesity
• Diabetes

The first step in diagnosing CHF is to see your provider for a careful health history and a physical exam. Physicians have a number of tests that they may order to diagnose this condition. The most common are blood tests, electrocardiogram (EKG), chest X-rays, stress tests, and, most importantly, an echocardiogram.

Heart damage can be reversed

An echocardiogram is a noninvasive ultrasound study that allows a physician to assess heart function, the size of the heart, and the condition of the heart valves. Depending on the findings, there may be further tests, such as a heart catheterization or coronary angiogram to look at the blood vessels supplying the heart. Once a diagnosis is made, your physician will be able to assess the cause of the condition and start treatment.

Early diagnosis and treatment are very important. There have been dramatic strides over the last three decades in the treatment of congestive heart failure. It was once thought that heart damage could not be reversed. We now know that this is not true.

Medication and treatments

There are at least five classes of medication that have clearly been shown to decrease symptoms of heart failure, improve the heart’s pumping function (ejection fraction) and increase survival rates.

In addition, there are treatments for heart valve disease and blocked arteries, both of which can weaken the heart muscle. Adequate blood flow to the heart can be restored. Certain pacemakers can help improve heart function, and implantable defibrillators can treat potentially dangerous heart rhythms that can accompany a weakened heart muscle and congestive heart failure.

Teamwork, exercise, and diet

Treatment of CHF may be the best example in medicine where optimal outcomes are achieved by the patient and physician working together.

The patient’s role in this partnership is crucial. Here’s what patients can do to feel better and make sure their treatment is as effective as possible:

• The single most critical thing is to avoid dietary salt (sodium). Sodium consumption directly relates to fluid retention, which can tax a weakened heart.
• Weigh themselves daily to monitor their fluid status and weight, and report changes as soon as possible to their care team.
• Take medications as directed and see their doctor for regular checkups to stay on top of the disease.
• Get cardiac rehabilitation early and exercise regularly thereafter. Exercise has clearly been shown to decrease symptoms, optimize physical conditioning around an imperfect heart and prolong life.
• Lose weight, maintain an optimal weight and maintain a healthy diet and lifestyle. All are critically important to long-term symptom relief and survival.

Living longer and better

There are many diseases that can masquerade as congestive heart failure. All that swells is not heart failure. In addition to conventional forms of heart failure, there also are similar conditions caused by a stiff heart muscle and secondary heart problems caused by chronic lung conditions. Most of these can be treated.

We now know how important it is to get early diagnosis and treatment for CHF. Patients can now have a brighter outlook on congestive heart failure that wasn’t there in decades past. This makes it possible to not only live longer but live better. A fulfilling, symptom-free life is achievable.

COVID-19 showed us that protecting your heart is more important than ever. Be sure to stay on top of treatments, medications, and routine care to keep yourself in the best condition possible to help fight off germs and illnesses.

Find a doctor

To learn more about congestive heart failure or to schedule a consultation about CHF or another potential heart condition, find heart and vascular services near you or find a specialist in our provider directory. Through Providence Express Care Virtual, you can also access a full range of healthcare services. 

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Related resources

Know your blood pressure numbers to fight ‘the silent killer’

Ask the expert: Can I reverse heart disease?

Love your heart: How to get the most out of your heart medications

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Download our free booklet, Living with Congestive Heart Failure:

(Compiled and reviewed by the Regional Cardiac Education Committee, Education Committee, clinical staff and physicians in Providence Health & Services' Portland Service Area.)