essay on congestive heart failure

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Congestive heart failure.

Ahmad Malik ; Daniel Brito ; Sarosh Vaqar ; Lovely Chhabra .

Affiliations

Last Update: November 5, 2023 .

• Continuing Education Activity

Congestive heart failure (CHF) is a complex clinical syndrome characterized by inefficient myocardial performance, resulting in compromised blood supply to the body. CHF results from any disorder that impairs ventricular filling or ejection of blood to the systemic circulation. Patients usually present with fatigue and dyspnea, reduced exercise tolerance, and systemic or pulmonary congestion. The etiology of HF is variable and extensive. A comprehensive assessment is required when evaluating a patient with HF. The general management aims at relieving systemic and pulmonary congestion and stabilization of hemodynamic status, regardless of the cause. This activity reviews the evaluation and management of congestive heart failure and highlights the role of the healthcare team in improving care for patients with this condition.

• Apply the staging and classification systems of heart failure.
• Assess and monitor patients with heart failure for signs of decompensation, fluid retention, and response to treatment.
• Select appropriate diagnostic tests, like echocardiography and biomarker assays, to aid in heart failure diagnosis and monitoring.
• Collaborate with multidisciplinary healthcare teams, including cardiologists, nurses, and pharmacists, to ensure coordinated and comprehensive care for heart failure patients.
• Introduction

Congestive heart failure (CHF), as defined by the American College of Cardiology (ACC) and the American Heart Association (AHA), is "a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood.” Ischemic heart disease is the leading cause of death worldwide and also the leading cause of CHF. CHF is a common disorder worldwide with a high morbidity and mortality rate. With an estimated prevalence of 26 million people worldwide, CHF contributes to increased healthcare costs, reduces functional capacity, and significantly affects quality of life. It is imperative to diagnose and effectively treat the disease to prevent recurrent hospitalizations, decrease morbidity and mortality, and enhance patient outcomes. [1]  

The etiology of heart failure (HF) is variable and extensive. The general management aims at relieving systemic and pulmonary congestion and stabilization of hemodynamic status, regardless of the cause. The treatment of HF requires a multifaceted approach involving patient education, optimal medication administration, and decreasing acute exacerbations. 

Left ventricle ejection fraction (LV EF) is used to classify HF. [1]

• HF with  reduced  ejection fraction (HFrEF): LV EF ≤ 40% 
• HF with  mildly reduced  ejection fraction: LV EF 41% - 49% and evidence of HF (elevated cardiac biomarkers or elevated filling pressures)
• HF with  preserved  ejection fraction (HFpEF): LV EF ≥ 50% and evidence of HF (elevated cardiac biomarkers or elevated filling pressures) 
• HF with  improved  ejection fraction: LV EF >40%, with previously documented LV EF ≤ 40%

Patients with HFpEF have traditionally been underdiagnosed but comprise between 44% and 72% of CHF cases. On echocardiogram (echo), LV EF ≥ 50% with evidence of impaired diastolic function. The most significant risk factor is hypertension (HTN), and other risk factors include older age, female sex, and diabetes. [2]

The ACC and the AHA together classify HF by stages, with the first 2 stages being asymptomatic and the second 2 being classified by severity of symptoms.

ACC/AHA Heart Failure Stages 

• Stage A: At risk for HF. No symptoms, structural heart disease, or evidence of elevated cardiac biomarkers, but risk factors are present. Risk factors include hypertension, diabetes, metabolic syndrome, cardiotoxic medications, or having a genetic variant for cardiomyopathy. 
• Stage B: Pre-HF. Patients have no signs or symptoms of HF but have structural heart disease, evidence of elevated filling pressures (by invasive or noninvasive assessment), or persistently elevated cardiomarkers in the absence of other reasons for elevated markers, like chronic kidney disease or myocarditis. 
• Stage C: Patients with structural heart disease and current or past history of HF symptoms. 
• Stage D: Patients with refractory symptoms that interfere with daily life or recurrent hospitalization despite targeted guideline-directed medical therapy.

The New York Heart Association Functional Classification is used for patients with symptoms of HF. This system is subjectively determined by clinicians and is widely used in clinical practice to direct therapy.

New York Heart Association Functional Classification

Based on symptoms, the patients can be classified using the New York Heart Association (NYHA) functional classification as follows: [3]

• Class I: Symptom onset with more than ordinary level of activity
• Class II: Symptom onset with an ordinary level of activity
• Class III: Symptom onset with minimal activity
• Class IIIa: No dyspnea at rest
• Class IIIb: Recent onset of dyspnea at rest
• Class IV: Symptoms at rest

There are many etiologies of CHF, and coronary artery disease (CAD) causing ischemic heart disease is the most common cause. Every attempt should be made to identify causative factors to help guide treatment strategies. The etiologies can be broadly classified as intrinsic heart disease and pathologies that are infiltrative, congenital, valvular, myocarditis-related, high-output failure, and secondary to systemic disease. [2] [4]  These classifications have significant overlap. The 4 most common etiologies responsible for about two-thirds of CHF cases are ischemic heart disease, chronic obstructive pulmonary disease (COPD), hypertensive heart disease, and rheumatic heart disease. Higher-income countries have higher rates of ischemic heart disease and COPD; lower-income countries have higher rates of hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and myocarditis.

Ischemic heart disease is by far the most common cause of CHF worldwide. Ischemia leads to a lack of blood flow to heart muscles, reducing the EF. Incidence is increasing in developing countries as they adopt a more Western diet and lifestyle, and improved medical care decreases the infectious burden in these countries (myocarditis is often infection-related.)

Valvular heart disease is another common intrinsic heart condition that can cause CHF. Rheumatic heart disease is the most common cause of valvular heart disease in children and young adults worldwide. It is caused by an immune response to group A Streptococcus and primarily causes mitral and aortic stenosis. [5]  The most common overall cause of valvular disease is age-related degeneration, and the aortic valve is the most commonly affected valve. Women are more likely to experience mitral valve rheumatic heart disease or mitral valve prolapse, while men are more likely to suffer from aortic valve diseases such as regurgitation or stenosis. Endocarditis is also more common in men. 

Hypertension causes CHF even in the absence of CAD or ischemic heart disease. High blood pressure causes mechanical stress by increased afterload and neurohormonal changes that increase ventricular mass. [2]  HTN is also strongly associated with other comorbidities for CHF development, and aggressively treating hypertension is shown to lower the incidence of CHF. [2]  

Cardiomyopathy is a heterogeneous group of diseases characterized by enlarged ventricles with impaired function not related to secondary causes such as ischemic heart disease, valvular heart disease, hypertension, or congenital heart disease. The most common types of cardiomyopathies are hypertrophic, dilated, restrictive, arrhythmogenic right ventricular, and left ventricular noncompaction. [6]  In addition to CHF, cardiomyopathy can present as arrhythmia or sudden cardiac death, further compelling the identification of underlying disorders. Many of these conditions have a genetic basis, and a detailed family history of sudden cardiac death, especially in first-degree relatives older than 35 years, should be taken. There are over 50 identified genes contributing to the development of dilated cardiomyopathy alone. Genetic determinants have variable phenotypic expression, and many nongenetic factors also affect the clinical symptoms. Some of these factors include diabetes, toxic exposure, or pregnancy. Fabry disease is a rare glycogen storage disease that can cause CHF symptoms through a hypertrophic cardiomyopathy pattern. [2] [6]  

Inflammatory cardiomyopathy is defined by myocarditis along with ventricular remodeling and cardiac dysfunction. The most common cause is viral infection. Other etiologies are bacterial, fungal, or protozoal infections; toxic substances or drugs; and immune-mediated diseases. Chagas disease is caused by Trypanosoma cruzi, which is endemic in Latin America   and commonly causes myocarditis, cardiomyopathy, and CHF. Other viral causes of myocarditis and inflammatory cardiomyopathy include adenoviruses, enteroviruses, herpes virus 6, Epstein-Barr virus, and cytomegalovirus. Viruses can also activate autoimmune myocarditis, including HIV, hepatitis C virus, influenzas A and B, and coronaviruses (including COVID-19). When associated with CHF, these conditions tend to have a poor prognosis. [7]

Infiltrative cardiomyopathies cause a restrictive cardiomyopathy pattern (simar to the genetically determined restrictive cardiomyopathy variant), which is notable for normal ventricular systolic function, but with diastolic dysfunction and restrictive filling dynamics of the LV and RV. This is often associated with a high E/A ratio showing increased early filling and delayed late filling. [6] [8]  

Cardiac amyloidosis results from misfolded protein deposits in the heart; this leads to cardiomyocyte separation, cellular toxicity, and tissue stiffness. Patients are preload dependent and are prone to symptomatic hypotension. Currently, tamifidis is the only medication known to prevent cardiac amyloidosis. It prevents, but does not reverse, amyloid deposition. Its high cost is also a limiting factor. [1] [9] [1]

Sarcoidosis is an acquired cardiomyopathy that presents with conduction defects and arrhythmias due to granuloma formation. The most common cardiac manifestation is CHF. Caution must be used when treating with beta-blockers due to the associated conduction abnormalities.

