Types of Heart Failure | Tests & Treatments | MedStar Health

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A team of heart failure specialists pose for a photo at MedStar Health.

Expert care from pioneers in heart failure treatment and research

More than 6 million Americans have heart failure, a chronic disease that worsens over time and can severely limit your ability to live a full and normal life. 

Our doctors are pioneers in heart failure treatments, having implanted the first HeartWare® left ventricular assist device (LVAD) in the country and having performed the first heart transplant in the District of Columbia. We continue to improve on these procedures while also aggressively pursuing even more effective therapies for the sickest of the sick.

Our team includes not only heart doctors and surgeons but also nutritionists, financial counselors, and social workers as part of our Patient Support program. We are one of the first advanced heart failure programs to integrate palliative care personalized pain management along every step of treatment.

Congestive Heart Failure

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Congestive heart failure (CHF) is a progressively worsening series of events which causes pressure to build within the heart chambers and venous system, resulting in an accumulation of fluid in body tissues.

What are the types of heart failure?

Heart failure occurs when your heart doesn’t fill with enough blood or doesn’t pump enough blood throughout your body. This is different from sudden cardiac arrest in which the heart actually stops beating.

There are three main types of heart failure:

  • Congestive heart failure, in which blood backs up and causes congestion in the body’s tissues. This most often results in swelling in the legs, but it also can interfere with lung and kidney function.

  • Left-sided heart failure, in which the heart does not have enough force to pump blood to the rest of the body.

  • Right-sided heart failure, in which the heart can’t effectively accept blood from the body and deliver it to the lungs.

 

Diastolic dysfunction and heart failure

Diastolic Dysfunction - Problems with the first part of a heartbeat

The two parts of the heart pumping cycle are the systole (ventricles contract and push blood out of the heart into the arteries), and the diastole, (ventricles stop contracting and relax). Diastolic dysfunction happens when the ventricles, the two lower chambers of the heart, become stiff, which prevents them from relaxing and properly filling up with blood and causing a disruption in the blood flow to the body and vital organs.

The distinction between diastolic dysfunction and diastolic heart failure lies in the increased severity of the latter condition, which is characterized by the accumulation of fluid in the legs, ankles, feet, abdomen, and lungs.

Diastolic dysfunction normally occurs after the age of seventy. Other causes include coronary artery disease, hypertension (high blood pressure), obesity, heart valve disease, and smoking.

Symptoms

There are no straightforward symptoms of diastolic dysfunction other than a gradual decrease in exercise tolerance. Once diastolic heart failure occurs, common signs and symptoms of this condition are shortness of breath, fatigue, weight gain, nausea, and leg swelling.

Diastolic Heart Failure

Diastolic Heart Failure is caused by a stiff left ventricle (lower chamber of the heart) prevents it from relaxing and properly filling up with blood. Blood flow to the body and vital organs is disrupted. This condition is also known as heart failure with preserved ejection fraction (HFpEF). This condition is often called chronic diastolic heart failure and left ventricular heart failure.

Medical conditions that can cause diastolic heart failure include coronary artery disease, hypertension (high blood pressure), diabetes, atrial fibrillation, obesity, chronic kidney disease, amyloidosis or other infiltrative heart disease, and obstructive sleep apnea.

Lifestyle improvements such as following a heart-healthy diet, quitting all forms of tobacco use, limiting the intake of alcohol and caffeine, regular exercise, stress management, and sleeping seven to eight hours a night can help you lower your risk of developing diastolic heart failure.

 

What can cause heart failure?

Most cases of heart failure are caused by damage to the heart due to an underlying condition, such as:


What are the possible risk factors for heart failure?

Along with having one of the conditions above that can cause heart failure, the following factors also can increase your risk for the disease:

  • Age (older than 65)

  • Drinking too much alcohol

  • Family history of heart failure

  • Gender (men are at higher risk)

  • Obesity

  • Race (African-Americans are at increased risk of heart failure)

  • Tobacco use

What are the stages of heart failure?

Doctors usually classify patients' heart failure according to the severity of their symptoms. The table below describes the most commonly used classification system, the New York Heart Association (NYHA) Functional Classification. It places patients in one of four categories based on how much they are limited during physical activity – Source: American Heart Association.

Physicians often use the two classifications systems together to decide the most appropriate treatment options.

Class

Patient Symptoms

I

No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).

II

Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).

III

Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.

IV

Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

Class

Objective Assessment

A

No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity.

B

Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.

C

Objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.

D

Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest.

How is heart failure diagnosed?

Diagnosing heart failure is the first step to developing a treatment plan. Your physician or other healthcare provider will ask you questions about your medical history, risk factors for heart failure, your current symptoms, and will perform a physical examination. Your provider will listen to your heart with a stethoscope to check for a heart murmur and will look at the veins in your neck and check your legs and belly looking for signs of swelling.

Your provider will often order a series of tests to confirm or rule out the diagnosis of heart failure including one or more of the following diagnostic and imaging procedures.

Angiogram (Angiography)

An angiogram is a special X-ray taken as a special dye is injected through a thin, flexible tube called a catheter to detect blockages or aneurysms in blood vessels.

Cardiac Catheterization

Cardiac catheterization is a minimally invasive way to diagnose and treat a variety of heart and vascular conditions by guiding thin, flexible tubes called catheters through blood vessels to problem areas.

Chest X-ray

Chest X-rays use a small dose of radiation to create pictures of the structures inside the chest, including the lungs, heart, and chest wall.

Computerized Tomography (CT) Scan

The cardiac computed tomography scan, or cardiac CT, uses X-rays to create three-dimensional images of your heart and blood vessels.

Echocardiogram

An echocardiogram uses high-frequency sound waves to create images of your heart.

Electrocardiogram (ECG)

An electrocardiogram, also known as an ECG, measures the heart’s electrical activity.

Heart Biopsy

In a heart biopsy, your doctor will remove small samples of your heart muscle tissue to monitor heart function or diagnose a problem. 

Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging, better known as cardiac MRI, is a combination of radio waves, magnets, and computer technology to create images of your heart and blood vessels.

Stress Tests

Stress tests are used to assess how your heart works during physical activity. There are several types of stress tests, including treadmill or bike stress tests, nuclear stress tests, stress echocardiograms, and chemically induced stress tests.

Treatments

Treatments for heart failure such as medications, remote patient monitoring, mechanical devices, such as defibrillators and pacemakers, heart valve interventions, and surgery may vary based on the cause and severity of your condition.

Learn More About Heart Failure Treatment

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Additional information

Advanced heart failure patient support

Our unique patient support program for advanced heart failure patients offers the resources you need to optimize your medical care and improve your quality of life.

Learn More About Our Advanced Heart Failure Program

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MedStar Health accepts most major health insurance plans. If you are uncertain as to whether your individual health insurance plan is accepted at MedStar Health, please call your insurance company.