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Congestive Heart Failure

Nurse listening to patient 's heartCongestive heart failure (CHF) is one of the most common reasons for hospitalization of patients age 45 and above. 

CHF is a serious condition in which the heart is unable to pump well enough to meet the body's need for oxygen. The term "congestive heart failure" comes from the failure of the heart to pump efficiently, resulting in congestion in the lungs by blood flowing back into the heart. The heart tries to make up for this by pumping harder and the situation grows worse. When the congestion occurs, patients experience shortness of breath. In the beginning this happens during exercise but as the condition worsens, patients will become short of breath even while they are resting. Initially patients may experience minor symptoms, such as swelling of the ankles. Often these symptoms are so minor that patients don't seek medical attention until damage to the heart has already occurred. The longer the heart has to over-work to make up for its inadequacy, the more the pumping ability is damaged.

What can lead to heart failure?

Some of the conditions that can lead to CHF include: 

Coronary artery disease: This is one of the most common causes of heart failure. This is a chronic disease that is sometimes referred to as "hardening of the arteries." The arteries become narrow and stiff and the free flow of blood is blocked. The reduced blood flow to the heart weakens the heart muscle.

High blood pressure: About 75 percent of all patients with CHF have been previously diagnosed with hypertension (high blood pressure). Uncontrolled high blood pressure causes the heart to work harder to pump blood under high pressure throughout the body.

Heart attack: After a heart attack, part of the heart is replaced with scar tissue and this makes the heart a less efficient pump. The weakened heart muscle fights to pump blood and the fibers stretch. This results in enlarged and damaged chambers in the heart.

Disease of the heart valves: Narrowing or leaking of one or more heart valves restricts blood flow within the heart and/or to the rest of the body. There may also be infection in the heart valves. Less commonly, disease of the heart valves may be caused by rheumatic heart disease.

Cardiomyopathy: This is a chronic heart condition where the heart becomes abnormally enlarged and thick. This severely weakens the ability of the heart to pump blood.

Congenital heart disease: A problem that is present from birth. This can involve defects in the heart or blood vessels.

Severe lung disease, such as pulmonary hypertension: When the right side of the heart can't produce enough strength to pump blood through diseased lungs, congestive heart failure can occur. 

Signs & Symptoms of Heart Failure 

  • Shortness of breath (also referred to as "dyspnea"). This is one of the earliest signs of heart failure. The patient will become winded and more fatigued just by doing regular activities. There is decreased tolerance to exercise.
  • Swelling of the legs. This is an early sign of heart failure, although it can also be caused by unrelated conditions.
  • Swollen neck veins
  • Mental confusion
  • Palpitations
  • Kidney malfunction (usually in the latter stages of heart failure) 

Treatment of heart failure

The earlier heart failure is detected and treated, the better the patient's long-term outlook. Lifestyle changes are advised and these include:

  • Regular exercise as approved by your physician
  • Schedule rest periods throughout the day
  • Stay away from excessive fluid intake
  • Limit the amount of salt you use — follow the diet prescribed by your physician
  • Completely avoid alcohol
  • Do not smoke
  • Keep a daily diary of your weight and notify your physician if you gain three or more pounds in a week. Weight gain may be a sign of fluid retention and the need for more intensive treatment. Failure to properly monitor your weight and take action could result in an emergency situation. Medications also are used to treat heart failure.

Depending on the cause of your heart failure and the damage that has occurred to your heart, medications may be used to reduce the heart's workload, remove excess fluid from your body, or widen the blood vessels to increase blood flow. 

Types of medicines used include:

  • Ace Inhibitors: The National Institutes of Health has reported that use of ACE Inhibitors has been the most important development in CHF survival rate improvement over recent years.  ACE Inhibitors lower blood pressure so your heart doesn't have to work as hard to pump blood.
  • Angiotensin Receptor Blocker (ARB): lowers blood pressure.
  • Diuretics ("water pills"): these help flush extra salt and water from your body.
  • Beta Blockers: Lowers blood pressure and slows heart rate.
  • Digoxin: This drug helps improve the effectiveness of the heart's pumping action.
  • Cardiotonics: These are powerful intravenous drugs that increase the force of the heart's pumping, thereby allowing the heart to beat less frequently and more effectively.

Click here for the Heart Failure Control Plan

Visit the American Heart Association to learn more about heart disease.