Cardiac hemochromatosis is present in 15% to 20% of patients with hereditary hemochromatosis. This condition initially presents with a restrictive pattern but develops into biventricular systolic dysfunction. [8]  Patients with restrictive cardiomyopathy physiology can develop hypotension when treated with traditional CHF medications due to preload dependence, so caution should be used to avoid systemic hypoperfusion. [10]  

Takotsubo or stress-induced cardiomyopathy (colloquially broken-heart syndrome) is an underrecognized cause of CHF, which causes transient left-ventricular wall abnormalities that are not localized to a specific vascular territory. It has several proposed pathophysiologic mechanisms, including coronary vasospasm, microcirculatory dysfunction, and increased activation of the sympathetic nervous system. This condition is treated with medications typical for CHF with the addition of antithrombotic medications in certain clinical situations with wall motion abnormalities. Recognized cases increased significantly during the COVID-19 epidemic. [11] [12] [13] [12]

Peripartum cardiomyopathy is a significant cause of maternal mortality. During pregnancy, cardiac output is increased by 20% to 30% due to increased heart rate and stroke volume. It presents with CHF due to LV systolic dysfunction during late pregnancy, postpartum, or up to several months after delivery. There is likely an underlying genetic component, and it is more common in women with advanced maternal age, Black race, and multifetal pregnancies. If wall motion abnormalities are present, anticoagulation is essential due to the hypercoagulable state caused by pregnancy. Recovery is variable by global region and inversely correlates with lowered EF. [14]

Obesity  is a leading cause of CHF in patients younger than 40 years, according to the "Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity" (the CHARM study). The "obesity paradox" described elsewhere has significant study flaws and is derived from older data. It is thought that up to 10% of CHF cases are attributable to obesity alone. Patients with obesity are more likely to have HFpEF, possibly secondary to adipose-produced cytokines such as IL-1b, IL-8, and TNFα. Adipose tissue also degrades natriuretic peptides. [15] [16] [17]

Tachycardia and arrhythmia can induce a low-output CHF state. There is usually dilation of all cardiac chambers, and there is preservation or thinning of biventricular wall thickness. Electrophysiologic changes, including prologued duration and decreased amplitude of action potentials in the myocytes, accompany this. All of these factors induce the typical neurohormonal response causing CHF. With rate control, these changes are often reversible due to myocardial hibernation. [18]

Thyrotoxicosis is a rare cause of HF despite initiating a hyperdynamic circulatory state. This may be partially due to activation of the renin-angiotensin-aldosterone axis, causing sodium and water retention, as well as upregulation of erythropoietin-stimulating agent, both of which will cause increased blood volume. Sustained tachycardia with or without atrial fibrillation can also cause CHF. [19]

High-output cardiac failure can be associated with thiamine deficiency, which is a rare condition found primarily among patients who are elderly, homeless, or have alcohol abuse disorder. Thiamine deficiency causes decreased ATP production with an accumulation of adenosine, which causes systemic vasodilation. This leads to lowered systemic vascular resistance and increased cardiac output. This evolves to weakened myocardium and decreased EF. Diuretic use can also cause urinary thiamine loss, further compounding the situation. [20] [21]  Other common causes of high-output cardiac failure are obesity, liver disease, and arteriovenous shunts. The causative physiologic changes are decreased afterload (ie, systemic vascular resistance) and increased metabolism. These can often present with preserved EF, pulmonary congestion, increased filling pressures, and elevated natriuretic peptides. [22] [23]

• Epidemiology

The global magnitude of the disease cannot be accurately assessed given the significant differences in geographical distribution, assessment methods, lack of imaging modalities, and non-adherence to the uniform staging and diagnosis of the disease. Approximately 1.2 million hospitalizations were due to CHF in 2017, with an increase in the percentage of patients with HFpEF compared to HFrEF. [1]  

By some reports, the incidence rate has plateaued; however, the prevalence increases as more patients receive therapy. This has not translated to improved quality of life or a decrease in the number of hospitalizations for patients with CHF. According to the Global Health Data Exchange registry, the current worldwide prevalence of CHF is 64.34 million cases. This translates to 9.91 million years lost due to disability (YLDs) and 346.17 billion US dollars in healthcare expenditure. [24]  

Age is a major determinant of HF. Regardless of the cause or the definition used to classify patients with HF, the prevalence of HF increases steeply with age. The Framingham Heart Study showed CHF prevalence to be 8 per 1000 males aged 50 to 59 years, with an increase to 66 per 1000 males aged 80 to 89. [25]  The incidence of HF in men doubles with each 10-year age increase after the age of 65, whereas in women, for the same age cohort, the incidence triples. Men have higher rates of heart disease and CHF than women worldwide. [26] [2]

The global registry also notes a predilection for a race with a 25% higher prevalence of HF in Black patients than in White patients. HF is still the primary cause of hospitalization in the elderly population and accounts for 8.5% of cardiovascular-related deaths in the United States. [26]

International statistics regarding the epidemiology of HF are similar. The incidence increases dramatically with age, metabolic risk factors, and a sedentary lifestyle. Ischemic cardiomyopathy and hypertension are significant causes of HF in developing countries. [27]  A notable difference based on a review of small cohort studies from these nations is a higher prevalence of isolated right HF. The theoretical cause of this is thought to be due to the higher prevalence of tuberculous, pericardial, and lung diseases. There is a lack of robust data to verify these claims.

• Pathophysiology

HF is a progressive disease. Any acute insult to cardiac structure or acute alteration secondary to genetic mutation, cardiac tissue infiltration, ischemia, valvular heart disease, myocarditis, or acute myocardial injury may initiate the compensatory mechanism, which, once exhausted, results in maladaptation. 

In the initial stages of CHF, several compensatory mechanisms attempt to maintain cardiac output and meet the systemic demands. The chronic activation of the sympathetic nervous system results in reduced beta-receptor responsiveness and adrenaline stores. This results in changes in myocyte regeneration, myocardial hypertrophy, and myocardial hypercontractility. [28]  The increased sympathetic drive also results in the activation of the renin-angiotensin-aldosterone system (RAAS) system, systemic vasoconstriction, and sodium retention. [28] [29]  

A decrease in cardiac output and increased sympathetic drive stimulate the RAAS, leading to increased salt and water retention, along with increased vasoconstriction. This further fuels the maladaptive mechanisms in the heart and causes progressive HF. In addition, the RAAS system releases angiotensin II, which has been shown to increase myocardial cellular hypertrophy and interstitial fibrosis, contributing to myocardial remodeling. [3]

A decrease in cardiac output stimulates the neuroendocrine system with a release of epinephrine, norepinephrine, endothelin-1 (ET-1), and vasopressin. These mediators cause vasoconstriction, leading to increased afterload. There is an increase in cyclic adenosine monophosphate (cAMP), which causes an increase in cytosolic calcium in the myocytes. This increases myocardial contractility and further prevents myocardial relaxation. Increased afterload and myocardial contractility with impaired myocardial relaxation increase myocardial oxygen demand. This paradoxical need for increased cardiac output to meet myocardial demand eventually leads to myocardial cell death and apoptosis. As apoptosis continues, a decrease in cardiac output with increased demand leads to a perpetuating cycle of increased neurohumoral stimulation and maladaptive hemodynamic and myocardial responses. [29]  The loss of myocytes decreases EF (cardiac contractility), which leads to incomplete LV emptying. Increased LV volume and pressure cause pulmonary congestion. [30]

