The new CHF: It’s treatable

This article was updated on August 10, 2020 to reflect the most recent research and to offer information to those with a heart condition during the COVID-19 pandemic.

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

The new CHF: It’s treatable

  • What is CHF, and what are its causes and risks?
  • How heart disease can be reversed.
  • A look at advances in treatments for congestive heart failure (CHF).

[3 MIN READ]

There was a time when a diagnosis of congestive heart failure meant a doctor could only try to ease a patient’s symptoms. No more. Now, heart failure can be identified earlier and treated sooner. We can not only treat the symptoms, we can slow the disease — and even reverse it.

Congestive heart failure (CHF) is a clinical syndrome in which the body doesn’t properly retain sodium. This leads to fluid around the heart so it can’t pump efficiently. The condition is most often due to a weakening heart muscle.

You may be wondering about COVID-19 and having a heart condition. It’s important to note that having heart disease doesn’t make you more likely to get the virus, but it does mean that you have a higher risk of a more serious infection if you do contract it. Since this is a new illness, there are still questions about what makes some patients more likely than others to get COVID-19. The bottom line is that if you have a heart condition, it’s smart to do everything you can to protect yourself against COVID-19.

Some sobering facts

In the United States:

  • There are about 6.5 million adults who are currently living with heart failure.  
  • It’s estimated that 550,000 new cases are diagnosed each year.
  • 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

Although the name sounds ominous, 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:

Watch for these symptoms

As the heart muscle loses strength, it often can’t handle the buildup of fluid, which can leak into the lungs, abdomen, feet and legs and cause swelling. People with CHF may also have:

  • Shortness of breath
  • Nighttime breathlessness
  • Fatigue
  • Cough with or without exertion
  • Abdominal pain

Keep in mind that all symptoms of heart failure aren’t exclusive to the disease. They could be caused by another condition such as diabetes, sleep apnea or obesity. The most important thing you can do first is talk with your doctor about any new or worrisome symptoms and learn what’s causing them.

Risk factors and diagnosis

Common risk factors that cause congestive heart failure to develop 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 doctor for a careful health history and a physical exam. Doctors have a number of tests they may order to diagnose this condition. The most common are:

  • Blood tests
  • Electrocardiogram (EKG)
  • Chest X-rays
  • Stress tests
  • Echocardiogram (the most important)

Heart damage can be reversed

An echocardiogram is a noninvasive ultrasound study that allows a doctor to assess heart function, the size of the heart and the condition of the heart valves. Based on the findings, there may be more tests, such as a heart catheterization or coronary angiogram to look at the blood vessels that are supplying the heart. Once a diagnosis is made, your doctor 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 in treating congestive heart failure over the last three decades. It was once thought that heart damage could not be reversed. We now know that this is not true.

Medicines and treatments

There are at least five classes of medicine that have clearly been shown to decrease symptoms of heart failure, improve the heart’s pumping function and raise survival rates.

New medicine has recently been approved to help treat CHF

This newer medicine comes from a group of drugs known as SGLT-2 inhibitors. The medicine lowers blood sugar by causing the kidneys to remove sugar from the body through urine. They help lower the risk of being hospitalized for heart failure in adults who have Type 2 diabetes and who also have established, or risk factors for, heart disease.

Devices that help treat heart valve disease and blocked arteries

There are also 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.

Making strides with portable heart pumps

These pumps are also making life better for people with CHF. These ventricular assist devices, or VADs, are battery-operated systems that can be carried in a backpack. They were once used as only temporary “bridge” devices to keep patients alive while they waited for transplants, but now they’re being viewed as a permanent solution when a transplant isn't possible.

Teamwork, exercise and diet

Treating CHF may be the best example in medicine to show how positive outcomes are achieved when the patient and doctor work together.

The patient’s role in this partnership is crucial. After all, 80% of heart disease is preventable. You can make a big impact on your risk by what you do, how you eat and how you live overall. By starting with small steps every day, you can take control of your risk for heart disease. Here’s what you can do to feel better and make sure your treatment is as effective as possible:

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

Living longer and better

There are many diseases that can masquerade as congestive heart failure. Along with 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.

And during COVID-19, 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.

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Are you or someone you love dealing with heart failure? Share what you’ve learned, ask questions or celebrate healthy victories @psjh. #heartfailure

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

This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

About the Author

The Providence Heart & Vascular Team is committed to bringing you many years of expertise and experience to help you understand how to prevent, treat and recover from cardiovascular diseases and conditions. From tips to eating better to exercise and everything in between, our clinical experts know how to help you help your heart.

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