Heart Failure -Ttypes And Stages

Heart Failure -Ttypes And Stages

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Every person’s body relies on the pumping heart to bring nutrient- and oxygen-rich blood to each of its cells.

Heart failure occurs when your heart muscle has become so weak that it cannot pump blood around the body effectively or fill properly with blood. As a result, the muscles and organs of the body do not receive enough oxygen and nutrients. This may cause fluid to build up in your body and make you feel short of breath or tired. 

Heart failure is a long-term situation that gets worse over time. This disease is more common in the elderly and can be life-threatening.So knowing what is a sign of worsening heart failure? can be a necessary issue.

This disorder, which is also called decompensated heart failure, is a serious disease that needs treatment, So it should be taken seriously.

The survival rate of people with heart failure depends on the severity of their disease. However, proper treatment will improve the signs and symptoms of heart failure and may contribute to my living longer.

Table of Contents

Types of heart failure

In most cases, heart failure is related to another disease.

Heart failure can occur on the left side of the heart, the right side, or both. It usually starts from the primary pumping chamber of the heart – the left ventricle. Each specific type of heart failure has its own distinctive features:

  • Right heart failure

    In this case, the right ventricle is too weak to pump blood to the lungs. This causes the collection of blood in the veins (blood vessels that return blood from the organs and tissues to the heart).

Increased intraveinal pressure can push fluid out of the veins into the surrounding tissue. As the blood goes back to the blood vessels, the body begins to retain fluids in the abdomen and lower body. Apart from this swelling, patients may also experience shortness of breath among their Right Heart Failure Symptoms.


  • Left heart failure

    It is the most common form of heart failure and starts when the left ventricle can’t pump blood around the body effectively.

As a result, blood pools in the pulmonary veins (the blood vessels that transfer blood away from the lungs). Finally, this can lead to fluid retention throughout the body, especially around the lungs. Common symptoms include swelling, difficulty breathing and coughing.


  • Biventricular heart failure

    This condition is a combination of left and right heart failure. When the damage spreads and both sides of the heart are affected, patients can experience swelling in the body and shortness of breath.

Cases of left-sided heart failure can be further classified into one of two subtypes, characterized by the way the ventricle is affected:

    • Systolic heart failure

      It happens when the left ventricle cannot contract with enough force to circulate blood properly. As the left ventricle strains to do work, it can become thin and weak, leading to backward blood flow, fluid accumulation, and swelling.

    • Diastolic heart failure

      It occurs when the heart muscle tightens. Because the chamber must relax to fill with blood between contractions, this tightness means that insufficient blood is available to pump to the rest of the body. This can lead to shortness of breath, wheezing, fatigue, irregular heartbeat, and swelling.

    • Mild heart failure

      Fortunately, a large number of people who experience mild heart failure make a full recovery after a considerable period of time. Mild heart failure is not very dangerous. 

Of course, those who suffer from this deficiency usually have an unhealthy lifestyle, and there is a possibility that they will be caught again later. Also, the name of heart failure is scary and life-threatening.

Mild heart failure can be completely resolved in up to 50% of cases, but in cases that remain in a person, it can be very dangerous and cause permanent complications in the person. Those who develop complications and develop serious problems usually live for five years, less or more.

Most of the time, this complication is caused by damage to the heart or various types of heart disease. Of course, heart failure also occurs if the heart muscle becomes too tight. The main area of blood pumping is the ventricles. 

The ventricles may stiffen and fail to fill properly with each heartbeat. Over time, the heart has problems and cannot deliver blood to the rest of the body.

In this situation, the doctor measures the amount of blood pumped and determines whether the heart is healthy or not. If there is a problem, the classification of failure is done with this method, and appropriate treatment is selected according to its level. 

This amount is called ejection fraction, and it should be at least 50% in a healthy heart. It means that 50% of the blood entering the ventricle must be pumped out.

However, if a person suffers from heart failure due to factors such as high blood pressure, the ejection fraction has a normal value, and the problem is the hardening of the heart muscle. 

Failure can affect the left side (left ventricle), the right side (right ventricle), or both sides of the heart. In most cases, failure starts from the left ventricle.

Different stages of heart failure

Heart failure is a severe illness that worsens over time. There are four stages of heart failure, which include a healthy heart with a high risk of failure (stage I) to advanced failure (stage D), Treatments can vary from non-surgical treatments for hrart failure to surgical treatments for heart failure. In other words, each stage has a special treatment plan. Ask your doctor what stage of heart failure you are in.

As heart failure progresses, the amount of blood being pumped to your organs decreases, and the failure progresses to a higher stage. If failure develops, it is unlikely to return. For example, a patient who has entered stage “B” of failure in most cases will not be able to return to stage “A”; for this reason, the goal of treatment is simply to prevent or slow down the progress of the disease.