Renal hypoperfusion causes the release of antidiuretic hormone (ADH), further potentiating sodium and water retention. Increased central venous and intraabdominal pressure causes reduced renal blood flow, further decreasing GFR. [31]

Decompensated CHF is characterized by peripheral vasoconstriction and increased preload delivery to the overburdened heart. The natriuretic peptides BNP and ANP are secreted but are ineffective in counteracting the excess sodium and water retention. [31]  

Neprilysin is an enzyme that breaks down several hormones, including BNP, ANP, and bradykinin; it targets several novel therapeutics. It is always used with an angiotensin receptor blocker because it increases angiotensin II levels, and when administered with an ACE inhibitor, it causes significant angioedema. [32] [33]

Causes of CHF are split about equally between HFrEF and HFpEF but require different treatment plans. In HFpEF, there is a decrease in myocardial relaxation and an increase in the stiffness of the ventricle due to an increase in ventricular afterload. This perpetuates a similar maladaptive hemodynamic compensation and leads to progressive HF. Patients with HFpEF tend to be older, female, and hypertensive. Atrial fibrillation and anemia are also more likely co-occurring conditions. There is some evidence that the prognosis is worse than those with HFrEF. It is possible that appropriate targets have not been identified for optimal therapeutic interventions. [34] [35]

• History and Physical

The diagnosis and classification of HF are primarily based on the presence and severity of symptoms and physical exam findings. It is imperative to obtain a detailed history of symptoms, underlying medical conditions, and functional capacity to treat the patient adequately.

Acute CHF presents primarily with signs of congestion and may also present with organ hypoperfusion or cardiogenic shock. [36]  The most commonly reported symptom is shortness of breath. This must be further classified as exertional, positional (orthopnea), and whether acute or chronic. Other commonly reported symptoms of CHF include chest pain, anorexia, and exertional fatigue. Anorexia is due to hepatic congestion, bowel edema, and reduced blood flow to splanchnic circulation. Some patients may present with a recumbent cough due to orthopnea. Patients may also experience abdominal discomfort due to hepatic congestion or ascites. Patients with arrhythmias can present with palpitations, presyncope, or syncope. 

Another symptom that increases morbidity is edema, especially of the lower extremities. This can limit mobility and balance; total body water and weight increases of > 20 lbs are not uncommon. 

While patients with acute HF present with overt respiratory distress, orthopnea, and paroxysmal nocturnal dyspnea, patients with chronic heart failure tend to curtail their physical activity; hence, symptoms may be obscured. It is essential to identify triggers of acute decompensation such as recent infection, noncompliance with cardiac medications, use of NSAIDs, or increased salt intake.

Physical Examination

The examination findings vary with the stage and acuity of the disease. Patients may have isolated symptoms of left-sided HF, right-sided HF, or combined.

General physical examination: The general appearance of patients with severe CHF or those with acutely decompensated HF includes anxiety, diaphoresis, tachycardia, and tachypnea. Patients with chronic decompensated HF can appear cachexic. On chest examination, the classical finding of pulmonary rales translates to heart failure of moderate-to-severe intensity. Wheezing may be present in acute decompensated heart failure. As the severity of pulmonary congestion increases, frothy and blood-tinged sputum may be seen. It is important to note that the absence of rales does not exclude pulmonary congestion. Jugular venous distention is another classical finding that must be assessed in all patients with HF. In patients with elevated left-sided filling pressures, hepatojugular reflux (sustained increase in JVP of >4 cm after applying pressure over the liver with the patient lying at a 45° angle) is often seen.

Patients with Stage D HF may show signs of poor perfusion, such as hypotension, reduced capillary refill, cold extremities, poor mentation, and reduced urine output. There may be pulsus alternans (an alternating weak and strong pulse), suggestive of severe ventricular dysfunction. The pulse can be irregular in the presence of atrial fibrillation or ectopic beats. Some degree of peripheral edema is present with most HF. [37]  Weight gain is another method for assessing volume retention, and precise daily weights can be a useful monitoring tool. 

Precordial findings in patients with HF include an S3 gallop, or displaced apex beat (dilated heart). There may be murmurs of associated valvular lesions such as the pansystolic murmur of mitral regurgitation or tricuspid regurgitation, systolic ejection murmur of aortic stenosis, or early diastolic murmur of aortic regurgitation. Patients with pulmonary hypertension may have palpable or loud P2 or parasternal heave. Patients with congenital heart disease may also have associated clubbing, cyanosis, and splitting of the second heart sound.  

An S3 gallop is the most significant and early finding associated with HF. [38]  Patients with hypertensive heart disease may have an S4 or loud A2. Patients with HF with preserved EF may have an S4 gallop related to ventricular noncompliance.

The commonly used Framingham Diagnostic Criteria for Heart Failure require the presence of 2 major criteria or 1 major and 2 minor criteria to make the diagnosis. This clinical diagnostic tool is highly sensitive for the diagnosis of HF but has a relatively low specificity. The Framingham Diagnostic criteria are as follows: [37]

Major Criteria

• Acute pulmonary edema
• Cardiomegaly
• Hepatojugular reflex
• Neck vein distention
• Paroxysmal nocturnal dyspnea or orthopnea
• Pulmonary rales
• Third heart sound (S3 Gallop)

Minor Criteria

• Ankle edema
• Dyspnea on exertion
• Hepatomegaly
• Nocturnal cough
• Pleural effusion
• Tachycardia (heart rate greater than 120 beats per minute)

A comprehensive assessment is required when evaluating a patient with HF. This includes a complete blood picture, iron profile, renal profile, and liver profile. After the basic metabolic and blood panel, patients require further investigations, depending on the etiology and clinical stage. [1]

A CBC  may suggest anemia or leukocytosis suggestive of an infection triggering CHF. 

A  complete renal profile  is necessary for all patients with HF. It indicates the degree of renal injury associated with HF and guides medication choice. It is essential to know baseline renal function before the patient is started on medications, including renin-angiotensin-aldosterone (RAAS) inhibitors, sodium-glucose transporter-2 (SGLT-2) inhibitors, or diuretics. Serum sodium level has prognostic value as a predictor of mortality in patients with chronic HF. "The Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure" (OPTIME-CHF) trial demonstrated a significantly increased risk of in-hospital mortality as well as 30-day mortality in patients with HF who presented with hyponatremia. [39]

A  liver profile is usually performed. Hepatic congestion secondary to HF may result in elevated gamma-glutamyl transferase levels, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). [40]

Urine studies can be useful in diagnosis. If amyloidosis is suspected, urine and serum electrophoresis and monoclonal light chain assays should be performed. If clinical suspicion is high despite negative testing for light chains, bone scintigraphy can be performed. [1]  

Serum B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-ProBNP) levels  can aid in differentiating cardiac from noncardiac causes of dyspnea in patients with ambiguous presentations. BNP is an independent predictor of increased left ventricular end-diastolic pressure, and it is used for assessing mortality risk in patients with HF. BNP levels correlate with NYHA classification, and the utility is primarily used as a marker to assess treatment efficacy. NT-ProBNP is the chemically inert N-terminal fragment of BNP and has a longer half-life. The ratio of NT-ProBNP/BNP varies depending on underlying comorbidities and may be a useful tool in the future. [41] In patients with a clear clinical presentation of HF, natriuretic peptides should not be used to drive treatment plans. It is important to remember that BNP and NT-ProBNP levels can be elevated in patients with renal dysfunction, atrial fibrillation, and older patients. Conversely, BNP levels can be falsely low in patients with obesity, hypothyroidism, and advanced HF (due to myocardial fibrosis).

Troponin-I or T suggests ongoing myocardial injury when persistently elevated and predicts adverse outcomes and mortality. 

An electrocardiogram  may show evidence of prior infarction, chamber enlargement, intraventricular conduction delay, or arrhythmia. It may also give clues to specific etiologies. A low voltage and pseudo infarction pattern of ECG is seen in cardiac amyloidosis. An epsilon wave is seen in ARVC. ECG also suggests the presence of ventricular desynchrony, with a QRS duration of more than 120 msec, predicting the patient's response to device therapy for HF. 

