The term “Heart failure” sounds alarming, but it does not mean the heart has suddenly stopped working. Instead, it means the heart has not been pumping as effectively as it should to deliver oxygen–rich blood to the body’s cells. Congestive Heart Failure (CHF) occurs when the heart’s weak pumping action results in a buildup of fluid (congestion) in the lungs and other body tissues.
Congestive Heart Failure usually develops slowly. Symptoms may not appear for years, and they tend to worsen gradually over time. That is the reason why it is most commonly seen in old age. The slow onset and progression of CHF results from the heart’s own efforts to deal with its gradual weakening. The heart compensates by enlarging and by forcing itself to pump faster to circulate more blood.
Risk Factors of Congestive Heart Failure
- Previous heart attacks.
- Coronary artery disease.
- Hypertension (high blood pressure).
- Heart valve disease (especially the aortic and mitral valves).
- Congenital heart defects.
- Alcohol and drug abuse.
If the left side of the heart has not been working well (left–sided heart failure), resulting in the flow of blood and fluid back up into the lungs, patients will experience shortness of breath, fatigue, and persistent coughing (especially at night). In advanced cases, persons may begin to cough up pinkish, blood–tinged sputum.
If the right side of the heart does not work properly (right–sided heart failure), the slowed down blood flow causes a buildup of fluid in the veins. The feet, legs, and ankles begin to swell under the increased fluid volume. This swelling is called edema. Sometimes, edema spreads to the lungs, liver, and the gastrointestinal tract. Fluid buildup causes patients to urinate more frequently, especially at night when body fluids are more evenly distributed. Fluid buildup also taxes the kidney’s ability to dispose of sodium and water, which can eventually lead to kidney failure. Once CHF is treated, the kidney’s function usually returns to normal.
As heart failure progresses, the heart eventually loses its ability to compensate and symptoms arise. In addition to those listed above, other symptoms may include
- Difficulty in breathing or difficulty in lying flat because of shortness of breath.
- Fatigue, weakness, and an inability to exercise or perform physical activities.
- Weight gain from excess fluid.
- Chest pain.
- Loss of appetite, indigestion.
- Swollen neck veins.
- Cold, sweaty skin.
- Rapid or irregular pulse.
- Restlessness, confusion, and decreased attention span and memory.
- Most physicians can make a tentative diagnosis of Congestive Heart Failure from the presence of edema and shortness of breath.
- With a stethoscope, a physician can listen to a patient’s chest for the crackling sounds of fluid in the lungs, the distinct sound of faulty valves (heart murmur), or the presence of a very rapid heartbeat. Tapping on the patient’s chest will reveal if fluid has accumulated in the chest cavity.
- A chest X ray can reveal an enlarged heart and fluid in and around the lungs.
- Electrocardiography (ECG or EKG) can be used to check for arrhythmias and cardiac stress, as well as reveal previous heart attacks.
- Echocardiography can be used to observe valve function, heart wall motion abnormalities, and overall heart size.
Treatment of Congestive Heart Failure
Studies show that drugs also help improve overall heart function and increase a patient’s exercise capacity. The following classes of drugs are often prescribed
- Diuretics, which help rid the body of excess fluid.
- Inotropics, such as digitalis and digoxin, which strengthen the heart’s ability to pump.
- Vasodilators, such as nitroglycerine compounds.
- Calcium channel blockers, which keep vessels dilated and lower blood pressure.
- Newer beta blockers, which have been shown to help increase exercise tolerance and improve symptoms over time.
- ACE inhibitors, which decrease blood pressure by inhibiting hormones that negatively impact blood pressure regulation.
- Therapy using inotropic drugs, which increase the heart’s ability to contract. These drugs are given through a small catheter placed directly in an artery.
- Heart valve repair or replacement.
- Pacemaker insertion.
- Correction of congenital heart defects.
- Coronary artery bypass surgery.
- Mechanical assist devices.
- Heart transplantation.
- Quit smoking.
- Control high blood pressure, cholesterol, and diabetes.
- Eat a sensible diet that includes moderate caloric intake and restricted salt.
- Limit consumption of alcohol and fluids, in general.
- Weigh daily to monitor fluid retention.
- Start a medically supervised aerobic exercise program.