Congestive Heart Failure in the Elderly

Congestive heart failure is caused when the heart fails to pump enough blood. This article discusses the various causes, symptoms, and treatment options available for congestive heart failure in the elderly.
HealthHearty Staff
Last Updated: Feb 10, 2018
Did You Know?
More than 5% American people in the age group of 60 to 69 years have congestive heart failure. According to the Center of Disease Control and Prevention (CDC), approximately 5.7 million Americans have heart failure.

Congestive heart failure is a very common condition that affects the elderly. It is caused by an inability of the heart to pump enough blood to meet the requirement of the body. The right side of the heart pumps blood to the lungs, where blood is oxygenated. The oxygenated blood returns to the left side of the heart, from where it is pumped into the blood vessels. The blood vessels then carry it to different parts of the body.
When the pumping action of the heart gets impaired, blood fails to circulate effectively. This increases pressure inside the blood vessels and causes fluid to accumulate in the veins and body tissues.
Types of CHF
Congestive heart failure (CHF) is usually classified into two categories - systolic heart failure and diastolic heart failure.
Systolic Heart Failure - Systolic heart failure occurs when the pumping action of the heart becomes less powerful. It is usually measured with the help of 'ejection fraction'. 'Ejection fraction' is calculated by dividing the amount of blood discharged from the left ventricle, by the maximum volume of blood remaining in the left ventricle when the heart is relaxed (at the end of the diastole). The normal ejection fraction should be greater than 55%; anything below it is diagnosed as systolic heart failure.
Diastolic Heart Failure - Sometimes, the heart can contract normally, but become stiff during diastole (when the heart is relaxing and filling with blood). As a result, the heart is not completely filled with blood. This is known as diastolic heart failure, which is often detected while doing a Doppler echocardiography. The ejection fraction is usually normal or above 55 % in the case of diastolic heart failure. This condition is more common in patients suffering from hypertension, and people older than 75 years of age. Women are more prone to diastolic heart failure than men.
Causes of CHF
Congestive heart failure can be associated with conditions that either impair the capacity of the heart to supply enough oxygenated blood, or put extra pressure on the heart by increasing the requirement for oxygen and blood in the body.
Elderly people are at an increased risk of suffering from this condition as the heart muscles weaken with age. Moreover, the heart wall and the valves inside the heart can thicken and become stiff as we grow old. Apart from age, the following conditions can also be associated with congestive heart failure in both younger and older adults.
Coronary Artery Disease - Coronary arteries are blood vessels that carry blood to the heart. When these arteries become narrow due to the buildup of plaque, they fail to supply enough blood to the heart, resulting in heart failure.
High Blood Pressure - High blood pressure or hypertension puts extra strain on the heart and blood vessels. The heart may eventually fail to keep up to this additional pressure, which can increase the risk of a heart attack, stroke, or heart failure.
Myocarditis - Myocarditis refers to an inflammation of the myocardium, or the middle layer of the heart wall, which is usually caused by a viral infection. Severe myocarditis can weaken the pumping action of the heart, which can result in congestive heart failure or an heart attack.
Congenital Heart Disease - It refers to an abnormality in the structure of the heart that is present at birth. A defect can be present in the heart wall or the valves, and it can obstruct the flow of blood in the heart, or cause blood to flow in an abnormal pattern.
Cardiomyopathy - Cardiomyopathy is characterized by weakened and enlarged heart muscles. The disease makes it difficult for the heart to pump blood effectively, which can eventually lead to heart failure.
Heart Arrhythmia - Arrhythmia refers to an abnormality in the rate of muscle contractions in the heart. It is characterized by irregular heartbeat, and is usually caused by abnormal electrical activities in the heart. Over a period of time, heart arrhythmia can also cause heart failure.
Hyperthyroidism - Hyperthyroidism is characterized by excessive production of the hormone thyroxine by the thyroid gland. Hyperthyroidism accelerates the rate of metabolism, and causes irregular or rapid heartbeat. It can also put more pressure on the heart by increasing the amount of blood and oxygen required by the body.