Chest radiographs are used to assess the degree of pulmonary congestion and cardiac contour (to determine the presence of cardiomegaly). Findings indicative of CHF on chest radiographs include enlarged cardiac silhouette, edema at the lung bases, and vascular congestion. In florid HF, Kerley B lines may be seen on chest radiographs. The absence of these findings in patients with a suggestive clinical presentation does not rule out CHF. [37]

Echocardiography  is the initial choice of modality in patients with suspected HF and is an easily available bedside tool. Echocardiography quantifies right and left ventricular function, denotes structural abnormalities in cardiac chambers and valves, and helps visualize the presence of focal wall motion abnormalities. However, in patients with severe obesity, pregnancy, or mechanical ventilation, it may be challenging to obtain adequate acoustic windows. Transesophageal echocardiography (TEE) is an alternative for these patients. Adequate rate control in patients with tachyarrhythmias is necessary to obtain adequate echocardiographic images. [37]

Cardiac catheterization  is often required for diagnosing ischemic cardiomyopathy and can be useful for accurately evaluating intracardiac pressures such as left ventricular end-diastolic pressure or pulmonary artery pressures.

Computed tomography  may be used for the assessment of coronary artery disease in a young patient with ventricular dysfunction (older patients are likely to have baseline calcifications). It may also be used in patients with congenital heart diseases causing HF. Cardiac CT may help with the detection of tumors causing HF. CT may also be used for the evaluation of stent patency and graft evaluation. 

SPECT-Myocardial Perfusion Imaging helps define the presence of ischemia in patients with newly diagnosed left ventricular dysfunction and not undergoing coronary angiography. It is particularly useful for assessing CAD in patients with no history of ischemia but elevated troponin. ECG-gated myocardial perfusion imaging is used to evaluate LV EF, regional wall motion, and regional wall thickening. EF measurement with this study may be affected in patients with an irregular heart rate, low count density, and extracardiac radiotracer uptake. ECG-gated images are also useful in recognizing artifactual defects seen on SPECT imaging, such as breast tissue and diaphragmatic attenuation. [42]

Cardiac magnetic resonance imaging has evolved as an essential tool when a discrepancy exists between the clinical stage of the disease and echocardiographic findings. It helps with the precise evaluation of volume, chamber sizes, and ventricular function. It also assesses the stage of valvular heart disease in detail. Cardiac MRI also helps with the evaluation of complex congenital heart diseases. The tool can also be used for noninvasive assessment of conditions such as myocarditis, dilated cardiomyopathy, infiltrative cardiomyopathy, or arrhythmogenic right ventricular dysplasia. [43]

Radionuclide multiple-gated acquisition (MUGA) scan is a reliable imaging technique for evaluating EF and is used in patients when there is a disparity of EF measurements from other studies. [42]

Noninvasive stress imaging includes stress echocardiography, stress cardiac MRI, and SPECT imaging. These studies can be used to assess the benefit of coronary revascularization in patients with ischemic cardiomyopathy. 

Genetic testing is indicated for identifying genetic variants causing cardiomyopathies, such as Titin, laminin A or C, myosin heavy chain, and cardiac troponin-T mutations. [44]

• Treatment / Management

The goal of therapy for chronic CHF is to improve symptoms and quality of life, decrease hospitalizations, and improve cardiac mortality. The goal of pharmacologic therapy is to control symptoms and to initiate and escalate drugs that reduce mortality and morbidity in HF. [1]

Management for the respective stages of HF is outlined by the American College of Cardiology and the American Heart Association. [1]

For Stage A (At-Risk for HF)  

• In patients with hypertension, guideline-directed medical therapy (GDMT) should be used for the management of hypertension.
• In patients with type 2 diabetes, SGLT-2 inhibitors are indicated to reduce HF hospitalizations. 
• Lifestyle modifications such as healthy eating, physical activity, maintaining a normal weight, and avoidance of smoking are indicated.
• The use of prognostication scores is recommended in patients with HF to estimate the risk of future HF events. [45]  Examples include the Framingham Heart Failure Risk Score (1999), Health ABC Heart Failure Score (2008), ARIC Risk Score (2012), and PCP-HF score (2019). 
• There should be optimal management of cardiovascular diseases in patients known to have coronary artery disease.
• Patients at risk for HF due to exposure to cardiotoxic medications (eg, chemotherapy) should be managed with a multidisciplinary approach.
• Natriuretic peptide screening and periodic evaluation are recommended. 

For Stage B (Pre-HF)

Management of Stage B is focused on preventing clinical HF and reducing mortality and adverse cardiovascular events.

• For patients with LV EF ≤40%, ACEi should be used to prevent clinical HF and for mortality reduction. 
• For patients with LV EF ≤ 40% and evidence of prior or recent acute coronary syndrome or myocardial infarction, the use of a statin and beta-blocker is recommended for reduction of mortality, CHF, and reducing adverse cardiovascular events. 
• For patients with LV EF ≤ 30% and receiving optimal medical therapy, with NYHA-class I and an expectation of meaningful survival of more than 1 year, a primary prevention ICD is recommended.  
• Beta-blockers are recommended for patients with LV EF ≤ 40%, irrespective of the etiology, to prevent symptomatic HF.
• For patients with LV EF ≤ 50%, the use of thiazolidinediones and non-dihydropyridine calcium channel blockers increases the risk of adverse outcomes and HF hospitalizations, so should be avoided. 
• Valve repair, replacement, or interventions have associated guidelines for asymptomatic valvular heart disease. 
• Patients with congenital heart disease also have associated guidelines.

For Stage C (HF)

• Multidisciplinary management is indicated for improving self-care and mortality of patients with HF.
• Patient education and social support are required for optimal management.
• Vaccination against respiratory illnesses is effective in reducing mortality. 
• It is reasonable to screen patients for frailty, depression, low literacy, low social support, and resource and transport logistics during healthcare encounters.
• A low-sodium diet is recommended.
• Exercise training is effective in improving functional class and quality of life.
• For patients with congestion, diuretics improve symptoms and reduce HF progression.
• A thiazide diuretic (such as metolazone) should be added only to patients who do not respond well to a moderate or high dose of loop diuretics.
• For patients with HFrEF, an ARNi is recommended to reduce mortality and morbidity. ARNi should not be given to patients who are intolerant of ACEi, and an ARB should be substituted. For patients not able to take an ARNi due to economic factors, the use of an ACEi or ARB is indicated. ARNi should not be used within 36 hours of the last dose of ACEi. For patients tolerating ACEi/ARB well, switching to ARNi is recommended, with a high economic value. As with ACEi, ARNi should not be given to patients with a history of angioedema. 
• For patients with HFrEF, the use of the beta-blockers carvedilol, bisoprolol, or sustained-release metoprolol is effective in reducing mortality and hospitalization.
• For patients with HFrEF, NYHA class II-IV, an eGFR of more than 30 mL/min/1.73 m2 and a serum potassium of less than 5.0 mEq/L, the use of MRA is recommended. For patients with a serum potassium of more than 5.0 mEq/L, the use of MRA is harmful. 
• For patients with HFrEF, the use of SGLT-2 inhibitors is recommended to reduce mortality and HF hospitalization, irrespective of the diabetes status. 
• For African American patients with HFrEF and NYHA class III-IV, who are already receiving optimal medical therapy (OMT), the addition of a combination of hydralazine and nitrate is recommended to reduce morbidity and mortality. This is of high economic value. 
• For patients with HFrEF and intolerant to RAASi or in whom RAASi is contraindicated due to renal insufficiency, the use of a combination of hydralazine and nitrate might be effective. 
• It is recommended to titrate medications aggressively to achieve desired outcomes. This can be done as frequently as 1-2 weeks as tolerated. 
• Ivabradine can be useful in patients on OMT with and heart rate of more than 70 bpm, providing mortality benefits, and reducing HF hospitalization. 
• Digoxin may be considered in symptomatic patients with sinus rhythm despite adequate goal-directed therapy to reduce the all-cause rate of hospitalizations, but its role is limited.
• In patients with HFrEF and recent HF, an oral soluble guanylate cyclase stimulator (Vericiguat) might be useful in reducing mortality and HF hospitalization. Vericiguat is a soluble guanylate cyclase stimulator that stimulates the intracellular receptor for endogenous NO, which is a potent vasodilator. It also improves cardiac contractility. [46] [47]
• An implantable cardioverter-defibrillator (ICD) is indicated for primary prevention of sudden cardiac death in patients with HF who have an LVEF of less than or equal to 35% and an NYHA functional class of II to III while on goal-directed medical therapy. It is also indicated if a patient has NYHA functional class I and an EF of less than or equal to 30% on adequate medical therapy.
• Cardiac resynchronization therapy (CRT) with biventricular pacing is recommended in patients with HFrEF and an NYHA functional class of II to III or ambulatory class IV with an LVEF less than or equal to 35%, QRS duration ≥ 150 msec, and sinus rhythm with left bundle branch block (LBBB) morphology. It can also be considered in non-LBBB morphology and QRS ≥ 150 msec.
• Revascularization is indicated in selected patients with coronary artery disease and HFrEF while on GDMT.
• Valvular heart disease interventions such as transcatheter edge-to-edge mitral valve repair or mitral valve surgery might be beneficial for patients with HF and on GDMT.   

