CHRONIC HEART FAILURE (CHF)

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What is Chronic Heart Failure (CHF)
 

Chronic heart failure is a clinical syndrome in which the heart is unable to provide adequate cardiac output at rest or during exertion. It develops as a result of myocardial damage and reduced myocardial contractility caused by various cardiac or systemic diseases.

Causes

The main underlying conditions leading to CHF include:

• Myocardial infarction (ischemic injury)
• Myocarditis
• Endocarditis
• Arterial hypertension
• Cardiomyopathies
• Valvular heart defects
• Cardiac arrhythmias

Classification (by left ventricular ejection fraction – LVEF)

According to the European Society of Cardiology (ESC), CHF is classified into:

1.    HFrEF – Heart Failure with Reduced Ejection Fraction (LVEF < 40%)
2.    HFmrEF – Heart Failure with Mildly Reduced Ejection Fraction (LVEF 41–49%)
3.    HFpEF – Heart Failure with Preserved Ejection Fraction (LVEF ≥ 50%)

Main Symptoms

• Dyspnea during physical exertion or at rest
• Orthopnea (dyspnea when lying flat)
• Peripheral edema (especially lower limbs)
• Hepatomegaly (enlarged liver)
• Pronounced fatigue, even with minimal exertion
• Paroxysmal nocturnal dyspnea

Diagnostics

The following diagnostic methods are essential:

• Echocardiography (EchoCG) – to assess ejection fraction and structural heart changes
• Electrocardiography (ECG) – for detecting arrhythmias or ischemic changes
• Blood tests for NT-proBNP or BNP – biomarkers of heart failure indicating cardiac overload
• Chest X-ray – to assess cardiomegaly and pulmonary congestion
• Coronary angiography – when ischemic heart disease is suspected

Modern Treatment Approaches

Treatment is tailored individually based on the CHF type and symptom severity.

a) Pharmacotherapy (typically lifelong):

• ACE inhibitors or ARBs (angiotensin receptor blockers)
• Beta-blockers
• Mineralocorticoid receptor antagonists
• Diuretics (if fluid retention is present)
• SGLT2 inhibitors (sodium-glucose co-transporter 2 inhibitors)

b) Interventional methods (as indicated):

• Implantable cardioverter-defibrillator (ICD)
• Cardiac resynchronization therapy (CRT)
• Surgical interventions (e.g., revascularization)

Possible Complications

• Frequent hospitalizations
• Cardiac arrhythmias
• Thromboembolic events
• Cardiogenic shock
• Secondary multi-organ dysfunction (kidneys, liver)

Prevention

• Blood pressure and glucose control
• Weight management
• Limiting salt and fluid intake
• Regular physical activity (when compensated)
• Cessation of smoking and alcohol
• Early diagnosis and management of underlying conditions (e.g., hypertension, ischemic heart disease)

When to See a Doctor

• New or worsening dyspnea, especially while lying flat
• Development of edema (legs, ankles)
• Unusual fatigue or decline in physical capacity
• Rapid weight gain due to fluid retention
• Irregular heart rhythm or palpitations
   

Cardiology Services at VitaMed Medical Center (Yerevan, Byureghavan, Charentsavan, Stepanavan)