Other Causes - Apart from the aforementioned conditions, sometimes congestive heart failure can also be associated with damaged heart valves, hemochromatosis, amyloidosis, anemia, and exposure to toxins, cocaine, and chemotherapy agents.
Certain factors can increase the risk of congestive heart failure. The main risk factors for this condition are:
✦ Age
✦ Smoking and alcohol abuse
✦ Obesity
✦ Sedentary lifestyle
✦ High blood pressure
✦ Diabetes
✦ Family history of heart failure
✦ Metabolic syndrome
✦ Diet high in cholesterol and saturated fats
✦ Excessive intake of salt
✦ Prior episodes of heart attacks
Symptoms of CHF
The symptoms of congestive heart failure are usually not so specific, especially in the elderly. Symptoms like shortness of breath with exertion and exercise intolerance can be sometimes considered a normal part of aging, rather than the symptoms of heart problems. Nevertheless, the following are some of the most commonly observed symptoms of congestive heart failure:
✦ Shortness of breath with little exertion
✦ Edema or fluid retention (especially in the legs and ankles)
✦ Exercise intolerance
✦ Productive cough
✦ Increased fatigue
✦ Breathing problems, especially when lying down
Fluid retention or edema is usually caused by the failure of the right side of the heart. When the right side of the heart is affected, the heart fails to pump blood to the lungs effectively. This results in the accumulation of blood in the veins. Eventually fluid begins to collect in the legs and feet and cause pitting edema, the type of edema where you can see an indentation for some time after applying pressure on the swollen area.
On the other hand, when the left side of the heart is affected, one can experience shortness of breath with physical exertion and also when lying down. Failure of the left side of the heart can cause pulmonary edema, where fluid accumulates in the lungs. Due to pulmonary edema, the airways fail to expand completely when the affected individual inhales. This can manifest in breathing problems besides causing a productive cough.
Diagnosis of CHF
Sometimes, the symptoms of congestive heart failure, like shortness of breath, can be confused with the symptoms of other respiratory ailments. Therefore, physicians evaluate the medical history of a patient along with conducting physical examinations in order to make a definitive diagnosis. The tests and examinations that are used for the diagnosis of congestive heart failure are:
✦ Chest X-ray and MRI
✦ Echocardiography
✦ Electrocardiogram (ECG)
✦ Exercise stress test
✦ Lung function test
✦ Angiography
✦ Blood tests
Treatment for CHF
Treatment for congestive heart failure depends on its underlying causes. If it is caused by coronary artery disease, cardiomyopathy, or a defect in the heart valves, then corrective surgery can be required at times. Sometimes, severe congestive heart failure can also require heart transplantation. Physicians also recommend a number of drugs to treat and relieve the symptoms associated with this condition. Medications that are usually prescribed by physicians for the treatment of congestive heart failure are:
✦ ACE inhibitors
✦ Angiotensin II (A-II) receptor blockers
✦ Beta blockers
✦ Aldosterone antagonists
✦ Digoxin
✦ Diuretics
✦ Nesiritide
Prevention of CHF
Along with medications, lifestyle and dietary changes are also recommended to manage congestive heart failure, and prevent it from worsening. Patients of congestive heart failure are usually advised to limit the consumption of alcohol and caffeine, and avoid smoking. They should also follow a low-fat and low-sodium diet to lower their blood cholesterol levels and regulate blood pressure. They should get adequate rest and keep stress and depression at bay. In addition to these, it is important to remain physically active by doing some gentle or moderate exercise, in order to lower the risk of heart failure.
Prognosis of heart failure in the elderly depends on several factors, such as the severity of the underlying heart disease, and the age of the elderly. The five-year survival rate for elderly patients with heart failure is estimated to be less than 35%. But, prognosis or outlook of heart failure is expected to improve in the near future with the development of more effective drugs and treatment options.
The symptoms of congestive heart failure can worsen rapidly, and therefore require immediate medical attention. So, if you experience any of the symptoms of congestive heart failure, especially shortness of breath that makes it difficult to sleep or lie down, unusual fatigue, and swelling in ankles and legs, then consider calling 911 or your local emergency number for medical help.
Disclaimer: This article is for informative purposes only, and should not be treated as a substitute for professional medical advice.