However, people with HF stage B remain asymptomatic. People at this stage will show symptoms of HF linked to underlying structural heart disease, including fatigue or breathlessness. These symptoms usually occur due to problems with the squeezing function of the left ventricle, or the pumping chamber of the heart. Stage C HF also includes people who no longer show symptoms but are currently undergoing treatment for previous symptoms such as those who spent time in the hospital with heart failure exacerbation.
At stage D, people will have advanced structural heart disease and display significant symptoms, even when they are at rest.
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This stage is severe and may require advanced specialized treatment, such as mechanical circulatory support, continuous inotropic infusion to make the heart squeeze harder, cardiac transplant, or hospice care. The most common type of HF is left-sided HF. The left side of the heart must work harder to move the same volume of blood around the body. This may cause a fluid buildup in the lungs and make breathing difficult as it progresses. Right-sided HF is less common. It occurs when the right ventricle cannot pump blood to the lungs. This can lead to blood backing up in the blood vessels, which may cause fluid retention in the lower legs and arms, abdomen, and other organs.
A person can have left-sided and right-sided HF at the same time. However, HF usually begins on the left side and can affect the right side if a person does not receive effective treatment.
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Without treatment, HF can be fatal. Even with adequate treatment, HF may get worse over time, triggering dysfunction of other organs throughout the body. HF is more likely to occur in people with other conditions or lifestyle factors that weaken the heart. People with a history of cardiovascular health issues or several risk factors for HF should seek immediate care if they experience symptoms of HF. As fluid builds up, people with HF may develop painful swelling, or edema. Swelling caused by HF can undermine movement and may lead to skin changes and skin breakdown. Fluid retention may also affect other organ function, making it harder to breathe or exercise.
Children with HF may experience delays in physical development, while infants with the condition may struggle to gain weight. A doctor or cardiologist will perform a physical exam. This involves listening to the heart, checking for fluid retention, and looking at the veins in the neck to see if there is extra fluid present in the heart. They may order other diagnostic tests, including:.
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People with advanced HF might need more intensive treatment. Medical procedures that may help include the following:. A surgeon might implant a medical device, such as:. Not everyone with HF is an appropriate candidate for a transplant, and people often have to wait a long time before having one. Heart surgery can be dangerous and invasive but is sometimes necessary, in combination with medications, to help treat HF in the best possible way. Not always; it depends on the cause of HF. Sometimes advanced HF is indolent and presents with symptoms only in its very advanced stages.
For this reason, it is essential to control risk factors that may cause stage A HF and follow up regularly with your doctor. Article last updated by Adam Felman on Thu 4 July Visit our Heart Disease category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Heart Disease. All references are available in the References tab.
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Heart failure. Heart failure [Fact sheet]. Heart failure: How to limit your fluids. Janussi, J. Heart failure and salt: The great debate. Lifestyle changes for heart failure. Medications used to treat heart failure. Parch, J. No longer failing to treat heart failure: A guideline review.
Recognizing advanced heart failure and knowing your options. Types of heart failure. Warning signs of heart failure. MLA Villines, Zawn.
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The most common type of HF is the chronic form, with occasional acute decompensations. This is the type of HF referred to in this work, unless specified otherwise.. This refers to a situation in which the clinical manifestation is due mainly to congestion of the pulmonary venous left HF or systemic right HF territory. In the first case, the dominant symptoms are progressive dyspnea, orthopnea, cough while lying down and paroxysmal nocturnal dyspnea, whereas in right HF jugular venous distension, hepatomegaly, ascites and edemas predominate..
Systolic and Diastolic Heart Failure. Systolic dysfunction of the left ventricle LV , indicated by dilatation of the cavity and a low ejection fraction, is the most classic manifestation of heart failure. Most such patients are middle and older-aged men with ischemic heart disease. However, the presence of typical symptoms of HF with preserved LV systolic function is as frequent as the latter situation: the study of these patients in general, individuals of advanced age, with a high proportion of women and a frequent background of arterial hypertension shows alterations in LV filling, usually with myocardial hypertrophy without cavity without dilatation.
Given the current relevance of this form of HF, 7,8 we dedicate a full chapter to it..
Congestive heart failure (CHF)
In fact, the NYHA's functional class has become so widespread that it has become synonymous with the severity of the underlying symptoms, and is used in workplace and legal medicine to estimate the level of handicap and prognosis of the patients. However, for various reasons this approach ignores serious conceptual problems: a the classification involves a high degree of subjectivity, both on the part of the patient as well as the doctor; b the functional class of a specific HF patient can fluctuate over short periods, especially when decompensatory situations exist, which is why it is advisable to avoid using this scale during unstable periods, and c the functional class of the NYHA presents little correlation with the level of ventricular dysfunction 9 and with the prognosis of patients.
Given the preceding, and a better understanding of the developmental process leading to HF, various authors on both sides of the Atlantic 3,11 advocate the use of a classification more in line with present concepts which include the preclinical stages of HF development, in which the identification of patients enables effective preventive interventions.
Stage A identifies patients at risk of developing HF, but who still lack structural cardiac abnormalities; stage B includes patients with structural disorders of the heart, generally due to progressive left ventricular remodeling, who have not yet presented clinical evidence of HF; Stage C indicates the presence of structural abnormalities with previous or current evidence of HF, and stage D refers to patients with severe forms of HF resistant to normal treatment, who require measures such as continuous infusion of inotropes, ventricular assist devices, heart transplants, etc.
Unlike the NYHA classification, this indeed reflects the expected progression of patients over the course of the disease and is useful for taking a specific therapeutic approach in each phase, aimed at slowing down or stopping the advance of HF. Nevertheless, the aim of this new stratification system is not to replace, but to complement the information provided by the NYHA classification, thus making it advisable to use both methods in the evaluation of each suspected HF patient..
The diseases that can lead to HF are very different and their detection is of great importance, as this can modify the diagnostic, therapeutic and preventive approach, as well as determine prognosis.
In practical terms, and in line with the main textbooks, 13,14 we will refer to three types of causes of HF: predisposing, determining and precipitating. The main causes are presented in Table Predisposing causes, also known as risk factors, are indicators associated with a greater probability of HF and can be identified in the population without heart disease or symptoms of HF. In turn, these are divided into etiological, probably etiological, and non-etiological causes.. Predisposing etiological causes include structural alterations, congenital or acquired, where there is a disorder of the peripheral vessels, coronary circulation, pericardium, myocardium, endocardium or cardiac valves that produces alterations in the normal physiology of the heart.
Within coronary artery disease, previous myocardial infarction is the single main factor, carrying an HF risk 10 times higher than in the normal population during the first year after the infarction and up to 20 times in the following years. Dilated cardiomyopathy and congenital cardiac abnormalities are other less prevalent predisposing etiologies of HF in the population..