Congestive Heart Failure

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What is congestive heart failure?

Congestive heart failure (CHF) is a chronic condition in which the heart is unable to pump blood efficiently enough to meet the body's demands. Despite its name, heart failure doesn't mean the heart has stopped — it means it is working harder than it should, and over time that extra strain leads to a progressive decline in function and quality of life.

CHF is one of the leading causes of hospitalization in the United States, but with expert management, many patients live well with the condition for years. The key is getting the right diagnosis, understanding the specific type of heart failure you have, and following a treatment plan that is actively adjusted as your condition changes.

What are the types of heart failure?

Heart failure is not a single diagnosis — it is a spectrum, and treatment depends heavily on which type you have.

Heart failure with reduced ejection fraction (HFrEF) Also called systolic heart failure, this occurs when the left ventricle — the heart's main pumping chamber — becomes weakened and enlarged, reducing its ability to squeeze blood out to the body. The ejection fraction (EF), which measures how much blood the heart pumps with each beat, is below normal (typically less than 40%). This is the type most commonly associated with prior heart attacks or longstanding coronary artery disease.

Heart failure with preserved ejection fraction (HFpEF) Also called diastolic heart failure, this occurs when the heart muscle becomes too stiff to relax and fill properly between beats. The pumping function appears normal, but the heart can't fill with enough blood to meet the body's needs. HFpEF is increasingly common and is strongly associated with hypertension, diabetes, obesity, and aging.

Right-sided heart failure The right ventricle pumps blood to the lungs to pick up oxygen. Right-sided failure often develops as a consequence of left-sided failure, but can also result from pulmonary hypertension or lung disease. It typically causes fluid buildup in the legs, abdomen, and peripheral tissues.

Understanding which type you have — and what is driving it — is essential to selecting the right treatment.

What symptoms should I watch for?

Heart failure symptoms can develop gradually and are often mistaken for normal aging or deconditioning. Common warning signs include:

• Shortness of breath with activity or when lying flat
• Swelling in the legs, ankles, or feet
• Persistent fatigue or weakness
• Rapid or irregular heartbeat
• Persistent cough or wheezing
• Sudden weight gain from fluid retention
• Reduced ability to exercise or do daily activities

If you experience a sudden worsening of any of these symptoms, contact your physician promptly. Rapid changes in heart failure status can escalate quickly.

What can I expect at a heart failure consultation?

Dr. Makam, DO, FACC, takes a thorough, individualized approach to heart failure. Your evaluation begins with a detailed discussion of your symptoms, how they affect your daily life, and how they have changed over time. Dr. Makam reviews your complete medical and family history, current medications, diet, fluid intake, and activity level.

Diagnostic testing is tailored to your situation and may include echocardiography to assess heart structure and function, an electrocardiogram (EKG), blood tests including BNP or NT-proBNP to measure heart strain, chest imaging, and stress testing when appropriate. For patients with complex or advanced heart failure, additional workup may be warranted to identify reversible causes or guide advanced therapies.

What treatments are available for heart failure?

Heart failure management has advanced significantly over the past decade. Guideline-directed medical therapy — the combination of medications proven to reduce hospitalizations and mortality in heart failure — is the cornerstone of treatment, and ensuring patients are on the right medications at the right doses is one of the most impactful things a cardiologist can do.

Depending on your type and severity of heart failure, your treatment plan may include:

• Optimization of guideline-directed medical therapy (beta-blockers, ACE inhibitors/ARBs, ARNI therapy, SGLT2 inhibitors, mineralocorticoid antagonists)
• Strict fluid and sodium management
• Daily weight monitoring with an action plan for changes
• A personalized, safe exercise and activity program
• Management of contributing conditions — particularly hypertension, diabetes, atrial fibrillation, and sleep apnea
• Device therapy evaluation (ICD, CRT) when indicated
• Coordination with your primary care physician and any other specialists involved in your care

Dr. Makam believes that patient education is as important as medication. Understanding your condition — what your numbers mean, what symptoms to watch for, and what to do when things change — is what keeps patients out of the hospital and living well with heart failure.

For expert heart failure management at our Anaheim or Corona, CA offices, call Makam Medical or requet an appointment online today.