Understanding heart failure

There are many causes that can lead to heart failure. Your cardiology healthcare provider needs to evaluate and treat you continually over a long period of time to navigate heart failure.

Heart failure can be caused by heart artery disease, such as prior heart attacks, but it can also be caused by viral illnesses, uncontrolled blood pressure, genetics among many other causes.

Understanding the classifications of heart failure can help patients better understand what’s happening in their bodies, and how to work with their care team to manage the condition effectively.

What’s Your Type?
The condition isn’t one-size-fits-all. Classification helps heart specialists determine how the condition affects a patient’s everyday life, and helps guide us to the most appropriate course of treatment.

In many cases, heart failure affects the left ventricle, the heart’s largest and most powerful chamber. The left ventricle can be too weak; this is called systolic heart failure. The ventricle can also be too stiff; this is called diastolic heart failure. People can often have both at the same time.

Congestive heart failure (CHF) is the technical term for heart failure. However, CHF has a distinct meaning. It refers to heart failure that causes tissue congestion. Swelling in the legs and ankles and/or difficulty breathing due to fluid in the lungs are common with CHF.

How Heart Failure is Classified
To better understand the severity of a patient’s heart failure, a cardiology specialist relies on established classification systems.
One of the most widely used is the New York Heart Association (NYHA) Functional Classification, which focuses on how heart failure symptoms affect daily life:

The American College of Cardiology (ACC) and American Heart Association (AHA) developed stages of heart failure to classify patients.

This classification system complements the NYHA system. The ACC/AHA stages include:
• Stage A: You have risk factors for heart failure, such as coronary artery disease — a type of heart disease — but not structural heart disease or heart failure symptoms. Structural heart diseases, such as aortic stenosis and mitral valve disease, affect the heart’s valves, muscles and other structures.
• Stage B: Structural heart disease is present, but not heart failure symptoms.
• Stage C: Heart failure symptoms and structural heart disease.
• Stage D: Advanced heart failure, which means the symptoms are difficult to manage and disrupt your daily life.

Why Early Detection Matters
Heart failure is a progressive condition, but early diagnosis and treatment can slow or even reverse its advancement and improve overall quality of life. Treatment for the condition varies based on the type and severity.

For many patients, care begins with important lifestyle changes like increasing physical activity, reducing alcohol and tobacco, maintaining a healthy weight and cutting back on sodium intake.

Medication can also play a role in a patient’s treatment plan, including:
• Beta-blockers to slow heart rate and lower blood pressure
• Diuretics to reduce fluid buildup
• Diabetic medications like SGLT2 inhibitors
• ACE inhibitors and Angiotensin receptor blockers to ease strain on the heart

In advanced cases of heart failure, additional therapies like cardiac rehabilitation or implantable devices may be considered.
Understanding heart failure causes, treatment and classification are valuable tools that can empower patients to take an active role in their care. With the right education, support and treatment plan, many people living with heart failure can continue leading active and fulfilling lives.

Stuart Smalheiser, M.D., is a triple board-certified interventional cardiologist with Beaufort Memorial Heart Specialists, specializing in advanced heart attack care, cardiac imaging and pacemaker and ICD implantation. He is the current Beaufort Memorial Chief of Medical Staff.