Heart Failure (Congestive Heart Failure - CHF) is a chronic, progressive cardiovascular condition in which the heart muscle is structurally or functionally unable to pump sufficient blood to satisfy the body's systemic oxygen and metabolic demands. Expert diagnostic evaluation and evidence-based medical therapy are provided by Dr. Sai Sekhar Pyla at Trinetra Medicals, Visakhapatnam.
Types of Heart Failure
- HFrEF (Heart Failure with Reduced Ejection Fraction): Systolic failure where LVEF is ≤ 40%, meaning the heart pump is weakened.
- HFpEF (Heart Failure with Preserved Ejection Fraction): Diastolic failure where LVEF is ≥ 50%, but heart chambers are stiff and unable to relax and fill properly.
Causes & Risk Factors
- Prior Myocardial Infarction (Heart Attack) causing permanent cardiac scar tissue.
- Long-standing uncontrolled Hypertension (High Blood Pressure).
- Diabetic Cardiomyopathy and chronic metabolic dysfunction.
- Valvular heart disease (aortic stenosis, mitral regurgitation) and viral myocarditis.
Symptoms & Clinical Signs
- Dyspnea (Shortness of Breath): Exertional dyspnea progressing to Orthopnea (inability to breathe while lying flat) and Paroxysmal Nocturnal Dyspnea (waking up gasping for air).
- Peripheral & Visceral Edema: Swelling in feet, ankles, shins, and abdomen (ascites) due to fluid retention.
- Persistent Cough: Pink, frothy sputum accompanying acute pulmonary congestion.
- Severe Fatigue & Rapid Weight Gain: Sudden weight increase of 1–2 kg over 48 hours from fluid buildup.
Diagnostic Evaluation
- NT-proBNP / BNP Blood Test: Key cardiac biomarker confirming elevated ventricular stretch and heart failure severity.
- 2D Echocardiogram (ECHO): Quantifies LVEF, ventricular volumes, diastolic filling pressures, and valve status.
- Chest X-ray: Visualizes cardiomegaly (enlarged heart) and pulmonary venous congestion / Kerley B lines.
- Renal & Electrolyte Panel: Monitors serum creatinine, BUN, sodium, and potassium levels.
Treatment & Management Protocol
- GDMT (Guideline-Directed Medical Therapy):
- ARNI (Sacubitril/Valsartan) or ACEi/ARB: Reduces cardiac strain and mortality.
- Beta-Blockers (Carvedilol, Bisoprolol, Metoprolol Succinate): Blunts sympathetic overactivity.
- MRA (Spironolactone / Eplerenone): Aldosterone receptor antagonist reducing cardiac fibrosis.
- SGLT2 Inhibitors (Dapagliflozin / Empagliflozin): Significantly reduces heart failure hospitalizations.
- Diuretic Therapy: Loop diuretics (Furosemide / Torsemide) to relieve pulmonary congestion and edema.
- Fluid & Sodium Restriction: Strict dietary salt limitation (< 2g/day) and daily morning weight tracking.
