What is Congestive Heart Failure?

Congestive heart failure (CHF), or heart failure, is a condition in which the heart can't pump enough blood to the body's other organs. This can result from

* narrowed arteries that supply blood to the heart muscle - coronary artery disease.
* past heart attack, or myocardial infarction, with scar tissue that interferes with the heart muscle's normal work.
* high blood pressure.
* heart valve disease due to past rheumatic fever or other causes.
* primary disease of the heart muscle itself, called cardiomyopathy.
* heart defects present at birth - congenital heart defects.
* infection of the heart valves and/or heart muscle itself - endocarditis and/or myocarditis.

The "failing" heart keeps working but not as efficiently as it should. People with heart failure can't exert themselves because they become short of breath and tired.

As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down.

About five million Americans are living with heart failure, and between 400,000 and 700,000 new cases are diagnosed every year. Heart failure is serious and can be life-threatening. About 250,000 people die annually of heart failure.

Common Symptoms?

Shortness of breath - If you have congestive heart failure, you may have difficulty breathing, especially when you lie down. This happens because you have to work a little harder to breath when you lie down because of the fluid in your lungs. You may awaken at night short of breath and have to sit or stand up to get relief. You may find yourself more comfortable with your head and chest elevated. As the buildup of fluid in the lungs become very severe, you may cough up frothy, pink liquid.

Exercise Intolerance - You may find yourself unable to tolerate exercise or even mild physical exertion. This happens because a failing heart cannot pump quite enough blood to provide all the oxygen and other nutrients your body needs while it is exercising. Your ability to exercise, even to walk at a normal pace, may be limited by feeling tired (fatigue) and shortness of breath.

Fluid Retention and Swelling - You may notice puffy swelling (edema) in your legs, feet, and ankles. Often, the swelling is more noticeable in the ankles or on the lower leg in the front where the bone is close to the skin. If you press down on the skin in the puffy areas, the indentation where your finger pressed may be visible for a few minutes. This swelling may be so severe as to reach up to the hips.

What Causes Congestive Heart Failure?

Heart failure often occurs because other cardiac conditions have damaged or weakened your heart, forcing it to work harder. A weakened heart can't pump blood efficiently throughout your body. This causes blood to pool in your legs, feet and ankles, your kidneys to retain excess water and sodium, and fluid to back up into your lungs, leading to shortness of breath.

Heart failure often results from the stress of a heart attack, high blood pressure, or other forms of heart disease such as valve disorders. In fact, all of the behaviors that you probably associate with heart attack or heart disease - such as smoking, being overweight, eating foods high in cholesterol and fat, and not exercising - also cause or contribute to heart failure. Sometimes, your heart becomes weakened without explanation, a condition known as idiopathic dilated cardiomyopathy.

If you have heart failure, chances are you've had one or more of the following conditions:

* Hypertension (high blood pressure)
* Coronary Artery Disease
* Heart attack
* Faulty heart valves
* Cardiomyopathy
* Heart defects present at birth (congenital heart defects)
* Abnormal heart rhythms (heart arrhythmia)

Treatments for Congestive Heart Failure

If you have heart failure, your doctor will monitor you closely. This means having follow up appointments at least every 3 to 6 months, figuring out any underlying cause and treating it, and periodic testing of your heart function. For example, an ultrasound of your heart, called an echocardiogram, will be done once in awhile to give an estimate of how well your heart is pumping blood with each stroke or beat.

It is also your responsibility to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that the pump function of your heart is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.

Other important measures include:

* Take your medications as directed. Carry a list of medications with you wherever you go.
* Limit salt and sodium intake.
* Don't smoke.
* Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan based on your degree of heart failure and how well you do on tests that check the strength and function of your heart. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.
* Lose weight if you are overweight.
* Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.


Medications that your doctor will consider prescribing include:

* ACE inhibitors such as captopril and enalapril -- these medications open up blood vessels and decrease the work load of the heart. These have become an important part of treatment
* Diuretics -- there are several types including thiazide, loop diuretics, and potassium-sparing diuretics; they help rid your body of fluid and sodium.
* Digitalis glycosides -- increase the ability of the heart muscle to contract properly; prevent heart rhythm disturbances
* Angiotensin receptor blockers (ARBs) such as losartan and candesartan which, like ACE inhibitors, reduce the workload of the heart; this class of drug is especially important for those who cannot tolerate ACE inhibitors
* Beta-blockers -- this is particularly useful for those with a history of coronary artery disease

Additional Information

American Heart Association (AHA)
7272 Greenville Ave.
Dallas, TX 75231
Toll-Free: (800) 242-8721
Fax: (214) 706-2139

National Heart, Lung and Blood Institute (NHLBI)
6701 Rockledge Dr.
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573