The treatment plan changes as each stage changes and can include medications, lifestyle modifications, and therapeutic devices implanted in your heart. You can compare the treatments you are receiving with the list below and ask your doctor for more information about them. These treatment plans may, of course, change based on new studies.


stage “a”

This stage is considered pre-failure, and it means that you have a high risk of developing heart failure due to the following risk factors.

  1. high blood pressure
  2. diabetes
  3. Coronary artery disease
  4. Metabolic syndrome
  5. History of alcohol abuse
  6. History of rheumatic heart disease
  7. Family history of heart muscle disease (cardiomyopathy)
  8. History of taking drugs that damage the heart (such as some chemotherapy drugs)


  • “A” stage treatment

    • The usual treatment plan at this stage is:
    • Regular physical activity, being active and walking daily
    • No smoking
    • High blood pressure treatment (medication, low sodium diet, and lifestyle modification)
    • Treatment of high blood cholesterol
    • Not using alcohol or other stimulants and narcotics
    • Use of medications, including angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, if you have diabetes, high blood pressure, or other vascular disorders. In addition, you should note that there are drugs that should be avoided in heart failure that you must be aware of.


stage “B”

This stage means that your left ventricle is functioning abnormally, but you do not have any signs or symptoms of failure. Most patients in stage B have an ejection fraction of 40% or less on echocardiography. This stage includes those who have heart failure with reduced left ventricular function for any reason.


  • “B” stage treatment

    • The treatments that were mentioned in the “A” stage.
    • Angiotensin-changing enzyme inhibitors or angiotensin II receptor blockers, if not prescribed in the previous stage
    • Beta-blockers if you have had a heart attack and your ejection fraction is less than 40%
    • Aldosterone antagonists if you have had a heart attack or have a combination of diabetes and an ejection fraction of less than 35% (these drugs reduce the risk of the heart becoming enlarged and failing)
    • Interventional and surgical treatments to correct coronary artery blockages, valvular diseases, or congenital heart diseases.


Stage “C”

  1. Patients’ heart failure has been diagnosed at this stage and has been symptomatic at present or in the past. Symptoms of this stage include:
  2. Shortness of breath
  3. fatigue
  4. Low ability for physical activity
  5. Weakness in the legs
  6. Waking up to urinate urgently
  7. Swelling of the legs and abdomen

  • Treatment of this stage

    • Treatments mentioned in steps “a” and “b”
    • Beta-blockers (if not already prescribed) to improve the ability of your heart muscle
    • Aldosterone antagonists (if you are not already using them) if vasodilators such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and beta-blockers are not enough to improve your symptoms
    • A combination of hydralazine and nitrates if your symptoms persist in some patients
    • Medicines are used to reduce heart rate if your heart rate is more than 70 beats per minute.
    • Diuretics for those who are still symptomatic with previous treatments
    • Limit sodium intake in the diet. Ask your doctor about the permissible amount
    • Monitor your weight daily and inform your doctor if you lose or gain more than 2 kg
    • Restriction of fluid intake. Ask your doctor about the permissible amount
    • Putting on an intraventricular pacemaker if needed
    • Operation of the defibrillator (internal shock device) if needed


Stage “D with reduced left ventricular function”

Patients who are in this stage have symptoms that do not respond well to treatment, and it is the last stage of heart failure.


  • The treatment plan includes:

    • The treatments mentioned in the previous steps
    • Investigating the possibility of a heart transplant, ventricular contraction assist device, heart surgery, continuous infusion of inotropic drugs, palliative treatments, and treatments that are in the research phase.

Note: If the patient needs heart transplant surgery. It should be noted that Heart Transplant Aftercare will be very important for maximum impact on recovery.


Stages “C” and “D” with preserved left ventricular function

In this situation, the treatment plan will include the following:


  • Treatments listed in steps “a” and “b”

    • Drug treatment of diseases that can cause or worsen heart failure, such as diabetes, atrial fibrillation, high blood pressure, obesity, coronary artery disease, chronic lung disease, high cholesterol, and kidney disease
    • Taking diuretics to relieve symptoms
    • In short, there are four stages for this disease, including stages A, B, C, and D. These stages vary from a high risk of developing this disorder to an advanced type. The stages of the complication are as follows:
    •        Stage A: the person is not yet diagnosed with the disorder But you are at higher risk because of one or more pre-existing conditions such as coronary artery illness, high blood pressure, or diabetes.
    •        Stage B: the person does not have the disease or its symptoms, But he has received the diagnosis of left shoulder pain and heart disease.
    •        Stage C: The person has symptoms and currently has heart disease that will require advanced treatment.
    •        Stage D: The person is suffering from an advanced type of disease that requires specialized treatment.


Heart failure occurs when the heart is unable to pump blood properly. As a result of this problem, fluid accumulates in the lungs and leads to difficulty in breathing. 

Gender differences such as anatomy, red blood cell count, and hormones cause different experiences of these diseases between men and women. Therefore, the initial symptoms and warning signs for women’s heart disease can be different from men. But in general, it includes fatigue, sudden weight gain, loss of appetite, persistent cough, etc.

