Definition

Chronic heart failure is defined as the prolonged inability of the heart to circulate enough blood throughout the body. Heart failure is a complex clinical syndrome caused by a disruption in the structure of the heart. Because the heart no longer functions as efficiently as it once did, the body's need for blood circulation and oxygen in the tissues is not met.  In chronic heart failure, complaints of heart failure are relatively stable compared to acute heart failure.

When the amount of blood pumped by the heart is reduced, the body attempts to compensate. The heart begins to beat faster, and its size grows larger. Other organs in the body that do not receive enough blood and oxygen are eventually damaged.

Heart failure is an incurable disease that will worsen with time. However, if properly treated, the symptoms can be effectively managed. Heart failure is common throughout the world, with a high morbidity and mortality rate. It is estimated that 64 million people around the world suffer from heart failure.  This large number has a significant impact on healthcare services.

Causes

Chronic heart failure is caused by a problem with the structure and function of the heart. The majority of cases of heart failure are caused by coronary heart disease, a condition in which fatty plaques block blood flow to the heart muscle. If coronary heart disease is left untreated, the heart muscle blood vessels can become completely blocked, and the heart muscle cells can die (myocardial infarction). Both of these conditions can impair the heart muscle's ability to pump blood throughout the body, leading to heart failure.

In addition, other heart disorders can cause heart failure, including:

• High blood pressure (hypertension)
• Heart valve disease
• Uncontrolled heart rhythm disorder
• Inflammation of the heart muscle (myocarditis)
• Congenital heart disease
• Heart muscle damage (cardiomyopathy)

Risk factor

Age is a major determining factor of heart failure. The incidence of heart failure increases as the patient's age increases. Heart failure is one of the main causes of elderly hospitalization.

The following are factors that increase a person's risk of developing heart failure:

• Inactive lifestyle
• Unhealthy diet
• Having metabolic risk factors such as:
• Overweight (obesity)
• High blood pressure
• Diabetes mellitus
• High cholesterol level
• Smoking habit
• Excessive alcohol consumption

Symptoms

The most common symptom of heart failure is shortness of breath. The doctor will also look into the cause of the shortness of breath, whether it occurs during physical activity or while lying in bed, and whether it is acute or chronic. Shortness of breath may also be felt at night and may wake the patient from sleep.

Other typical complaints that heart failure patients routinely report are fatigue, palpitations, chest pain, and swelling of the legs.

In addition to the above symptoms, there can also be less typical symptoms in patients such as:

• Night cough
• Decreased appetite
• Confusion or decreased mental status
• Dizziness
• Fainting
• Irregular pulse
• Enlarged abdomen and bloating

Diagnosis

Interview and physical examination

To establish a diagnosis of chronic heart failure, the doctor will ask you detailed questions about your complaints, and inquire about any previous medical conditions you may have, such as coronary heart disease, diabetes, heart valve disease, or high blood pressure. In addition, your doctor will inquire about any risk factors that you or your family may have, as well as other questions about heart failure.

The doctor will assess the patient's clinical appearance. During a physical examination, your doctor will listen to your heart and lung sounds as well as check for fluid buildup in your feet and ankles. The doctor will also assess your nutritional status, blood circulation, and whether your hands or feet are cold and bluish due to a lack of oxygen.

Supporting examination

After performing a physical examination, the doctor will perform a supporting examination, which may include:

1. Blood test

The doctor will perform blood tests in the laboratory for other abnormalities such as anemia, renal impairment or thyroid gland dysfunction. Examination of electrolytes, especially sodium levels in the blood, has prognostic value regarding the risk of death in patients with chronic heart failure

In addition, the doctor will check blood sugar, cholesterol levels, liver function, and heart function. One of the tests, BNP (B-type Natriuretic Peptide), will calculate BNP levels to assess the severity of heart failure, and the risk of dying from the disease, as well as check if the given therapy has any benefit to the patient

2. Imaging examinations

Imaging examinations such as chest X-rays can be done to look at the heart, and lungs, as well as the structure of blood vessels and other tissues in the chest. The results of the examination will show if there is an enlarged heart, abnormal fluid buildup, or signs of lung damage. Other imaging examinations that are the doctor's choice in heart failure screening are echocardiography or ultrasound of the heart. Doppler ultrasound is also one of the examination methods, which can provide an overview of blood flow in the heart and lungs

3. ECG (echocardiogram) examination

During an ECG examination, electrodes will be attached to your chest, feet, and hands. These electrodes will record the electrical activity of your heart. The doctor will then interpret and assess the condition of your heart, such as your heart rhythm, if there are any signs of coronary heart disease, heart enlargement, or if you have had a previous heart attack

There is also a specialized ECG test called an exercise stress test, performed while walking on a treadmill machine or stationary bike. Your chest will be connected to a heart monitor. From this test, the doctor will assess how your heart performs during strenuous activity or exercise. In certain conditions, patients can do this test without exercise but with the help of certain medications

4. Cardiac Catheterization

This examination is done to check the condition of the blood vessels in the heart. This examination is performed when the cause of heart failure is due to coronary heart disease. This is done in a sterile operating room.

Management

The doctor will treat you based on the symptoms you describe and how they affect your daily activities. Are you still able to perform normal activities? Do you experience shortness of breath during strenuous activities, or do the symptoms appear even when you are resting or doing nothing? The goal of chronic heart failure therapy is to alleviate symptoms, improve quality of life, reduce hospitalization, and lower the mortality rate associated with this disease.

Once chronic heart failure has been diagnosed, the doctor will recommend a treatment plan for you. In most cases, this treatment plan includes lifestyle changes and medication. Medications are administered according to the type of heart failure you have, the underlying cause, and its severity. The combination of medications will be monitored and changed regularly depending on the needs and progression of your condition.

The doctor will also advise you to participate in a rehabilitation program to help you exercise safely and maintain a heart-healthy lifestyle. If necessary, they will offer to fit you with a device that allows your heart to beat properly. Heart transplantation is rarely needed in these cases.

Complications

Patients with chronic heart failure who do not receive therapy and treatment may experience a lower quality of life, significant weight loss, and kidney or liver problems. Other heart disease complications may occur, such as rhythm disturbances in the heart ventricles, end-stage coronary heart disease, or dilation of the heart ventricles, making it difficult for the heart to pump blood. Sudden cardiac death can also occur.

Prevention

The most effective way to prevent heart failure is to adopt a healthier lifestyle, which can be accomplished by taking the following steps:

• Quitting smoking and avoiding cigarette smoke from active smokers
• Maintain a healthy diet by avoiding foods that contain a lot of saturated fat, sugar, or salt
• Lose weight if you are obese or overweight
• Exercise regularly
• Do not consume alcohol
• Manage stress levels 
• In addition, if you have high blood pressure and diabetes, get regular medical check-ups and follow your doctor's advice

When to see a doctor?

Always monitor your health. Because chronic heart failure can worsen with time, you should be aware of the changes that occur in your body. If your symptoms worsen or you develop new complaints such as those listed above, see your doctor immediately and seek medical attention.

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