For Stage D (Advanced HF)

• Referral to an HF specialist is indicated.
• It is reasonable to utilize inotropic support and device therapy in patients awaiting mechanical cardiac support or transplant. Inotropic support alone can be used in patients not eligible for a transplant or mechanical cardiac support. 
• Mechanical cardiac support such as a durable left ventricle assist device (LVAD) or ECMO can be beneficial as a bridge to transplant.  
• For highly selected patients, cardiac transplant is indicated to improve survival and quality of life.
• Goals of care should be decided by shared decision-making. This includes considering comorbid conditions, frailty, and socio-economic support. Palliative care should be offered as indicated after shared decision-making. 
• Differential Diagnosis

Diseases that may present with clinical features of volume overload or dyspnea are in the differential for HF. These include acute renal failure, acute respiratory distress syndrome, cirrhosis, pulmonary fibrosis, nephrotic syndrome, and pulmonary embolism.

According to the Centers for Disease Control and Prevention (CDC), in December 2015, the rate of HF-related deaths decreased from 103.1 deaths per 100,000 population in 2000 to 89.5 in 2009 but subsequently increased to 96.9 in 2014. The report noted that the trend correlates with a shift from coronary heart disease as the underlying cause of HF deaths to metabolic diseases and other noncardiac causes of HF, such as obesity, diabetes, malignancies, chronic pulmonary diseases, and renal disease. The mortality rate following hospitalization for HF is estimated at around 10% at 30 days, 22% at 1 year, and 42% at 5 years. This can increase to greater than 50% for patients with stage D HF. [48]

The Ottawa Heart Failure Risk Score is a useful tool for determining prognosis in patients presenting to the emergency department with HF.  [49]  This score is used to determine the 14-day mortality risk, hospital readmission, and acute coronary syndrome to help arrive at safe disposition planning. Patients with a score of 0 are considered low risk. A score of 1 to 2 is considered moderate risk, a score of 3-4 is considered high risk, and a score of 5 or higher is considered very high risk. The scoring criteria are as follows:

One point for each of the following:

• History of stroke or transient ischemic attack
• Oxygen saturation less than 90%
• Heart rate greater than 110 bpm on the 3-minute walk test
• Acute ischemic ECG changes 
• An NT-ProBNP level of greater than 5000 ng/L

Two points for each of the following: 

• Prior history of mechanical ventilation for respiratory distress
• Heart rate greater than 110 bpm on presentation
• Blood urea nitrogen (BUN) greater than 33.6 mg/dL (12 mmol/L)
• Serum bicarbonate greater level than 35 mg/d
• Complications

Complications of CHF include:

• Reduced quality of life
• Arrhythmia and sudden cardiac death
• Cardiac cachexia
• Cardiorenal disease
• Liver dysfunction
• Functional valvular insufficiencies (such as functional MR or TR)
• Mural thrombi and risk of thromboembolism (brain, kidney, lung, major limb vessels)
• Recurrent hospitalizations and nosocomial infection
• Consultations

The consultation type depends on the disease stage and the intended management strategy. Commonly consulted specialists include HF specialists, the cardiac transplant team for stage D CHF, cardiam imaging radiologists, cardiac rehabilitation, dieticians, and, if aligned with patient preference, palliative care (also for class D).

• Deterrence and Patient Education

Risk factor reduction and aggressive management of comorbid conditions are crucial to reducing morbidity and mortality associated with HF. In addition to compliance with medications, patients need guidance on self-monitoring of symptoms of HF and avoiding the triggers of HF. These strategies can help prevent the development of HF in patients at high risk for the disease and slow the progression in those who are already diagnosed with it. Patient education is necessary to facilitate self-care and compliance. Close supervision, including surveillance by the patient and family, home-based visits, telephone support, and remote monitoring, is recommended. Socio-economic support is pivotal in the appropriate management of the disease. [1] Patients require close clinical follow-up for assessing volume status, effects of drug therapy, and escalation of care as indicated. 

• Enhancing Healthcare Team Outcomes

HF is a complex clinical syndrome with high morbidity and mortality. HF requires a multifaceted treatment approach, including patient education, pharmacologic management, and surgical interventions to optimize clinical outcomes. Specialty-trained HF nurses are an essential component of the multidisciplinary team in educating patients on the importance of lifestyle modifications and medical compliance to help improve morbidity and mortality. Educating patients on symptom assessment and weight management is essential to prevent HF exacerbations and hospital admissions. The HF-trained social worker and case manager can help evaluate the patient in community settings or in-home visits to help the patient adhere to the lifestyle modifications. Clinical pharmacists assist medical providers by reviewing patient medication lists and decreasing potential adverse drug-drug interactions. Primary care medical providers and cardiologists must coordinate care to minimize any adverse outcomes of medical therapy and prevent the progression of this disease. A collaborative interprofessional team can significantly improve the quality of life for patients with HF and decrease mortality.

• Review Questions
• Access free multiple choice questions on this topic.
• Comment on this article.

congestive heart failure Image courtesy S Bhimji MD

Disclosure: Ahmad Malik declares no relevant financial relationships with ineligible companies.

Disclosure: Daniel Brito declares no relevant financial relationships with ineligible companies.

Disclosure: Sarosh Vaqar declares no relevant financial relationships with ineligible companies.

Disclosure: Lovely Chhabra declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Malik A, Brito D, Vaqar S, et al. Congestive Heart Failure. [Updated 2023 Nov 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

In this Page

Bulk download.

• Bulk download StatPearls data from FTP

Related information

• PMC PubMed Central citations
• PubMed Links to PubMed

Similar articles in PubMed

• Heart Failure With Preserved Ejection Fraction (HFpEF). [StatPearls. 2024] Heart Failure With Preserved Ejection Fraction (HFpEF). Golla MSG, Shams P. StatPearls. 2024 Jan
• Biventricular pacing (cardiac resynchronization therapy): an evidence-based analysis. [Ont Health Technol Assess Ser....] Biventricular pacing (cardiac resynchronization therapy): an evidence-based analysis. Medical Advisory Secretariat. Ont Health Technol Assess Ser. 2005; 5(13):1-60. Epub 2005 Sep 1.
• Enhanced External Counterpulsation (EECP): An Evidence-Based Analysis. [Ont Health Technol Assess Ser....] Enhanced External Counterpulsation (EECP): An Evidence-Based Analysis. Medical Advisory Secretariat. Ont Health Technol Assess Ser. 2006; 6(5):1-70. Epub 2006 Mar 1.
• Review Combination Use of Ivabradine with Sacubitril/Valsartan: A Review of Clinical Effectiveness and Guidelines [ 2020] Review Combination Use of Ivabradine with Sacubitril/Valsartan: A Review of Clinical Effectiveness and Guidelines Pohar R, MacDougall D. 2020 Feb 13
• Review Heart Failure With Preserved Ejection Fraction: A Review. [JAMA. 2023] Review Heart Failure With Preserved Ejection Fraction: A Review. Redfield MM, Borlaug BA. JAMA. 2023 Mar 14; 329(10):827-838.

Recent Activity

• Congestive Heart Failure - StatPearls Congestive Heart Failure - StatPearls

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

83 Heart Failure Essay Topics

🏆 best essay topics on heart failure, ✍️ heart failure essay topics for college, 👍 good heart failure research topics & essay examples, 🌶️ hot heart failure ideas to write about.

