Congestive Heart Failure

When you have heart failure, your weakened heart cannot pump enough blood and oxygen to your organs. You may be short of breath, retain fluid, or feel unusually tired. This condition can make everyday activities like walking and climbing stairs more difficult.

What is congestive heart failure?

Congestive heart failure occurs when the heart isn’t pumping blood as efficiently as it should. As a result, the flow of blood to the vital organs decreases and causes the pressures in the heart to increase. This prevents the heart from pumping enough blood that supplies the oxygen and nutrients to meet the body’s needs. Congestive heart failure can be caused by a number of conditions that damage the heart muscle, such as coronary artery disease, heart attack, cardiomyopathy, and high blood pressure. 

Congestive heart failure versus heart failure

Heart failure when associated with congestion or fluid retention is referred to as congestive heart failure. The fluid retention can be in the lungs (pulmonary congestion or pulmonary edema), legs, ankles, liver (hepatic congestion), or the abdomen (ascites).

Types of heart failure are:

Left-sided heart failure

The heart’s left ventricle is the most important chamber that is responsible for delivering blood and oxygen to all organs. When the left ventricle fails, the function of all organs is affected. There are two types of left-sided heart failure:

Systolic (HFrEF)

This occurs when the heart muscle doesn’t contract with enough force, which leads to less oxygen-rich blood being pumped through the body. 

Diastolic (HFpEF)

With this condition, the heart contracts normally, but the left ventricle is stiff, causing pressure, inside the heart to rise. 

Right-sided heart failure

The heart’s right ventricle works to pump blood into the lungs to be filled with oxygen. During right-sided heart failure, the right ventricle loses its ability to pump. This causes the blood to back up into the veins. Right-sided heart failure typically results in fluid retention and swollen feet, ankles, and legs.  

Acute heart failure

Acute heart failure, also referred to as decompensated heart failure, is a life-threatening condition with rapidly developing symptoms that require immediate medical care. With acute heart failure, the heart struggles to deliver enough oxygen to meet the body’s needs. 

"Being cared for in a system where clinicians are actively engaged in clinical trials and multi-center collaborations is key."

Stephen Bailey, MD — System Chair, Department of Thoracic and Cardiovascular Surgery

What is cardiogenic shock?

Cardiogenic shock means that there is sudden, severe loss of heart function that results in dangerously low blood pressures, and inability of the heart to pump enough blood to get oxygen to vital organs and tissues. This condition can result in life-threatening organ dysfunction.

Cardiogenic shock can occur as a result of:

• A massive heart attack.
• Heart surgery.
• Cardiomyopathy (a disease that makes it harder for the heart muscle to pump blood).
• Chronic heart failure.

When a patient is in shock, time is of the essence. At AHN, a team of experts specializing in cardiogenic shock will act quickly to:

• Make a rapid diagnosis and start therapy right away.
• Decide on the right course of care for the best chance of survival.
• Use proven decision-making pathways.

This process has made huge improvements in helping more patients survive cardiogenic shock.

Congestive heart failure symptoms and stages

Some people may not encounter any symptoms of heart failure. Those who do, however, could experience symptoms that are either constant, intermittent, or progressive, including: 

• Shortness of breath with exercise, or at rest, caused by congested lungs. 
• Wheezing or coughing caused by congested lungs. 
• Swollen feet, ankles, legs, and abdomen caused by fluid retention. 
• Rapid weight gain due to fluid retention. 
• Loss of appetite or nausea.
• Dizziness and confusion due to less blood flow to the brain. 
• Feeling weak or fatigue due to less blood circulating to major organs. 
• Rapid or irregular heartbeats (palpitation) from the heart trying to pump more blood into the body.
• NT-proBNP levels that are higher than normal.

Based upon the severity of symptoms, people with congestive heart failure are categorized using the New York Heart Association (NYHA) Functional Classification system. It places people in one of four classes based on how much they are limited during physical activity.

Class I

There are no limitations to physical activity. Regular physical activity does not cause fatigue, shortness of breath, or palpitation.

Class II

There is slight limitation of physical activity, though the person is comfortable at rest. Regular physical activity results in fatigue, palpitation, or shortness of breath. 

