Congestive Heart Failure
What is congestive heart failure?
Congestive heart failure, also called CHF or heart failure, is a serious and complex disease in which the heart muscle has been damaged or has to work too hard because of heart disease and other conditions, such as obesity. Although the heart continues to beat, the damaged heart muscle is too weak to efficiently pump enough oxygen-rich blood to and from the body, resulting in potentially life-threatening congestion in the lungs and other tissues of the body.
Congestive heart failure is a common complication of heart attack and other types of heart disease that damage the heart muscle. These diseases include hypertension, heart valve disorders, arrhythmias, and cardiomyopathy. Congestive heart failure can also be caused by anemia.
In general, congestive heart failure affects both the left and right sides of the heart, but it can affect one side more than the other, depending on the location and severity of damage.
In left-sided CHF, the left side of the heart is damaged and unable to effectively pump blood from the heart to the body. This results in blood backing up into the lungs and increasing blood pressure in the lungs. The increase in pressure causes a buildup of fluid in the lungs, which can lead to a life-threatening condition called acute pulmonary edema.
In right-sided CHF, the right side of the heart is damaged and unable to effectively relax to permit blood flowing from the body back into the heart. This results in a backup of blood and an increase in pressure in the veins that carry blood from the body to the heart. In turn, this leads to swelling (edema) of the lower extremities and sometimes of other areas of the body.
Acute CHF, in which fluid builds up rapidly in the lungs and causes pulmonary edema, is an immediately life-threatening condition that can quickly lead to respiratory failure, cardiac arrest and death. Immediate emergency treatment best minimizes the risk of these and other serious complications of heart failure. Seek immediate medical care (call 911) if you, or someone you are with, have symptoms of acute congestive heart failure, such as shortness of breath, difficulty breathing, congested cough, and chest pain. If you do not have the above symptoms, but have swelling in the extremities, abdomen or face, seek prompt medical care.
What are the symptoms of congestive heart failure?
Congestive heart failure symptoms are due to a lack of oxygen in the tissues of the body caused by a damaged heart that cannot pump blood efficiently. Symptoms can vary between individuals and can differ depending on the severity of the disease and the side of the heart affected (left side, right side, or both sides).
It is common to have some symptoms of both left-sided and right-sided congestive heart failure. Early symptoms may develop slowly, and in some cases, you may not have noticeable symptoms until congestive heart failure has progressed and become severe.
Symptoms of right-sided congestive heart failure
The primary symptom of congestive heart failure caused by damage to the right side of the heart is swelling (edema) of the feet and ankles. In more severe cases, edema can extend to the legs, abdomen, upper extremities, and face.
Symptoms of right-sided congestive heart failure include:
- Malaise (feeling sick)
- Swelling (edema), which may include swelling of the feet, ankles, legs, abdomen, arms and face
Symptoms of left-sided congestive heart failure
The primary symptom of congestive heart failure caused by damage to the left side of the heart is shortness of breath and difficulty breathing (dyspnea) due to a buildup of fluid in the lungs. A buildup of fluid in the lungs is called pulmonary edema.
Shortness of breath and difficulty breathing can occur at rest or with exertion and often occurs when lying down, which can interrupt sleep. In mild cases, shortness of breath can be relieved to various degrees by sleeping in a semi-upright position.
Congestion and fluid in the lungs also lead to wheezing, chest pain, and an ongoing cough that brings up frothy phlegm that may be tinged with blood.
Serious symptoms that might indicate a life-threatening condition
Left-sided congestive heart failure can result in an immediately life-threatening condition called acute pulmonary edema, a sudden buildup of fluid in the lungs. Seek immediate medical care (call 911) if you, or someone you are with, have symptoms of left-sided congestive heart failure including:
Anxiety and restlessness
Change in level of consciousness or alertness, such as passing out or unresponsiveness
Cold, clammy skin
Fatigue and weakness
Loose, wet cough that may produce frothy and possibly blood-tinged phlegm
Pallor (an extremely pale or grayish coloring) or cyanosis (a bluish coloring of the nails, lips and possibly the skin)
Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking
What causes congestive heart failure?
Congestive heart failure is a common complication of heart diseases and conditions that damage the heart muscle or make it work too hard. This makes the heart weak and unable to pump blood effectively through the body. Diseases, disorders and conditions that can cause congestive heart failure include:
Advanced age (65 years and older)
Atherosclerosis and coronary artery disease (buildup of plaque on the walls of the coronary arteries; atherosclerosis is a type of arteriosclerosis)
Cardiac arrhythmias (abnormal heart rhythms)
Cardiomyopathy (diseased heart muscle)
Congenital heart diseases (heart diseases or abnormalities present at birth)
Diabetes (chronic disease that affects your body’s ability to use sugar for energy)
Heart attack, also called myocardial infarction (death of heart tissue due to a lack of oxygen)
Hypertension (high blood pressure)
Hyperthyroidism (overactive thyroid)
Myocarditis (type of inflammation of the heart)
Severe anemia (low number of red blood cells)
What are the risk factors for congestive heart failure?
Diseases and conditions that increase the risk of developing heart disease or cardiovascular disease also increase the risk of eventually developing congestive heart failure as a complication. Risk factors include:
African American ancestry
Atherosclerosis and coronary artery disease (buildup of plaque on the arteries that supply the heart)
Diabetes (chronic disease that affects your body’s ability to use sugar for energy)
Excessive alcohol consumption
Family history of heart disease or cardiovascular disease
Hypertension (high blood pressure)
Having high levels of certain substances in the body, which can be determined by blood tests, can also increase the risk for heart disease and congestive heart failure. These include:
High cholesterol, which can lead to atherosclerosis
High C-reactive protein level, which reflects inflammation
High homocysteine level, which may damage artery walls and increase the risk of developing blood clots. Blood clots can cause a heart attack and lead to congestive heart failure.