• Pathophysiology of Heart Failure
• Congestive Heart Failure and Orem’s Theory
• Congestive Heart Failure: Nursing Diagnosis & Care Plan
• The Heart Failure Patients: Health Belief Model
• Program Evaluation and Measurement Tools for Heart Failure Patients Attending Cardiac Rehab
• Congestive Heart Failure and Nursing Care
• Reducing Congestive Heart Failure Readmission Rates
• Congestive Heart Failure: Patient Education Plan Congestive heart failure represents a serious economic burden for patients. It may adversely affect the quality of life and become a source of distress for the patient’s relatives.
• Congestive Heart Failure Congestive heart failure occurs when the heart is unable to perform its functions properly and, therefore, muscles and organs cannot be supplied with enough blood.
• Congestive Heart Failure and Patient Readmission This paper proposes research on the nature of congestive heart failure and why affected persons tend to be readmitted in their respective hospitals.
• Chronic Heart Failure, Care and Teaching Plan This paper examines the case study of a 76-year-old patient with CHF and cardiomyopathy and proposes an approach to care, treatment plan, and education plan.
• Congestive Heart Failure Project Proposal Educational intervention for congestive heart failure patients before air travel will decrease the probability of cardiac complications during or after the flight.
• Teach-Back Method for Heart Failure Patients The project focuses on how readmission of heart failure patients can be eliminated in hospitals within the United States through the teach-back method.
• Nursing: Safety for a Heart Failure Patient This case study about patient safety presents clinical indicators, team interactions, and safety concepts for a heart failure patient.
• Congestive Heart Failure Discussion Chronic heart failure is a pathological condition in which the heart fails to supply the organs and tissues with the necessary amount of blood.
• Aspects of Congestive Heart Failure Congestive heart failure is a severe abnormality. It is characterized by the inability of the heart muscles to pump the right amount of blood.
• Heart Failure as Dangerous Heart Disease Heart failure is a syndrome arising from the deterioration of the heart’s pumping function, resulting in its inability to provide a regular blood supply to the entire body.
• Change Proposal Evaluation Plan to Congestive Heart Failure Patients This proposal to educate and provide tools to Congestive heart failure patients to avoid an exacerbation is when their travel.
• Congestive Heart Failure Patients Who Travel The paper analyzes that in patients with congestive heart failure who travel frequently, education about managing their condition reduces the incidence rate of exacerbations.
• Traveling With Congestive Heart Failure Disease Patients who suffer from congestive heart failure (CHF) have several recommendations regarding traveling and transportation.
• Medical Intervention in Acute Heart Failure and COPD The essay evaluates the health condition related to the quality medical intervention in acute decompensated heart failure and chronic obstructive pulmonary disease.
• Teaching Plan Proposal on Heart Failure This paper will seek to write a teaching plan proposal on heart failure and the education that nursing provides to the patients admitted to the hospital.
• Heart Failure Etiology and Related Medical Terms Heart failure is a chronic and complex disease characterized by inadequate pumping of blood by the heart. It is a common condition, affecting over 20 million people globally.
• Decreasing Congestive Heart Failure Readmission Congestive heart failure (CHF) is a common condition diagnosed in elderly patients (65 years and older) after discharge that often leads to readmission.
• Heart Failure, Its Causes and Risk Factors The development of heart failure is defined by blood not being pumped as actively as it should, causing the heart to malfunction.
• Crataegus Oxycantha’s Impact on Heart Failure This article evaluates how WSS 1442 extract from C. oxyacantha works in patients who have mild to moderate symptoms of heart failure.
• Congestive Heart Failure Patients’ Length of Stay This essay shall focus on a quality improvement plan that addresses the length of stay for congestive heart failure patients (CHF).
• A Home-Based Nurse-Coached Inspiration Muscle Training Intervention in Heart Failure The paper aims to review and analyze the article “Home Based Nurse-Coached Inspiration Muscle Training Intervention In Heart Failure” by Padula et al.
• Nurse-Coached Muscle Training in Heart Failure Written in 2009 by Padula & Yeaw, the article looks into a homemade nurse-coached inspiratory muscle training mitigation in heart failure, and it forms the basis of this review.
• Feedback: Heart Failure Project The Project’s main objective is to decrease 30-day readmissions of heart failure patients at Odessa Regional Medical Center (ORMC) in Odessa Texas.
• In-Home Monitoring for Congestive Heart Failure and Rehospitalization Heart failure constitutes a significant healthcare burden, which includes mortality, hospitalizations, and associated costs.
• Diagnosis and Clinical Management Strategies of Congestive Heart Failure Congestive heart failure is a disease, which appeared to be the most frequently met among other heart diseases, and all professionals search for strategies of problem decision.
• Chronic Bronchitis, Heart Failure, Hypertension, and Diabetes Mellitus This paper discusses the symptoms and causes of such diseases as chronic bronchitis, heart failure, hypertension, and diabetes mellitus.
• Congestive Heart Failure Patients and Reducing the Readmission Rates This paper includes two discussions in medicine: Congestive Heart Failure Patients and Reducing the Readmission Rates and Childhood Obesity.
• The Causes of Congestive Heart Failure A literature review is a description of a publication on a certain subject. In the selection of the topic of study by the researchers, there are some procedures.
• Diuretics to Treat Congestive Heart Failure This essay discusses diuretics and drugs that increase cardiac muscle strength and are the main drug treatment for congestive heart failure.
• Home Visit to a Patient with Congestive Heart Failure This case study is a home visit to an 82-year-old female patient, who lives alone and was recently discharged from the hospital for exacerbation of her congestive heart failure.
• Chronic Heart Failure Management: Design Phase Ziaeian and Fonarow report that medical therapies that are found to be beneficial for CHF outcomes and readmission rates are critically underutilized in patients.
• Heart Failure: Nursing Research in Design Phase It is worth noting that congestive heart failure is a pathology in which a patient experiences a violation in the circulation of oxygen.
• Ethical Challenges in Advanced Heart Failure Heart failure is a serious health condition that requires researchers that study the problem to be aware of potential ethical issues.
• Heart Failure: Preventing Readmissions and Repeated Hospitalizations Early hospital readmissions occurring within a 30-day post-discharge period are of the greatest interest for researchers.
• Heart Failure Readmissions: Nursing Study Design The paper is devoted to the literature review revolving around the issue of the readmission of patients with heart failure along with the description of the methodology.
• Heart Failure Education: Implementation Phase The proposed intervention would require between 3 to 5 nurses. Their responsibilities would include providing patients with educational means of managing CHF.
• Preventing Diabetes and Heart Failure Hospitalizations The goal of this research is to acquire data regarding the opinion given by patients suffering from diabetes mellitus (DM) and heart failure (HF).
• American Association of Heart Failure Nurses Nursing associations may play a considerable role in the professional development of a nurse by providing education and creating information-sharing networks.
• “The Future as a Series of Transitions: Qualitative Study of Heart Failure Patients and Their Informal Caregivers” the Article by Jones, J., Nowels, C. T., Sudore, R., Ahluwalia, S., & Bekelman, D. B. The purpose of this study was to conduct a qualitative research on patients with heart failure and their informal caregivers.
• Heart Failure Readmissions: Nursing Study Planning The number of hospitalizations of patients with heart failure is an urgent problem in the modern healthcare sector.
• Heart Failure Education: Project Implementation Education of patients on the risks associated with congestive heart failure is expected to be multi-dimensional since different patients have various needs.
• Congestive Heart Failure: Planning a Research The study determines which educational methods are the most effective in the context of helping older patients with congestive heart failure faced with frequent readmissions.
• Readmissions With Heart Failure: Study Results The regression analysis revealed a correlation between the intensity of programs and people’s rate of readmission with congestive heart failure.
• Life with Heart Failure: Research Methodology Patients with heart failure “are often elderly and their primary chronic symptom is severe exercise intolerance that results in a reduced quality of life”.
• Congestive Heart Failure: Research Methodology Patients with comorbidities that are risk factors for repeated occurrences of CHF complications are significantly valuable for qualitative analysis in this research.
• Congestive Heart Failure Readmission: Study Design Readmission of congestive heart failure patients is a major problem in the United States because it exerts pressure on medical practitioners in the country.
• Congestive Heart Failure and Self-Care Theory Self-care aims to redirect the decision-making process towards maintenance and management of congestive heart failure reducing instances of adverse events and readmission.
• Congestive Heart Failure Studies: Data Analysis The proposed research is meant to reveal the relationship between nursing care in the form of providing education for patients and admission rates.
• Congestive Heart Failure Research Planning There is a need to conduct research and determine potential ways to improve current approaches and practices in the field of congestive heart failure.
• Heart Failure, Asthma, and Wheezing Treatment The patient is diagnosed with asthma, and she receives the required treatment. However, the symptoms remain because she takes other medicines.
• Heart Failure Rehospitalization and Nursing Care One of the emerging issues in health care is the prevention of unnecessary re-hospitalization of patients diagnosed with certain conditions such as heart failure.
• Hospital Readmissions Reduction in Heart Failure The authors used no specific measurement instruments such as surveys, but compared the readmission rates for the experimental and the control groups.
• Preventing Hospital Readmissions for Congestive Heart Failure There is a perception that home-visiting programs and multidisciplinary heart failure (MDC-HF) clinic interventions can reduce readmission rates.
• Heart Failure Patients and Telephone Intervention Patients diagnosed with heart failure or HF experience a significant reduction in their quality of life experience. The disease takes a tremendous toll on their financial resources.
• Congestive Heart Failure in Elderly Congestive heart failure (CHF) in elderly is a complex health problem that arises due to structural or functional cardiac disorder.
• Congestive Heart Failure Patient Readmission Rates The problem of congestive heart failure is increasingly found not only in elderly patients but also among young people.
• Heart Failure Patients and Telenursing Intervention Telenursing becomes a popular method of evidence-based care that helps patients to manage health conditions without having to drive long distances to the hospital.
• Congestive Heart Failure and Reducing Readmission Rates This paper discusses to reduce congestive heart failure readmission rate in adult patients 30 days after discharge, mainly through patient education.
• Congestive Heart Failure Patients’ Treatment Options Treatment options for patients with congestive heart failure are primarily determined by the professional skills of health workers and by the desire of sufferers.
• Readmission Rates: Heart Failure This study is concerned with the rate of readmissions for patients with congestive heart failure, which happens within 30 days after one’s discharge from the hospital.
• Nurses-Led Telephone Intervention in Heart Failure The article under analysis is “Impact of a nurses-led telephone Intervention program on the quality of life in patients with heart failure in a district hospital of Greece.”
• Heart Failure Causes and Readmission Factors The paper aims to discover the main causes of heart failure and factors that have a direct impact on readmission rates of the patients with this medical condition.
• Congestive Heart Failure and Evidence-Based Therapies Congestive heart failure, also known as CHF, is increasingly becoming a major health problem in the United States.
• Heart Failure Patients and Phone Intervention The purpose of the following paper is to analyze if the method of telephone intervention is effective in increasing CHF patients’ life quality.
• Heart Failure Study and Human Rights Protection The present paper discusses ethical considerations and plans in the protection of human rights during the study on congestive heart failure (CHF) patients post-discharge.
• Heart Failure and Cardiovascular Disorders: Learning Plan Heart failure problems, associated with cardiovascular disorders, appear to be the issues of general concern and discussion among clinicians and patients on a global scale.
• “Impact of a Nurses-Led Telephone Intervention Program on the Quality of Life in Patients With Heart Failure in a District Hospital of Greece”: Article Critique The purpose of the given paper is to identify strengths and weaknesses of the article to understand its implications to nursing practice.
• Chronic Bronchitis, Heart Failure, Hypertension Chronic bronchitis (CB) is one of the usual occurrences during chronic obstructive pulmonary disease (COPD). It presents divergent clinical complications.
• Heart Failure Readmission: Evidence-Based Project The aim of this paper is to outline an evidence-based project proposal for the reduction of heart failure rehospitalization rates.
• Heart Failure Patients’ Education and Readmission This paper focuses on the provision of educational services to congestive heart failure patients and its effects on this population’s readmission rates.
• Heart Failure Readmission and Preventive Measures This paper provides a review of the literature on strategies used to reduce readmission rates among patients with congestive heart failure.
• Congestive Heart Failure Education and Readmission Rates The problem of educational deficit in relation to congestive heart failure (CHF) in elderly patients can be observed in an acute care setting.
• Congestive Heart Failure and Nutrition Issues There are four essential problems in the presented medical case. They include the patient’s CHF, retention of fluid, nutrition issues, and loneliness.
• Congestive Heart Failure Education and Follow-Up The proposed solution (education and follow-up) will be monitored to assess its effectiveness in reducing congestive heart failure readmission rates in geriatric patients.
• Hispanic Population With Heart Failure The research problem was based on the realization that the effectiveness of heart failure management programs had not been tested when in Hispanic participants.
• Anemia, Cardiomyopathy, and Congestive Heart Failure There are very many serious health conditions. Anemia is one of the most serious diseases. The paper would cover the condition on Ms. A.

