Congestive heart failure, or CHF, refers to the failure of the heart to perform its main function: to pump blood throughout the body. It occurs when the flow of blood, or cardiac output, from the heart decreases, or fluids back up or "congest" within the heart, or both. Insufficient cardiac output can only be considered congestive heart failure if the heart is receiving enough blood in the first place. Congestive heart failure is the eventual result of any number of numerous cardiac conditions that impede the heart's ability to pump blood. Therefore, it is a symptom of underlying disorders which require treatment.
The list of these associated disorders is lengthy and some of them may be present without a patient's knowledge. Some of the most common are high blood pressure, or hypertension, which forces the heart to pump against increased resistance to meet demand; ischemia, a condition stemming from coronary artery disease (CAD) in which the heart muscle receives insufficient oxygen and is damaged as a result; and valvular heart disease, in which some of the heart's valves become either narrowed or infected, or leak pumped blood back into the heart. Abnormal heart rhythms, or arrhythmia, as well as a heartbeat that is either too slow or too fast, can all reduce cardiac output. In individuals with an overactive thyroid gland or anemia, the heart works overtime to provide the body's tissues with enough oxygen and over time can lead to congestive heart failure. Furthermore, any diseases of the heart muscle itself, the surrounding pericardium, as well as birth defects of the heart, can result in congestive heart failure.
Because congestive heart failure stems from any number of these problems, it typically develops over time. Symptoms include weakness or fatigue, shortness of breath, reduced stamina, rapid heartbeat, and swelling of the ankles, legs, feet, or abdomen.
Congestive heart failure is almost always chronic; however, there are treatments available. The most common is medication. Categories of these drugs include ACE inhibitors that widen blood vessels to improve blood flow, beta blockers to slow the heart, and diuretics to prevent the body from retaining fluids. Some of the conditions that led to congestive heart failure may require surgery, such as a coronary bypass to treat narrowed arteries. There are also implantable devices that can help. Mechanisms such as implantable cardioverter-defibrillators or bioventricular pacemakers use electrical impulses to maintain a regular heartbeat. There are also mechanical heart pumps that can be implanted to help maintain healthy blood flow. Severe cases sometimes require heart transplants.
The best treatment however, is prevention. Lifestyle factors that place stress on an individual's heart include a diet excessive in salt and/or cholesterol, smoking, being overweight, or not taking prescribed medication. Addressing such risk factors early can prevent congestive heart failure entirely.
You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms can include:
Congested lungs. Fluid back up in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen (called edema), and weight gain. Symptoms may cause an increased need to urinate during the night. Bloating in your stomach may cause a loss of appetite or nausea.
Dizziness, fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a fast or irregular heartbeat.
If you have heart failure, you may have one or all of these symptoms or you may have none of them. In addition, your symptoms may not be related to how weak your heart is; you may have many symptoms but your heart function may be only mildly weakened. Or you may have a more severely damaged heart but have no symptoms.
After congestive heart failure is diagnosed, treatment should be started immediately. Perhaps the most important and yet most neglected aspect of treatment involves lifestyle modifications. Sodium causes an increase in fluid accumulation in the body's tissues. Because the body is often congested with excess fluid, patients become very sensitive to the levels of intake of sodium and water. Restricting salt and fluid intake is often recommended because of the tendency of fluid to accumulate in the lungs and surrounding tissues. An American "no added salt" diet can still contain 4 to 6 grams (4000 to 6000 milligrams) of sodium per day. In individuals with congestive heart failure, an intake of no more than 2 grams (2000 milligrams) of sodium per day is generally advised. Reading food labels and paying close attention to total sodium intake is very important. Severe restriction of alcohol consumption also is advised.
Likewise, the total amount of fluid consumed must be regulated. Although many people with congestive heart failure take diuretics to aid in the elimination of excess fluid, the action of these medications can be overwhelmed by an excess intake of water and other fluids. The maxim that "drinking eight glasses of water a day is healthy" certainly does not apply to patients with congestive heart failure. In fact, patients with more advanced cases of congestive heart failure are often advised to limit their total daily fluid intake from all sources to 2 quarts. The above guidelines for sodium and fluid intake may vary depending on the severity of congestive heart failure in any given individual and should be discussed with their physician.
An important tool for monitoring an appropriate fluid balance is the frequent measurement of body weight. An early sign of fluid accumulation is an increase in body weight. This may occur even before shortness of breath or swelling in the legs and other body tissues (edema) is detected. A weight gain of two to three pounds over two to three days should prompt a call to the physician, who may order an increase in the dose of diuretics or other methods designed to stop the early stages of fluid accumulation before it becomes more severe.
Aerobic exercise, once discouraged for congestive heart failure patients, has been shown to be beneficial in maintaining overall functional capacity, quality of life, and perhaps even improving survival. Each person's body has its own unique ability to compensate for the failing heart. Given the same degree of heart muscle weakness, individuals may display widely varying degrees of limitation of function. Regular exercise, when tailored to the person's tolerance level, appears to provide significant benefits and should be used only when the individual is compensated and stable.
Depending on the underlying cause of congestive heart failure, potentially reversible factors should be explored. For example:
In certain persons whose congestive heart failure is caused by inadequate blood flow to the heart muscle, restoration of the blood flow through coronary artery surgery or catheter procedures (angioplasty, intracoronary stenting) may be considered.
Congestive heart failure that is due to severe disease of the valves may be alleviated by valve surgery in appropriate patients.
When congestive heart failure is caused by chronic, uncontrolled high blood pressure (hypertension), aggressive blood pressure control will often improve the condition.
Heart muscle weakness that is due to longstanding, severe alcohol abuse can improve significantly with abstinence from drinking.
Congestive heart failure that is caused by other disease states may be similarly partially or completely reversible by appropriate measures.