Class III

There is a noticeable limitation of physical activity, though the person is comfortable at rest. Less than regular activity causes fatigue, palpitation, or shortness of breath.

Class IV

The person is unable to carry on any physical activity without discomfort, and there are symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

There are also four stages of systolic heart failure. It’s important to note that, typically, heart failure cannot be reversed, and you can only progress to more advanced stages over time, including: 

Stage A

This includes people at high risk for developing systolic heart failure, also referred to as pre-heart failure. 

Stage B

This category involves patients diagnosed with systolic left ventricular dysfunction. At this stage, patients usually aren’t experiencing signs and symptoms of heart failure. 

Stage C 

This is classified as patients diagnosed with systolic heart failure who have current or prior symptoms. 

Stage D 

This refers to patients diagnosed with systolic heart failure who are experiencing advanced symptoms after receiving medical care.

While there isn’t a cure for this progressive disease, you can enjoy a better quality of life with a number of treatments available at Allegheny Health Network (AHN) Cardiovascular Institute.

Heart failure care at AHN: Why choose us?

Our specialized heart failure program is among the best in the United States and has been recognized for its excellence by the American Heart Association. We offer:

Leading experts

Our board-certified physicians have specialized training in the care of heart failure patients, having worked alongside world-renowned heart specialists, while completing residencies and fellowships at the country’s top-tier heart programs. We offer this expertise at AHN to help you achieve the best possible results, closer to home.

Advanced treatments

At AHN, you have access to a number of the latest heart failure diagnosis and treatment options including medical therapies and devices still in the clinical trial phase. We also offer surgical treatment options, including cardiac transplantation, valve repair or replacement, and mechanical circulatory support.

Home heart monitoring

The CardioMEMS™ implantable device allows us to monitor your heart failure remotely as you go about daily life. Daily pressure readings alert our team to early signs of decompensating heart failure before symptoms start, allowing us to adjust treatments quickly to prevent the development of symptoms and emergent hospitalization. This, and other heart failure monitoring tools, allows for round-the-clock monitoring of your heart.

Heart failure clinic

The heart failure clinic allows you to experience our 360-Degrees of Care Program, designed to improve your symptoms, and greatly reduce your risk of hospitalization. Through the clinic, you will have access to our multidisciplinary team of physicians, surgeons, nurse coordinators, pharmacists, dietitians, and palliative and supportive care specialists. We also offer cardiovascular rehabilitation to promote stamina, strength, and mobility. Learn more about the AHN Heart Failure Clinic.

Personalized focus

Your health is our number-one priority. Working together with the multidisciplinary team, our team of heart failure specialists will develop a treatment plan that addresses your unique health needs.

Leaders in heart failure care

The following AHN hospitals have earned gold status in the American Heart Association’s Get With the Guidelines® – Heart Failure certification program:

• Allegheny General
• Allegheny Valley
• Canonsburg
• Jefferson
• St. Vincent

Learn more about the Cardiovascular Institute.

Diagnosing heart failure

There isn’t a cure for heart failure. However, doctors at the AHN Cardiovascular Institute are committed to protecting your heart from further damage and minimizing symptoms, so you can enjoy life more fully, live longer, and stay out of the hospital.

Our specialists use the most advanced imaging methods and other diagnostic tools to determine the cause, severity, and nature of your heart failure.

Your physician may order heart testing or heart imaging procedures.

Diagnosis through heart testing

Electrocardiogram (EKG/ECG)

This procedure measures your heart’s electrical activity and shows signs of heart damage, or irregular heartbeat (arrhythmia).

Holter monitor or event monitor

This wearable EKG/ECG device provides continuous measurements of your heart’s electrical activity for up to 30 days. 

Stress test

This exercise test on a treadmill or bicycle measures how your heart responds to exercise and helps diagnose blocked arteries to your heart. It also provides an accurate measure of your functional capacity (oxygen consumption).

Cardiac catheterization

Your doctor inserts a flexible tube, or catheter, into a blood vessel, either in your neck, leg, or wrist under X-ray. This is done to locate blockages in the arteries of your heart or to measure the pressures inside your heart, and the amount of blood your heart pumps with each beat.