Cite this post

• Chicago (N-B)
• Chicago (A-D)

StudyCorgi. (2022, June 5). 83 Heart Failure Essay Topics. https://studycorgi.com/ideas/heart-failure-essay-topics/

"83 Heart Failure Essay Topics." StudyCorgi , 5 June 2022, studycorgi.com/ideas/heart-failure-essay-topics/.

StudyCorgi . (2022) '83 Heart Failure Essay Topics'. 5 June.

1. StudyCorgi . "83 Heart Failure Essay Topics." June 5, 2022. https://studycorgi.com/ideas/heart-failure-essay-topics/.

Bibliography

StudyCorgi . "83 Heart Failure Essay Topics." June 5, 2022. https://studycorgi.com/ideas/heart-failure-essay-topics/.

StudyCorgi . 2022. "83 Heart Failure Essay Topics." June 5, 2022. https://studycorgi.com/ideas/heart-failure-essay-topics/.

These essay examples and topics on Heart Failure were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 8, 2024 .

Congestive Heart Failure Essays

Congestive heart failure, pico(t) questions and an evidence-based approach, evidenced-based practice assignment, popular essay topics.

• American Dream
• Artificial Intelligence
• Black Lives Matter
• Bullying Essay
• Career Goals Essay
• Causes of the Civil War
• Child Abusing
• Civil Rights Movement
• Community Service
• Cultural Identity
• Cyber Bullying
• Death Penalty
• Depression Essay
• Domestic Violence
• Freedom of Speech
• Global Warming
• Gun Control
• Human Trafficking
• I Believe Essay
• Immigration
• Importance of Education
• Israel and Palestine Conflict
• Leadership Essay
• Legalizing Marijuanas
• Mental Health
• National Honor Society
• Police Brutality
• Pollution Essay
• Racism Essay
• Romeo and Juliet
• Same Sex Marriages
• Social Media
• The Great Gatsby
• The Yellow Wallpaper
• Time Management
• To Kill a Mockingbird
• Violent Video Games
• What Makes You Unique
• Why I Want to Be a Nurse
• Send us an e-mail

Discussion and Conclusion on Congestive Heart Failure

Pssst… we can write an original essay just for you.

Any subject. Any type of essay. We’ll even meet a 3-hour deadline.

writers online

Congestive heart failure is a major chronic condition that possesses a significant source of health debilitation. According to the PICOT questions, it is evident that readmission rate is another significant problem that results from the congestive heart failure. Ideally, the chronic heart failure requires intensive nursing care because the patients should be monitored throughout the treatment plan. Monitoring for various abnormal signs should be done to ensure that the level of stability is maintained in the patient. Readmission rates are also linked to the exposure to the nosocomial infections in the centers of care (Roger, 2013). The prevalence is increased among the debilitated patients. This area has also been identified as a gap in the management and acre for the congestive heart failure.

Don't use plagiarised sources.Get your custom essay just from $11/page

Notably, congestive heart failure increases in prevalence with age. As one progresses towards aging, it is evident that they are predisposed to getting the condition, and if not properly intervened, can lead to the development of further underlying conditions that stir further debilitation of health status (Alt, 2014). In this case, there is a need for providing advanced nursing care to the target population to counter deliverables that are involved in the process. It is also effective because it lowers the readmission rates in the healthcare settings.

Since congestive heart failure does not easily manifest the symptoms, adequate and competent medical services are vital at every stage of care for the patients. Lifestyle orientation is another area in which the clients become much adapted to the various services offered after intervention implementation. Leading an active life is essential in greatly minimizing the occurrence of the condition, readmission levels, and general underlying conditions. Ideally, with the progression of the condition, a more patient-centered approach can be adapted to provide adequate leverage in the condition assessment for the patients is improved (Roger, 2013). One such important area is the nurse-patient partnership that is aimed at creating detailed therapeutic care that is patient-centered and backed up with the various aspects of clinical care and nursing.

