Congestive heart failure (CHF) happens when the heart is structurally damaged and not strong enough to pump blood to the tissues of the body. Caused by coronary artery disease, high blood pressure or cardiomyopathy, fluid accumulates and backs into the lungs, causing the typical CHF symptoms. CHF is primarily seen in the elderly. The American College of Cardiology identifies four classes of CHF that help identify disability and guide treatment.
Stage A
Stage A patients are defined by the American College of Cardiology (ACC) as those persons at high risk for heart failure without structural damage or symptoms. Stage A patients are treated to prevent heart failure, and include those with known habits or factors that increase the risk for development of CHF, including hypertension, atherosclerosis, diabetes, obesity and a family medical history. Goals for therapy set forth by the ACC include treatment of high blood pressure. Smokers, alcoholics, sedentary persons and illicit drugs users are encouraged to avoid these high-risk habits. A small group of patients will receive drug treatment.
Stage B
ACC defines Stage B patients as those with structural heart disease and no symptoms. This group includes those with Stage A risk factors and those with previous heart attacks, left ventricular changes and valve disease. As with the earlier stage of CHF, patients in this group are at risk for worsening symptoms with any further injury to the heart, so the goals for treatment of Stage B are the same as those for Stage A. Drug treatment is used in a small group of patients, with an additional use of beta-blockers in those patients who need it. In some cases, patients are treated with defibrillators.
Stage C
Stage C is defined by having symptoms in addition to structural damage, according to the ACC. Patients experience disability due to shortness of breath with exercise and extreme tiredness. Shortness of breath is caused by the heart's inability to pump fluid out of the heart, therefore it backs up into the lungs and out to the extremities, causing fluid retention. Measures of goals and treatment are the same as those for Stage A and B, in addition to dietary salt restriction and diuretics to reduce fluid buildup. Routine drugs include beta-blockers and ACE-inhibitors for all Stage C patients. Some patients are prescribed other drugs and possibly an implantable pacemaker.
Stage D
The final stage defined by the ACC for heart failure is Stage D. These patients experience extreme disability and exercise restriction from their symptoms, which are present even at rest. Patients have trouble lying down, and fluid accumulates and causes swelling in the legs, ankles and lower back. Drug and device therapies are tailored to the patient's needs. However, most CHF patients in Stage D are in need of end-of-life care. According to Merck, patients in Stage D are encouraged to discuss their personal wishes regarding ventilation and resuscitation with family members. Disease management should not be abandoned, with the main goal of end-of life therapy to improve quality of life.
