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Congestive Heart Failure

What is congestive heart failure?
What are the symptoms of congestive heart failure?
What causes congestive heart failure?
How is congestive heart failure diagnosed?
How can congestive heart failure be treated?

What is congestive heart failure?

Congestive heart failure, also called just heart failure, means your heart is unable to pump enough blood to supply your body's needs. It doesn't mean your heart is about to fail, or stop. It is a serious condition, however—it means your heart is working harder than it should but is still not keeping up with your body's demands. The reason it's called congestive heart failure is that it often results in a buildup of fluid—or congestion—in your lungs and other bodily tissues.

The condition can affect one or both sides of your heart; most cases involve both sides:

  • Right-side heart failure, which means your heart isn't able to pump enough blood to the lungs, so your blood isn't sufficiently oxygenated as it begins its journey through your circulatory system. Right-side heart failure often causes a buildup of fluid in your abdomen and legs.
  • Left-side heart failure, which means your heart isn't able to pump enough of the oxygen-rich blood from your lungs out to the rest of the body. Left-side heart failure often causes a buildup of fluid in your lungs, which results in shortness of breath or a sense of heaviness in your chest.

About 5.1 million people in the U.S. are affected by congestive heart failure, according to the National Institutes of Health. It is typically a chronic, long-term condition.

What are the symptoms of congestive heart failure?

Symptoms of a disease are indications that can be detected by the patient, such as pain or fatigue (while signs are indications that can be detected by a doctor, such as the results of a blood test or an X-ray). Congestive heart failure typically develops slowly over a long period of time.

As your heart has to work harder and harder in an effort to meet your body's demand for oxygen, you will begin to experience symptoms. The most common ones are trouble breathing, even when lying flat; fatigue or inability to exercise; and swelling in your feet, ankles, legs, and abdomen and in the veins of your neck. All of these symptoms are caused by the buildup of fluid in your body.

The condition may also result in weight gain; chest pain; loss of appetite or a feeling of indigestion; clammy skin; a fast or irregular heartbeat; feelings of restlessness or confusion; difficulty remembering things; insomnia (trouble sleeping); a need to urinate more often, especially at night; and a cough that is often worse when you're lying down.

What causes congestive heart failure?

Image of heart's arteries Conditions commonly associated with congestive heart failure are hypertension (high blood pressure), diabetes, and atherosclerosis in the arteries that supply your heart itself with blood; this is known as coronary artery disease or coronary heart disease. Atherosclerosis is the progressive buildup of plaque, or deposits of cholesterol, inflammatory cells and other substances on the arterial walls; this buildup occurs over a period of years or even decades. As a result, the arteries narrow, reducing their ability to carry blood. Moreover, atherosclerosis leads to a loss of the arteries' ability to dilate, or expand, in response to exercise; this process is sometimes called "hardening of the arteries."

Other conditions that are often involved in the development of congestive heart failure are diseases of the heart valves; diseases of the heart muscle (known as cardiomyopathies); inflammation of the heart muscle (known as myocarditis); a disturbance of the heart's rhythm (known as arrhythmias); disorders of the thyroid gland; and congenital heart defects (defects present from birth).

In addition, your likelihood of developing congestive heart failure may be increased by such factors as chemotherapy or radiation treatment for cancer; HIV/AIDS; and alcohol or drug abuse.

How is congestive heart failure diagnosed?

A thorough physical exam and a detailed medical and family history are important first steps in diagnosing congestive heart failure. Your doctor will probably ask you about your symptoms' character and pattern of occurrence, as well as about any other health problems you may have.

Often, diagnostic tests will also be necessary. They may include an electrocardiogram (also referred to as an ECG or EKG), which measures and records your heart's electrical activity; a chest X-ray; an MRI of your heart; blood tests; an echocardiogram (an ultrasound image of your heart); a Holter monitor test (this involves wearing a small, portable device that records your heart's electrical activity over the course of 24 to 48 hours); a stress test; or angiogram (also referred to as cardiac catheterization), which uses opaque dye to image your cardiovascular system.

How can congestive heart failure be treated?

Congestive heart failure can't be cured, but there are a number of ways to treat the condition, so as to minimize its symptoms and delay its progression.

Your doctor may recommend lifestyle changes (such as losing weight, not smoking, limiting your intake of salt and staying active) and/or medications (including drugs that can lower your blood pressure, relax your blood vessels, slow your heartbeat, or help your heart beat more strongly, as well as diuretics, which reduce the fluid buildup in your tissues).

If your congestive heart failure is the result of abnormally functioning heart valves, your doctor may recommend repair or replacement of your aortic valve or repair or replacement of your mitral valve. These highly effective therapies will allow your heart to once again efficiently move blood and fluid through your body, resulting in a significant decrease in your heart failure symptoms.

If those measures are unable to sufficiently control your symptoms, and your heart failure is caused largely by atherosclerosis in your coronary arteries, your doctor may recommend a coronary artery bypass graft.

The best approach depends on a number of factors, including the extent and severity of your heart failure, your age, other diseases you may have, and your feelings about the different options. In all cases, however, early diagnosis and treatment are important, in order to slow the condition's progress.


Page reviewed on: Jun 26, 2015

Page reviewed by: Jock McCullough, MD

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