Chronic Heart Failure: Symptoms, Diagnosis, and Management

Chronic Heart Failure

Hello, doctor.
Around March 2018, after jogging and taking a shower, I suddenly had difficulty breathing and had to squat down to relieve it.
I then noticed that I would easily feel short of breath during exercise or when lifting heavy objects.
In April, I went to the cardiology department at Tri-Service General Hospital for some tests, and the doctor diagnosed me with hypertensive heart disease with heart failure class II.
I started taking antihypertensive medication.
Before medication, my blood pressure was around 160/90 or higher, and after starting the medication, it was about 130-140/80-100, occasionally dropping to 120/80, but this was rare.
I switched medications several times, but the results were similar.
Later, I brought my X-ray, ECG, and echocardiogram reports to other hospitals and clinics for consultation, but they all said I did not have heart failure.
In April 2020, I saw a different doctor at Tri-Service General Hospital and underwent another echocardiogram.
Below is a comparison of my two echocardiogram results:
2018: LV-D: 55, LV-S: 36, LVS: 12, LVPW: 10, LA: 42, AO: 29, RV: 30, PAP: 25, LVEF: 63%
2020: LV-D: 56, LV-S: 33, LVS: 11, LVPW: 9, LA: 38, AO: 33, RV: 23, PAP: 28, LVEF: 72%
The second report indicated that the heart size is normal, but it seems to be at the borderline.
From my online research, it appears that "heart failure" and "chronic heart failure" are not the same, and there is also "heart failure with preserved ejection fraction." I would like to ask which category my condition falls into.
Is there a possibility of recovery? I am 34 years old, 184 cm tall, and weigh 112 kg.
I usually sit for long periods and exercise infrequently, but now I go for a walk every other day on average.
I do not have edema in my lower limbs, I do not experience shortness of breath while lying down, but I do feel short of breath during exercise and when lifting heavy objects.
I cough up clear phlegm, my blood sugar is normal, and I also have mild persistent asthma and gastroesophageal reflux.
Thank you very much!

Eric, 30~39 year old female. Ask Date: 2021/01/26

Dr. Wu Xueming reply Cardiology

Based on your symptoms and examination report, it is recommended that you increase your physical activity, lose weight, and maintain your blood pressure within the normal range.
This can help alleviate your symptoms and prevent future deterioration of heart function.

Reply Date: 2021/01/26

More Info

Chronic heart failure (CHF) is a complex clinical syndrome that arises when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs. It can manifest through a variety of symptoms, diagnostic criteria, and management strategies. Based on your history and the details provided, let's delve into the symptoms, diagnosis, and management of chronic heart failure.

Symptoms of Chronic Heart Failure
The symptoms of CHF can vary widely among individuals, but common manifestations include:
1. Shortness of Breath (Dyspnea): This can occur during exertion or even at rest in more advanced cases. You mentioned experiencing shortness of breath during activities like running or lifting heavy objects, which aligns with typical CHF symptoms.

2. Fatigue: Individuals with CHF often report feeling unusually tired or fatigued, even with minimal exertion.

3. Fluid Retention: This can lead to swelling in the legs, ankles, and abdomen. You noted that you do not have lower extremity edema, which is a positive sign.

4. Coughing or Wheezing: This may occur due to fluid accumulation in the lungs, and you mentioned having a cough with clear sputum, which could be related to your underlying conditions.

5. Increased Heart Rate: Many patients experience palpitations or an increased heart rate as the heart works harder to compensate for its reduced efficiency.

Diagnosis of Chronic Heart Failure
Diagnosis typically involves a combination of clinical evaluation, imaging studies, and laboratory tests:
1. Clinical History and Physical Examination: Your history of hypertension and symptoms like dyspnea during exertion are critical in assessing your risk for CHF.

2. Echocardiography: This is a key diagnostic tool that evaluates heart structure and function. Your echocardiogram results from 2018 and 2020 show a preserved left ventricular ejection fraction (LVEF), which is a good indicator. An LVEF above 50% typically suggests heart failure with preserved ejection fraction (HFpEF).

3. Electrocardiogram (ECG): This test can reveal arrhythmias or other electrical abnormalities in the heart.

4. Chest X-ray: This can help identify fluid in the lungs or an enlarged heart.

5. Blood Tests: These can include tests for kidney function, electrolytes, and biomarkers like B-type natriuretic peptide (BNP), which can indicate heart failure.

Management of Chronic Heart Failure
Management strategies for CHF are multifaceted and tailored to the individual:
1. Medications: Antihypertensive medications are crucial in managing blood pressure and reducing the workload on the heart. Other medications may include diuretics for fluid retention, ACE inhibitors, or beta-blockers to improve heart function.

2. Lifestyle Modifications: Regular physical activity, a heart-healthy diet, and weight management are essential. You mentioned that you are starting to walk every other day, which is a positive step. Gradually increasing your activity level can help improve your symptoms and overall heart health.

3. Monitoring and Follow-Up: Regular follow-up with your healthcare provider is vital to monitor your heart function and adjust treatment as necessary. Given your concerns about the diagnosis of heart failure, it is important to maintain open communication with your cardiologist.

4. Management of Comorbidities: Addressing other health issues, such as asthma and gastroesophageal reflux disease (GERD), is also important, as these can exacerbate heart failure symptoms.

Conclusion
Based on the information provided, it appears that you may be experiencing symptoms consistent with heart failure, particularly during exertion. However, your preserved ejection fraction suggests that you may be dealing with heart failure with preserved ejection fraction (HFpEF). While CHF is a chronic condition, many patients can manage their symptoms effectively with appropriate treatment and lifestyle changes. It is essential to work closely with your healthcare team to monitor your condition and make necessary adjustments to your management plan. Regular exercise, dietary changes, and adherence to prescribed medications can significantly improve your quality of life and overall heart health.

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