Congestive Heart Failure

Recognized Expertise, Leading-Edge Treatments

Chronic heart failure (CHF, congestive heart failure, or heart failure) is a long-term, progressive condition in which the heart muscles become too weak or too stiff to pump enough blood to adequately supply the body with oxygen. Often, a buildup of fluid in the body results from this heart condition.

In some cases, the heart can’t effectively pump blood out of its chambers; in other cases, the heart muscle is too stiff (cardiomyopathy) for the heart to fill with blood. Right-sided heart failure causes blood to accumulate in the gastrointestinal tract and extremities, while left-sided heart failure causes blood to accumulate in the lungs.

Typically a chronic condition, heart failure is not the same as cardiac arrest or heart attack. 

UT Southwestern’s Heart Failure Program gives patients direct access to the most cutting-edge diagnostic testing, medications, devices, and procedures available for this life-limiting condition.

Eight of our physicians have earned American Board of Internal Medicine subspecialty certification in advanced heart failure and transplant cardiology – giving our team the level of expertise necessary to treat even the most complex and challenging conditions.

Our specialists offer a variety of both noninvasive and invasive diagnostic studies, which enable them to pinpoint the precise nature of every patient’s condition and tailor heart failure treatment to each unique diagnosis. 

Importantly, each member of our team is strongly committed to educating patients about their conditions and working with them to develop personalized treatment plans based on their unique medical circumstances, preferences, and goals.

UT Southwestern is home to both a specialized Heart Care Unit at William P. Clements Jr. University Hospital and a dedicated Cardiac Rehabilitation Program. Cardiac rehabilitation is a critical component of recovery and can prevent future heart disease.

Risk Factors for Congestive Heart Failure

Congestive heart failure has a number of risk factors, such as:

• Coronary artery disease
  
• Hypertension (high blood pressure)
  
• Diabetes
  
• Cardiomyopathy
  
• Certain heart rhythm disorders
  
• Advanced age
  
• African-American descent
  
• Chronic alcohol and/or drug abuse
  
• Hyperthyroidism or hypothyroidism
  
• Prior chemotherapy and/or radiation therapy for cancer
  
• Obesity
  
• Pulmonary hypertension
  
• Sedentary lifestyle
  
• Previous heart valve disease
  
• Previous coronary artery bypass graft surgery
  
• Family history of heart failure
  

Congestive Heart Failure Symptoms

Although symptoms of congestive heart failure can appear suddenly, they usually come on gradually, over time.

Some heart failure symptoms are caused by fluid backing up in the lungs, abdomen, or extremities. Others reflect the heart’s reduced ability to deliver oxygen-rich blood to the body. Symptoms that persist or worsen despite treatment indicate that heart failure is becoming more advanced.

Heart failure symptoms can include:

• Abnormal heart rhythm or palpitations
• Chronic cough or wheezing
• Decreased urine production
• Difficulty sleeping
• Fatigue or fainting spells
• Feeling of fullness, loss of appetite, or abdominal pain
• Fluid retention, which causes swollen extremities or abdomen (edema)
• Loss of muscle mass
• Nausea or vomiting
• Shortness of breath upon exertion or when lying down
• Sleep apnea
• Weight gain

Patients diagnosed with heart failure who have been hospitalized at least twice in the past year should consider asking their doctors for a referral to UT Southwestern’s advanced heart failure specialists for an evaluation.

Diagnosing Congestive Heart Failure

UT Southwestern cardiologists can often make a preliminary diagnosis of heart failure by taking a detailed medical history and conducting a careful physical examination. Blood and urine tests can reveal problems with the liver and kidneys, measure lipids and thyroid function, and detect signs of diabetes.

Additional tests – most noninvasive – used to diagnose congestive heart failure might include:

• Electrocardiogram (ECG or EKG): To look for underlying heart problems such as heart enlargement, abnormal cardiac rhythms, and coronary artery disease
  
• Echocardiography (echo or cardiac ultrasound): To evaluate heart valve function, pumping capacity, and structural changes
  
• Cardiac MRI: To evaluate the heart’s structure and function and look for scarring
  
• CT imaging: To see detailed, cross-sectional views of the heart and cardiac arteries
  
• Chest X-ray: To evaluate the structure of the heart and lungs
  
• Cardiopulmonary stress test: To measure the heart’s aerobic capacity (level of fitness)
  
• Cardiac catheterization/angiography: To look for blockages in the coronary arteries
  

Congestive Heart Failure Treatment

The treatment of heart failure can be viewed as a continuum. In general, early treatment focuses on lifestyle changes and optimization of basic medical therapies. The next steps in treatment might include more aggressive medical therapies or the installation of a device such as a pacemaker or implantable cardioverter-defibrillator (ICD).

For the small percentage of patients for whom heart failure continues to progress despite less aggressive treatments, our team of experts offers the most advanced surgical solutions, such as left ventricular assist devices and heart transplantation.

UT Southwestern offers heart failure treatments that include:

Lifestyle Changes

• Quit smoking
• Avoid alcohol, caffeine, and stress
• Reduce fluid intake
• Reduce the amount of salt in the diet

Medications

• Angiotensin-converting enzyme (ACE) inhibitors
  
• Angiotensin-receptor blockers (ARBs)
  
• Angiotensin-receptor antagonists combined with a neprilysin inhibitor (ARNi)
  
• Mineralocorticoid receptor blockers (aldosterone blockers)
  
• Beta blockers to lower blood pressure
  
• Digitalis drugs to regulate and strengthen the heartbeat
  
• Anti-arrhythmic drugs to regulate the heart rate
  
• Vasodilators to open arteries and improve blood flow
  
• Digoxin to stimulate the heart
  
• Diuretics to reduce water retention
  

Surgery

• Angioplasty and stenting: To improve blood flow in patients with coronary artery disease
• Bi-ventricular pacemaker implantation: To regulate heart rhythm or help both sides of the heart contract at the same time
• Cardioverter-defibrillator implantation: To regulate heart rhythm
• Coronary artery bypass surgery: To improve blood flow in patients with blocked coronary arteries

For eligible patients whose heart failure continues to progress despite these treatments, UT Southwestern offers the most advanced solutions available, such as:

• Left ventricular assist device (LVAD): A battery-operated, implanted device that helps the left ventricle pump blood through the body
  
• Other types of mechanical circulatory assistance devices: Implanted devices that help the heart function
  
• Heart transplantation: Replacing the diseased heart with a healthy donor heart
  

Support Services

UT Southwestern offers a wide range of resources to help patients with heart failure adopt helpful lifestyle modifications and comply with medical regimens. Our Heart and Lung Transplant Clinic cares for patients with advanced heart failure, ventricular assist devices, and pulmonary hypertension in a hospital-based outpatient setting.

Services include patient education, stress management, closely supervised cardiac rehabilitation, support resources, and long-term follow-up. All are designed to help patients stay out of the hospital, improve their well-being, and extend their lives.

Clinical Trials

As one of the nation’s top academic medical centers, UT Southwestern offers a number of clinical trials aimed at improving the outcomes of patients with cardiovascular disease.

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials might receive treatments years before they are available to the public.