A Doctor and Dietitian Talk About Heart Failure

Written by Lori A. Stevens RD, LDN, Reviewed by Jessica Noelle Stevens, MD

So, you’ve been diagnosed with CHF.  It can be overwhelming and more than a little scary. What is CHF anyway? What is heart failure? Are they the same? What does it all mean for your life? Learn about the stages of heart failure and learn tips to manage your diagnosis and improve your quality of life.

Feelings of fear, frustration, and confusion are totally understandable.  The word failure alone sounds ominous. Does this mean your heart is about to stop? Is it going to get worse? How quickly will it get worse? And most importantly, what should you do now?

This article sums up the types of heart failure, defines CHF, and gives you the information you need to live your best life despite your diagnosis. Let’s break it down. 

What is Heart Failure?

Having heart failure means your heart is not pumping blood as well as it should. The job of your heart is to deliver nutrients and electrolytes throughout the body, allowing your muscles and vital organs to work properly. The body is an interconnected system, and the heart, along with the blood vessels connect it.

Heart failure can cause many problems, including fluid buildup throughout the body. Fluid buildup in your lungs can make it harder for you to breathe, causing coughing, fatigue, and swelling of your feet, legs, and hands. Edema is the medical term for swelling or puffiness caused by excess fluid in body tissues.

What is Congestive Heart Failure?

CHF is an abbreviation and stands for congestive heart failure.  The term “congestive” is used to describe the accumulation of fluid, and is often used interchangeably with “heart failure.” However, it is important to note that not all cases of heart failure involve fluid accumulation and congestion. The term “heart failure” encompasses a wider range of symptoms and stages of the condition, while “congestive heart failure” is a specific stage of the disease.

I used the name “The CHF Dietitian” for my blog because the most common referral I receive is for CHF. However, this blog is for all people diagnosed with heart failure, no matter the cause.

An older couple are outside.  The woman is on a swing. She is looking lovingly at a man standing next to the swing. They are managing a diagnosis of heart failure.
You can enjoy life despite a heart failure diagnosis

What are the Three Main Types of Heart Failure?

  • Left-sided Heart Failure with Reduced Ejection Fraction

Left-sided heart failure with reduced ejection fraction, also known as systolic heart failure, is a type of heart failure in which the left ventricle of the heart is unable to pump blood efficiently. This is the most common type of heart failure. The left ventricle’s pumping ability, or ejection fraction, is reduced, meaning that it is not contracting as strongly as it should. This results in a buildup of blood in the lungs, making it difficult to breathe.

  • Left-Sided Heart Failure with Preserved Ejection Fraction

Left-sided heart failure with preserved ejection fraction, also known as diastolic heart failure, is a type of heart failure in which the left ventricle of the heart is unable to relax and fill with blood properly, even though the left ventricle’s pumping ability (ejection fraction) is still normal. This type of heart failure also results in a buildup of blood in the lungs, making it difficult to breathe.

  • Right-Sided Heart Failure

Right-sided heart failure, also known as right ventricular failure, occurs when the right ventricle of the heart is unable to pump blood efficiently. The right ventricle is responsible for pumping blood to the lungs to pick up oxygen, and when it fails, it results in a buildup of blood in the veins and other parts of the body.

Right-sided heart failure is often a result of left-sided heart failure. When the left ventricle fails to pump blood efficiently, it puts additional strain on the right ventricle, leading to right-sided heart failure. Other causes of right-sided heart failure can include lung disease, congenital heart disease, and certain medical conditions such as pulmonary embolism (a blood clot in the lungs).

Symptoms of right-sided heart failure can include shortness of breath, fatigue, swelling in the legs, ankles, and abdomen, and rapid or irregular heartbeat.

Four Stages of Heart Failure 

Heart failure has four stages and tends to progress over time, although medications and lifestyle changes can greatly slow this process.   

  • Stage A Pre heart failure–You are at high risk of developing heart failure but there are no changes in the actual heart structure yet.  You likely have high blood pressure and a strong family history of cardiomyopathy, coronary artery disease, and autoimmune disease affecting the heart such as rheumatic fever. 
  • Stage B In this stage, there are some structural changes to the heart, and the measurement that we call “ejection fraction” is affected.  A normal ejection fraction is 50-75%.  In stage B, the ejection fraction is decreased–typically 40% or less. 
  • Stage C In this stage, you will be experiencing symptoms.  There has been some weakening of the left ventricle and the heart is not pumping as well.  You may feel tired more easily and you may notice some swelling, called edema.  Edema is usually noticed in your legs and feet but can occur throughout your body. 
  • Stage D This is the most severe stage of heart failure and you will likely experience some shortness of breath, fluid retention, and fatigue.  It is especially important to continue to take the prescribed medications, follow your doctor’s instructions, and eat a heart failure diet. While heart failure cannot be reversed at this stage, there are many treatments available that can slow or stop the worsening of your disease. 

What Happens Next? 

The good news is that medications and lifestyle changes can help no matter what stage of heart failure you have.  Your physician can help you with medications. It’s up to you to work on eating well and keep active, within your doctor’s recommendations. 

Lifestyle changes are a challenge!  Let’s face it, changing how you eat is hard, but dietary changes will make a huge difference.

For activity, you may be able to participate in a cardiac rehabilitation program which will help your build strength in a safe way, based on your specific needs. Check with your physician.

The CHF Dietitian is here to help you no matter what type or stage of heart failure you have!  Good nutrition will help you manage your symptoms, slow the progression of your disease, and live a healthier, happier life. 

Managing Heart Failure with Diet 

Your physician may have told you to follow a “low sodium” or “low salt diet”.  Salt is actually the common name for the combination of sodium and chloride.  You may see it called salt in some places and just sodium in others.  Don’t let that confuse you.  I will use the word sodium in most places on this site. 

Sodium causes your body to retain fluid and can make swelling worse, which is hard on your heart, kidneys, and other organs.  The current recommendations by the American Heart Association are to limit your sodium to 2300mg per day.  For those with more severe heart failure, your physician may have told you to strive for 1500mg per day. 

Whatever your physician’s recommendation, it is important to follow it, take your medications, and keep your follow-up appointments!

While it sounds easy, decreasing sodium can be complicated because salt is hidden in many foods that don’t even taste salty, like bread.  You will need to learn to estimate your daily intake, read labels and find the best low sodium options.  You will also need to learn new ways to prepare flavorful foods because we all know it’s much easier to stick to a healthy eating plan if you are enjoying what you eat! 

Here is an article by the American Heart Association detailing their sodium recommendations. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day

There is another very important thing you can do to help manage CHF and slow its progression.  Eating foods that are good for your heart while avoiding foods that worsen heart disease is just as important as lowering your sodium. That’s because coronary artery disease and high blood pressure are the two most common causes of heart failure. 

The articles on this site will help you eat a heart-healthy diet, manage your symptoms, and discover delicious new low sodium recipes.  Follow along for tips, tricks, education, and all the information you need to stay on track. 

So jump on over to my article on nutrition and heart failure. Let me know what you think! Six Tips for Heart Failure Nutrition—Getting Started 

Don’t forget to sign up for my free email list to stay up to date on the latest heart failure nutrition information!

References: Heart Failure: Types, Symptoms, Causes & Treatments. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure. Accessed October 2022. 


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