Caring for those with congestive heart failure is expensive because of the services offered. Ideally, health insurance services are recommended in this case to help cater for the various expenses realized when meeting all the required deliverables concerning the same condition of congestive heart failure.

As evaluated in the discussion, congestive heart failure is increasingly becoming a threat to the management of different case conditions and the underlying orders as well as. Notably, despite the advancement in medicine, management of the HF is challenging because of the symptoms of the different manifestation. Increased mortality and mobility associated with the congestive heart failure have been identified as a red flag in the offering care and management services. Good exercise, enhancement of therapeutic strategies, and adherence to the treatment, management, and care should be followed according to the rubric. It is also important to determine the significant risk factors for the condition. Examples of such are; type 2 diabetes, smoking, drinking alt of alcohol and some medications especially for the terminal illnesses. In as much as it is perceived that older people are the most affected individuals, it should also be noted that the condition affects all other age conditions depending on the causation process.

Alt, E. (2014). U.S. Patent No. 8,777,851. Washington, DC: U.S. Patent and Trademark Office.

Norhammar, A., Johansson, I., Thrainsdottir, I. S., & Rydén, L. (2017). Congestive heart failure. Textbook of Diabetes, 659-672.

Roger, V. L. (2013). Epidemiology of heart failure. Circulation research, 113(6), 646-659.

Tissot, C., da Cruz, E. M., & Miyamoto, S. D. (2014). Congestive Heart Failure. In Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care (pp. 2045-2062). Springer London.

  Remember! This is just a sample.

Save time and get your custom paper from our expert writers.

In case you can’t find a sample example, our professional writers are ready to help you with writing your own paper. All you need to do is fill out a short form and submit an order

Hypertension and Congestive Heart Failure Essay

It is important to note that hypertension is a cardiovascular disease that refers to elevated blood pressure. The given analysis will focus on the case of Dr. Ally, who is a 49-year-old professor with several underlying conditions. Due to not taking his medications, the patient experiences a range of issues, which are linked with hypertension, and it is contributing to a left-sided form of congestive heart failure.

The patient’s problems include essential hypertension, fatigue, dyspnea, epistaxis, dizziness, and blurred vision. In his eyes, hypertension can cause damage to the small blood vessels in the retina, leading to a condition called hypertensive retinopathy. This can cause vision changes such as blurriness, floaters, and even blindness (“Hypertension,” n.d.). In his heart, hypertension can lead to left ventricular hypertrophy and increased workload on the heart. This can lead to heart failure, which can cause rales or crackles on chest auscultation, as well as fatigue, dyspnea, and other symptoms. The doctor suggests that the patient might have developed congestive heart failure, but it is likely to be left-sided since it is the most common starting site and causes breathing issues (“Respiratory depression,” n.d.; Chopra et al., 2021). Common antihypertensive drugs that may have been used include diuretics, digitalis, calcium channel blockers, and beta blockers. Cardiac glycosides, such as digitalis, “increase the contractibility of the heart muscle, reduce the heart rate” (“Digitalis,” n.d., para. 2). Diuretics work by increasing urine output, which reduces blood volume and pressure.

In conclusion, the patient experiences a range of issues related to hypertension, which is likely to cause left-sided congestive heart failure since it is the most common in the population. It is important to note that Dr. Ally’s condition highlights the importance of regular checkups and adherence to medication regimes. It is essential to keep hypertension under control to prevent long-term complications such as heart failure, kidney disease, and retinal damage.

Chopra, H. K., Nanda, N. C., Narula, J., Wander, G. S., Manjunath, C. N., & Chandra, P. (2021). Hypertension: New frontiers — A textbook of cardiology . Jaypee Brothers Medical Pub.

Digitalis [PDF document]. (n.d.).

Hypertension [PDF document]. (n.d.).

Respiratory depression [PDF document]. (n.d.).

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2024, January 28). Hypertension and Congestive Heart Failure. https://ivypanda.com/essays/hypertension-and-congestive-heart-failure/

"Hypertension and Congestive Heart Failure." IvyPanda , 28 Jan. 2024, ivypanda.com/essays/hypertension-and-congestive-heart-failure/.

IvyPanda . (2024) 'Hypertension and Congestive Heart Failure'. 28 January.

IvyPanda . 2024. "Hypertension and Congestive Heart Failure." January 28, 2024. https://ivypanda.com/essays/hypertension-and-congestive-heart-failure/.

1. IvyPanda . "Hypertension and Congestive Heart Failure." January 28, 2024. https://ivypanda.com/essays/hypertension-and-congestive-heart-failure/.

Bibliography

IvyPanda . "Hypertension and Congestive Heart Failure." January 28, 2024. https://ivypanda.com/essays/hypertension-and-congestive-heart-failure/.

• The Analysis of Reasons for Eye Floaters
• Left-Sided Heart Failure and Nursing Intervention
• Heart Failure: Cardiology and Treatment
• Retinopathy in Diabetic Patients: Diagnosis and Treatment Options
• Differences in Incidence of Diabetic Retinopathy
• Auscultation as a Diagnostic Tool
• The Different Types of Heart Failure
• Dyspnea in Cancer Patients
• Analyzing the Three Types of Cardiovascular Drugs
• Modern Medicine and Herbs
• Heart Diseases in Florida: Cardiology
• Hypertension: Risk Factors and Treatment
• Heart Attack: Cellular Functions and Problems
• Heart Rate, Stroke Volume, and Cardiac Output: Nervous and Chemical Factors
• Coronary Heart Disease Caused by Stress

From the corral: Heart complications

During the least 10 years, there have been increasing problems with heavy feedlot cattle suddenly dropping dead. This is due to congestive heart failure. In the past, this problem was limited to cattle residing in high altitudes and did not occur at lower altitudes. It was called brisket disease because the brisket would become swollen with fluid. The most recent research shows that congestive heart failure is related to intensive selection for economically important traits such as rapid growth and meat production.

Colorado State University (CSU) researchers Isabella M. Kukor, Timothy Holt, and their colleagues inspected herds of feedlot cattle at a processing plant. Sixty-six percent had normal hearts and 34% had signs of heart problems. When hearts are inspected on the viscera table, the signs of congestive heart failure are swelling of the heart. Cattle that are in end-stage heart failure have a heart that looks like a bloated soccer ball. The CSU researchers also found that heart failure was related to certain Angus sires. Their paper was published in Translational Animal Science, Vol. 5, Supplement S1, December 2021.

Recently, I talked to managers who fed Angus-Holstein cross steers (beef on dairy) and they have traced late-stage deads back to single sires. When they stopped using the semen from a single sire, late-stage deads were drastically reduced. Cattle that are in end-stage congestive heart failure will often appear to have pneumonia.

A huge study was conducted by Justin W. Buchanan from Simplot and colleagues from Gencove Genetics. They inspected the hearts of over 32,000 feedlot cattle. Eighty percent of the cattle had normal hearts and 4.14% were in end-stage congestive heart failure. In a paper they published in 2023 in Frontiers in Genetics, they reported that Angus cattle had a higher incidence of congestive heart failure.

Congestive heart failure is scored with a five-point scoring system where a score of 1 is normal and 5 is a bloated soccer ball. Both research studies contain easy-to-use photographic scoring tools for scoring cattle at the plant. They can be easily found online by typing keywords: “beef cattle congestive heart failure” into either Google images or Google Scholar.

Tim Holt, DVM, at CSU assesses susceptibility to heart failure using a pulmonary arterial pressure (PAP) test. This can be used to test Angus bulls. It could also be used to find sires that would be less susceptible. This will probably require a slight reduction in genetic selection for traits such as rapid weight gain and marbling.

Related Articles

From the corral: refining the framework, from the corral: leading the way, from the corral: auditing pro tips, current issues & directories.

Popular Articles

Danish crown to close slaughtering facility, choctaw nation, three rivers meat hold grand opening of new plant, owner of five poultry plants owes workers $3.8 million in back wages, damages, superior farms takes on denver ballot initiative that would shutter its plant, popular galleries.

New on the menu

Spring has sprung—with new sandwiches.

Conagra Brands focuses on future in frozen food

Innovations across frozen food brands capitalize on popular consumer and restaurant trends.