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Congestive Heart Failure (CHF)

What is congestive heart failure?

Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscles. While often referred to simply as “heart failure,” CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently.

You have four heart chambers. The upper half of your heart has two atria, and the lower half of your heart has two ventricles. The ventricles pump blood to your organs and tissues, and the atria receive blood as it circulates back from the rest of your body.

CHF develops when your ventricles can’t pump blood in sufficient volume to the body. Eventually, blood and other fluids back up inside your:

  • lungs
  • abdomen
  • liver
  • lower body

CHF can be life-threatening. It’s important to get immediate medical treatment for it.

What are the most common types of CHF?

 Type 1

Left-sided CHF is the most common type of CHF. It occurs when your left ventricle doesn’t properly pump blood out to your body. As the condition progresses, fluid can build up in your lungs, which makes breathing difficult.

Right-sided CHF is when the right ventricle has difficulty pumping blood to your lungs. Blood backs up in your blood vessels, which causes fluid retention in your lower extremities, abdomen, and other vital organs.

It’s possible to have left-sided and right-sided CHF at the same time. Usually, the disease starts in the left side and then travels to the right when it’s left untreated.

What are the causes of CHF, and am I at risk?

Causes

CHF may result from other health conditions that directly affect your cardiovascular system. That’s why it’s important to get annual checkups to lower your risk for heart health problems, including high blood pressure (hypertension), coronary artery disease, and valve conditions.

Hypertension

When your blood pressure is higher than normal, it may lead to CHF. Hypertension occurs when your blood vessels become restricted by cholesterol and fat. This makes it harder for your blood to pass through them.

Coronary artery disease

Cholesterol and other types of fatty substances can block the coronary arteries, which are the small arteries that supply blood to the heart. This causes the arteries to become narrow. Narrower coronary arteries restrict your blood flow and lead to damage in your arteries.

Valve conditions

Your heart valves regulate blood flow through your heart by opening and closing to let blood in and out of the chambers. Valves that don’t open and close correctly may force your ventricles to work harder to pump blood. This can be a result of a heart infection or defect.

Other conditions

While heart-related diseases can lead to CHF, there are other seemingly unrelated conditions that may increase your risk, too. These include diabetes, thyroid disease, and obesity. Severe infections and allergic reactions may also contribute to CHF.

What are the symptoms of CHF?

Symptoms

In the early stages of CHF, you most likely won’t notice any changes in your health. As your condition gets worse, you’ll experience gradual changes in your body.

Symptoms you may notice firstSymptoms that indicate your condition has worsenedSymptoms that indicate a severe heart condition
fatigueirregular heartbeatchest pain that radiates through the upper body
swelling in your ankles, feet, and legsa cough that develops from congested lungsrapid breathing
weight gainwheezingskin that appears blue, which is due to lack of oxygen in your lungs
increased need to urinate, especially at nightshortness of breath, which may indicate pulmonary edemafainting

Chest pain that radiates through the upper body can also be a sign of a heart attack. If you experience it or any of the other symptoms that point to a severe heart condition, please seek immediate medical attention.

How is CHF diagnosed?

Diagnosis

After reporting your symptoms to your healthcare provider, they may refer you to a heart specialist, or cardiologist.

Your cardiologist will perform a physical exam. The exam may involve listening to your heart with a stethoscope to detect abnormal heart rhythms. To confirm an initial diagnosis, your cardiologist might order certain diagnostic tests to examine your heart’s valves, blood vessels, and chambers.

Here are some tests your cardiologist may recommend:

  • An electrocardiogram (EKG or ECG) records your heart’s rhythm.
  • An echocardiogram uses sound waves to record the heart’s structure and motion.
  • An MRI takes pictures of your heart.
  • Stress tests show how well your heart performs under different levels of stress.
  • Blood tests can check for abnormal blood cells and infections.
  • Cardiac catheterization will show blockages of the coronary arteries. Your doctor inserts a small tube into your blood vessel and threads it from your upper thigh (groin area), arm, or wrist.

What medications and treatments will I need?

Treatment

You and your doctor may consider different treatments depending on your overall health and how far your condition has progressed.

Medications

There are several medications that can be used to treat CHF:

  • Angiotensin-converting enzyme inhibitors (ACE inhibitors) open up narrowed blood vessels to improve blood flow. Vasodilators are another option if you cannot tolerate ACE inhibitors.
  • Beta-blockers can reduce blood pressure and slow a rapid heart rhythm.
  • Diuretics reduce your body’s fluid content. CHF can cause your body to retain more fluid than it should.

Surgeries

If medications are not effective on their own, more invasive procedures may be required. Angioplasty, a procedure to open up blocked arteries, is one option. Your cardiologist may also consider heart valve repair surgery to help your valves open and close properly.

What can I expect in the long term?

Outlook

Your condition may improve with medication or surgery. Your outlook depends on how advanced your CHF is and whether you have other health conditions to treat, such as diabetes or hypertension. The earlier your condition is diagnosed, the better your outlook will be. See your doctor to determine the best treatment plan for you.

CHF and genetics

You asked, we answered

  • Is congestive heart failure genetic? Can lifestyle changes help prevent it?
  • There has been some early research that shows a gene alteration in people who have congestive heart failure (CHF). However, this does not necessarily mean it is hereditary. Genes can be altered in other ways that are not inherited from your parents, such as environmental insults. There are diseases that run in families that lead to CHF, such as heart valve abnormalities, hypertension (high blood pressure), and coronary artery disease. If these diseases run in your family, you can help avoid CHF by exercising at least 150 minutes a week, eating healthfully, and lowering stress.

    - Debra Sullivan, PhD, MSN, RN, CNE, COI

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