There are various medical and surgical treatments to treat this condition. If the drugs do not affect the person, the doctor recommends various surgical methods. The life expectancy of heart failure patients after diagnosis is likely to be five years or more.

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Author and specialist

Dr. Majid Zahrabi,


  • Board Certified Neurosurgeon
  • DHA certificate holder
  • Plantation certificate holder, France
  • Certified holder of Discogol, France
  • A pioneer in the non-surgical treatment of disc herniation in the Middle East and CIS countries.
  • Under the training and coaching of Professor Jacques Theron (founder of Discogel Therapy) since 2008
  • More than 400 successful cervical and 1300 lumbar discogel injections
  • Trained and certified several neurosurgeons and spine surgeons in the Middle East and CIS countries for the treatment of Discogel
  • Strong belief in patient-centered care planning and participation
  • Neurosurgeon and spine surgeon at Imam Khomeini and Amir Mazandarani Hospital, Sari, Iran, with more than 430 surgeries annually, 2000-2011
  • Neurosurgeon and spine surgeon at Farmaniyeh, Nikan and Yas Sepid Hospital, Tehran, Iran, with more than 400 surgeries annually, 2011-2012
  • Neurosurgeon at Iranian Hospital, Dubai, 2022-2023
  • Since 2015, he has been working as a reference doctor for the treatment of intervertebral disc herniation with Discogel and has trained many doctors of spine-related specialties in various countries of the Middle East and CIS in person/practically and online.



  • Individual training sessions under the direct supervision of Professor Jacques Theron in Discogel treatment, 2008-2020
  • Training sessions under the supervision of Professor Thierry Boye on spinal implants, 2007
  • Participation and presentation in several national and international medical and neuro-spinal conferences
  • Board certificate by Iran Neurosurgery Board, 2001
  • Neurosurgery assistant training course, Isfahan University of Medical Sciences, Isfahan, Iran, 1996-2001 (In 2001, he graduated from Isfahan University of Medical Sciences with the first rank in the country.
  • His thesis the titled:The Application of human amniotic membrane in repair of dura matter in dogs.” ( It was happening for the first time in the world. )
  • General medical education, Tabriz University of Medical Sciences, Tabriz, Iran, 1984-1993


Published books:

  • CT scan of the brain for doctors
  • Etiology and treatment of painful spine disorders
  • Atlas of diagnosis, prevention, and treatment of spine disorders
  • The most common mistakes in the treatment of spinal disorders
  • Reading brain CT scan in simple language (3rd place in the book of the year)
  • Treatment of head and spine injuries

Publications and articles:

  • Bacteriostatic and bactericidal effects of DISCOGEL® (https://www.researchgate.net/)
  • Muscle recovery, reduction of pain, and improvement of movement strategies in patients with lumbar discopathy after injection of Discogel.
  • The article on the initial results of the treatment of intervertebral disc herniation with discogel injection, which won the second-best poster rank at the Pan Arab International Congress of Interventional Radiology (March 14-16, 2015) and was accepted for presentation at the Chicago Pain Congress.
  • The use of human amniotic membrane in dura mater repair in dogs, a study for the first time in the world.



  • Annual Congress of Physiotherapists of Iran, 2019
  • Chicago International Pain Congress, 2019
  • Iran International Pain Management Congress, 2018
  • Annual Congress of Physiotherapists of Iran, 2018
  • Presentation of Discogel as an innovative solution for the treatment of spinal disc herniation in Armenia for orthopedic specialists and neurosurgeons, 2017
  • First Live Workshop and Seminar on Minimally Invasive Disc Therapy (DISCON), 2017
  • Presentation of Discogel as an innovative solution for the treatment of spinal disc herniation in Azerbaijan for orthopedic specialists and neurosurgeons, 2016
  • Seminar of Iranian official managers, 2016
  • Presentation of Discogel as an innovative solution for the treatment of spinal disc herniation in Tajikistan for orthopedic specialists and neurosurgeons, 2016
  • International Neurological Intervention Congress in Iran, 2014
  • Educational seminar for nurses on treatment approaches for head and spine trauma, 2014
  • Educational seminar for general practitioners on treatment approaches for head and spine trauma, 2014
  • Speech at the Retraining Seminar for General Practitioners and Specialists in Dubai (Discon) in 2017
  • Speech in the internal retraining courses of Irani Hospital, Dubai
  • Holding lecture sessions and practical workshops on the treatment of intervertebral disc herniation with discogel injection in Azerbaijan, Tajikistan, Ukraine, Oman, and Armenia during the years 2015 to 2021.
  • Giving a lecture and holding a practical workshop for neurosurgeons in Vietnam at Ho Chi Minh City University in 2023

Dr. Majid Zohrabi started treating his patients in Dubai in 2022 and continues his activities in private medical centers in the UAE.