Endomyocardial biopsy

During cardiac catheterization, your doctor will insert a bioptome or a biopsy catheter to remove a tiny piece of your heart muscle so that we can evaluate what is responsible for damaging your heart.

Diagnosis through heart imaging

Chest X-rays

These images show heart enlargement or damage, as well as fluid retention in your lungs (pulmonary edema) due to heart failure.

Echocardiogram (echo)

This ultrasound procedure measures the size of your heart, pumping action of your heart, also known as ejection fraction, and evaluates how your heart valves are working.

Multigated acquisition (MUGA) scan

Also called a blood pool scan, this nuclear imaging test uses an injectable radioactive substance (tracer) to measure ejection fraction, or how well your heart pumps blood with each heartbeat.

Single-photon emission computerized tomography (SPECT) scan 

This nuclear imaging test uses an injectable tracer to evaluate blood flow to the different regions of the heart. This test is often combined with a stress test.

Cardiac magnetic resonance imaging (MRI)

This scan uses radio waves and a magnetic field to create real-time 3D images of your heart’s structure and function. Learn more about cardiovascular imaging.

Computed tomography angiogram (CTA)

During a CT scan, an injectable dye reveals blockages in blood vessels that supply blood to your heart. This test can also evaluate calcium deposits in the arteries and valves in your heart.

Positron emission tomography (PET) scan

This nuclear heart scan also uses tracers to display blood flow to your heart and check for heart damage. In addition, this test can also evaluate the metabolic activity of your heart.

Cardiac pyrophosphate (PYP) scan

This nuclear heart scan also uses a radioactive tracer (PYP) to evaluate for a heart condition called cardiac amyloidosis. 

"Treatments for end stage heart failure require a big commitment from the patient, family and treatment team."

Stephen Bailey, MD — System Chair, Department of Thoracic and Cardiovascular Surgery

Heart failure treatments at AHN

Depending on the severity of your condition, your doctor may recommend one or more of the following:

Medication management

A number of medications can relieve symptoms, improve heart function, and slow disease progression in heart failure. These medications can also help you live longer with an improved quality of life. Our team will work with you to start and manage all your medications. When appropriate, you may have the opportunity to participate in clinical trials to receive the latest medication treatment for your heart failure. Learn more about cardiovascular research at AHN.

Heart support devices

Heart rhythm devices

Depending upon how weak your heart is, you may be a candidate for an implantable cardioverter defibrillator (ICD), a cardiac resynchronization therapy (CRT) pacemaker, or both.

Heart failure devices

You may be a candidate for either a cardiac contractility modulation (CCM) device, or a baroreceptor stimulation (Barostim™) device which can help to improve your heart function and your symptoms.

Mechanical circulatory support

Once your heart weakens substantially, and you are not responding as well to medical therapy, you may need a ventricular assist device (VAD), or other type of mechanical circulatory support to help your heart function.

Extracorporeal membrane oxygenation (ECMO)

This machine pumps your blood outside of your body, oxygenates it, and then returns oxygenated blood back to you. It is sometimes needed as a lifesaving measure when your heart stops or you go into shock. Learn more about ECMO

Heart surgeries

Heart valve surgery

We offer minimally invasive, catheter-based procedures to treat structural heart disease. These include transcatheter aortic valve replacement (TAVR) and MitraClip® for patients with heart valve disease too ill to undergo traditional surgery. Learn more about heart valve surgery.

Minimally invasive bypass surgery

Our surgeons use innovative robotic technology to divert blood flow (bypass) around a diseased artery in the heart. The improved blood flow in turn can improve heart function. Find out if robotic and minimally invasive surgery is right for you.

Heart transplants

Heart transplantation can be lifesaving in patients with heart failure who are failing all other treatments. Our heart transplant program has some of the best patient survival rates in Pennsylvania, according to the Scientific Registry of Transplant Recipients.

Contact us

Call (412) DOCTORS (412) 362-8677 or request an appointment with AHN cardiovascular services.