Reducing your risk of congestive heart failure
You can reduce your risk of developing heart disease and congestive heart failure by:
Eating a heart-healthy diet that is low in saturated fat and trans fats and high in fiber, whole grains, fruits, and vegetables
Limiting alcohol intake to one drink per day for women and two drinks per day for men
Maintaining a healthy weight
Participating in a regular exercise program
Reducing excessive stress
How is congestive heart failure treated?
Congestive heart failure is a complex disease that requires a treatment plan that uses a multifaceted approach that is individualized to the type and severity of your congestive heart failure, your risk factors, lifestyle, medical history, age, and other factors. Congestive heart failure is a serious, life-threatening disease, but it is not always fatal. The prognosis depends on the severity of congestive heart failure, the underlying cause, your age and general health, and the presence of coexisting diseases, such as diabetes.
General prevention and treatment measures for congestive heart failure
Treatment for congestive heart failure includes preventive care aimed at minimizing the risk factors for having a heart attack and other forms of heart disease. General preventive and treatment measures include:
Lifestyle and dietary changes to achieve and maintain an ideal weight and fitness level. It is generally recommended that people with congestive heart failure follow a heart-healthy diet that is low in saturated fat, trans fats, and sodium. Excessive salt leads to fluid retention and increases blood pressure.
Periods of prescribed rest
Regular medical care and treatment of risk factors, such as high cholesterol, hypertension, obesity, smoking, diabetes, and excessive alcohol consumption
Medications used to treat congestive heart failure
Treatment of congestive heart failure also includes medications. Medications include:
Aldosterone blockers (Aldactone), which may be used for severe congestive heart failure
Beta-blockers (metoprolol, atenolol and propranolol), which lower blood pressure, control heart rate, and reduce strain on the heart
Cholesterol-lowering medications (statins), which can reduce the risk of heart attack and stroke. Cholesterol-lowering medications also reduce the risk of recurrent heart attack and stroke.
Digitalis drugs (digoxin), which slow and strengthen the beating of the heart to make the heart muscle more effective in pumping blood
Diuretics (Lasix, Bumex, HCTZ), which pull excess fluid out of the lungs and tissues of the body by increasing urine production
Treatment of severe congestive heart failure
Severe congestive heart failure with acute pulmonary edema (a rapid buildup of fluid in the lungs) is often diagnosed and initially treated in an emergency room setting. Treatment includes:
Intensive monitoring and stabilization of heart rhythm and vital signs. In some cases, this may require cardiopulmonary resuscitation (CPR), and advanced life-support measures, such as intubation and mechanical ventilation to support breathing.
Intravenous medications to rapidly draw fluid out of the lungs and reduce strain on the heart
Monitoring your heart rate and rhythm with an electrocardiogram (known as an EKG or ECG) and blood tests to determine the extent of heart damage
Supplemental oxygen to ease breathing and increase the amount of oxygen that is delivered to the heart tissue and the rest of the body
Surgical treatments for congestive heart failure
A variety of surgical procedures may be used in the treatment of some cases of congestive heart failure including:
Angioplasty and stent placement may be recommended for people with congestive heart failure who have severely blocked coronary arteries. In this procedure, the affected artery is widened using a balloon device, and a stent (hollow tube) is placed in the artery to keep it open.
Coronary artery bypass may be recommended for people with congestive heart failure who have severely blocked coronary arteries. In this surgery, new graft arteries are placed to bypass the blocked coronary artery or arteries. Blood flow is then redirected through healthy new graft arteries to the affected heart tissues.
Heart transplant may be needed in severe cases of congestive heart failure in which medications and lifestyle and dietary changes do not improve heart function.
Left ventricular assist device (LVAD) is a device that is connected to the heart. An LVAD helps to improve heart function and may be used as a bridge treatment while waiting for a heart transplant or as a treatment in itself.
Pacemaker may be used in some cases to control abnormal heart rhythms.
Valve surgery repair or replacement of damaged heart valves
Other treatments for congestive heart failure
Other treatments and therapies that may be recommended as part of a complete treatment program for congestive heart failure include:
Cardiac rehabilitation and physical therapy can help strengthen the body, reduce complications, increase alertness, reduce fatigue, improve your overall health, and enhance your ability to function in everyday activities.
Palliative care to improve the overall quality of life for families and patients with serious diseases
Regular follow-up care to help monitor your treatment and progress and to address any problems or complications promptly
Complementary or alternative treatments, such as acupuncture, massage therapy, and yoga to reduce stress and improve well-being. Complementary treatments are not meant to substitute for full medical care.
What are the possible complications of congestive heart failure?
Complications of congestive heart failure are life threatening. Complications include a rapid or severe buildup of fluid in the lungs (pulmonary edema), which can lead to respiratory failure, respiratory arrest, and death. Pulmonary edema also increases the risk of developing serious infections of the lungs, such as pneumonia.
Congestive heart failure also impacts the quality of life and can lead to serious and permanent disability. You can best help minimize the risk of serious complications of congestive heart failure by following the treatment plan you and your health care professional design specifically for you. Serious and life-threatening complications of congestive heart failure include: