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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 body’s organs and tissues, and the atria receive blood from your body 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 can back up inside your:

  • lungs
  • abdomen
  • liver
  • lower body

CHF can be life-threatening. If you suspect you or someone near you has CHF, seek immediate medical treatment.

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Types

What are the most common types of CHF?

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.

There are two kinds of left-sided heart failure:

  • Systolic heart failure occurs when the left ventricle fails to contract normally. This reduces the level of force available to push blood into circulation. Without this force, the heart can’t pump properly.
  • Diastolic failure, or diastolic dysfunction, happens when the muscle in the left ventricle becomes stiff. Because it can no longer relax, the heart can’t quite fill with blood between beats.

Right-sided CHF occurs 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 left untreated.

Congestive heart failure stages

Stage Main symptoms Outlook
Class I You don’t experience any symptoms during typical physical activity. CHF at this stage can be managed through lifestyle changes, heart medications, and monitoring.
Class II You’re likely comfortable at rest, but normal physical activity may cause fatigue, palpitations, and shortness of breath. CHF at this stage can be managed through lifestyle changes, heart medications, and careful monitoring.
Class III You’re likely comfortable at rest, but there’s a noticeable limitation of physical activity. Even mild exercise may cause fatigue, palpitations, or shortness of breath. Treatment can be complicated. Talk with your doctor about what heart failure at this stage may mean for you.
Class IV You’re likely unable to carry on any amount of physical activity without symptoms, which are present even at rest. There’s no cure for CHF at this stage, but there are still quality-of-life and palliative care options. You’ll want to discuss the potential benefits and risks of each with your doctor.
 

Causes and risks

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

CHF may result from other health conditions that directly affect your cardiovascular system. This is 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 can 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.

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Symptoms

What are the symptoms of CHF?

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

Symptoms you may notice first Symptoms that indicate your condition has worsened Symptoms that indicate a severe heart condition
Fatigue irregular heartbeat chest pain that radiates through the upper body
swelling in your ankles, feet, and legs a cough that develops from congested lungs rapid breathing
weight gain wheezing skin that appears blue, which is due to lack of oxygen in your lungs
increased need to urinate, especially at night shortness of breath, which may indicate pulmonary edema fainting
 

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

Learn more: Warning signs of a heart attack »

Symptoms of heart failure in children and infants

It can be difficult to recognize heart failure in infants and young children. Symptoms may include:

  • poor feeding
  • excessive sweating
  • difficulty breathing

These symptoms can easily be misunderstood as colic or a respiratory infection. Poor growth and low blood pressure can also be signs of heart failure in children. In some cases, you may be able to feel a resting baby’s rapid heart rate through the chest wall.

Diagnosis

How is CHF diagnosed?

After reporting your symptoms to your doctor, 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. Abnormalities in your heart’s rhythm, such as a rapid heartbeat or irregular rhythm, could suggest that the walls of your heart’s chamber are thicker than normal. That could be a warning sign for a heart attack.
  • An echocardiogram uses sound waves to record the heart’s structure and motion. The test can determine if you already have poor blood flow, muscle damage, or a heart muscle that doesn’t contract normally.
  • An MRI takes pictures of your heart. With both still and moving pictures, this allows your doctor to see if there’s damage to your heart.
  • Stress tests show how well your heart performs under different levels of stress. Making your heart work harder makes it easier for your doctor to diagnose problems.
  • Blood tests can check for abnormal blood cells and infections. Blood tests can also check the level of BNP, a hormone that rises with heart failure.
  • Cardiac catheterization can show blockages of the coronary arteries. Your doctor will insert a small tube into your blood vessel and thread it from your upper thigh (groin area), arm, or wrist. At the same time, the doctor can take blood samples, use X-rays to view your coronary arteries, and check blood flow and pressure in your heart chambers.
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Treatment

How is it treated?

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

Congestive heart failure drugs

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

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.

You may be prescribed one of the following:

ACE inhibitors shouldn’t be taken with the following medications, as they may cause an adverse reaction:

  • Thiazide diuretics can cause an additional decrease in blood pressure.
  • Potassium-sparing diuretics, such as triamterene (Dyrenium), eplerenone (Inspra), and spironolactone (Aldactone), can cause potassium build-up in the blood. This may lead to abnormal heart rhythms.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, and naproxen, can cause sodium and water retention. This may reduce the ACE inhibitor’s effect on your blood pressure.

This is an abbreviated list, so you shouldn’t assume that something is safe to take because it isn’t listed. You should always speak with your doctor before taking any new medications.

Beta-blockers can reduce blood pressure and slow a rapid heart rhythm.

This may be achieved with:

blockers shouldn’t be taken with the following medications, as they may cause an adverse reaction:

  • Antiarrhythmic medications, such as amiodarone (Nexterone), can increase cardiovascular effects, including reduced blood pressure and slowed heart rate.
  • Antihypertensive medications, such as lisinopril (Zestril), candesartan (Atacand), and amlodipine (Norvasc), may also increase the likelihood of cardiovascular effects.
  • Albuterol’s (AccuNeb) effects of bronchodilation may be amplified by beta-blockers.
  • Fentora (Fentanyl) may cause low blood pressure.
  • Antipsychotics, such as thioridazine (Mellaril), may also cause low blood pressure.
  • Clonidine (Catapres) may cause high blood pressure.

Some medications may not be listed here. You should always consult your doctor before taking any new medications.

Diuretics reduce your body’s fluid content. CHF can cause your body to retain more fluid than it should.

Your doctor may recommend:

  • Thiazide diuretics, which cause blood vessels to widen and help the body remove any extra fluid. Examples include metolazone (Zaroxolyn), indapamide (Lozol), and hydrochlorothiazide (Microzide).
  • Loop diuretics, which cause the kidneys to produce more urine. This helps remove excess fluid from your body. Examples include furosemide (Lasix), ethacrynic acid (Edecrin), and torsemide (Demadex).
  • Potassium-sparing diuretics, which help get rid of fluids and sodium while still retaining potassium. Examples include triamterene (Dyrenium), eplerenone (Inspra), and spironolactone (Aldactone).

Diuretics shouldn’t be taken with the following medications, as they may cause an adverse reaction:

This is an abbreviated list containing only the most common drug interactions. You should always talk to your doctor before taking any new medications.

Surgeries

If medications aren’t 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.

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Outlook

What can I expect in the long term?

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.

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CHF and genetics

CHF and genetics

Prevention

How to prevent congestive heart failure

There are several things you can do to lower your risk of heart failure, or at least delay onset. You can:

  • Not smoke: If you do smoke and haven’t been able to quit, ask your doctor to recommend products and services that can help. Secondhand smoke is also a health hazard. If you live with a smoker, ask them to smoke outdoors.
  • Maintain a well-balanced diet: A heart-healthy diet is rich in vegetables, fruits, and whole grains. Dairy products should be low fat or fat-free. You also need protein in your diet. Things to avoid include salt (sodium), added sugars, solid fats, and refined grains.
  • Exercise: As little as one hour of moderate aerobic exercise per week can improve your heart health. Walking, bicycling, and swimming are good forms of exercise. If you haven’t exercised in a while, start with just 15 minutes a day and work your way up. If you feel unmotivated to work out alone, consider taking a class or signing up for personal training at a local gym.
  • Watch your weight: Being too heavy can be hard on your heart. Follow a balanced diet and exercise regularly. If you aren’t at a healthy weight, talk to your doctor about how to move forward. You can also consult with a dietician or nutritionist.
  • Be careful: Drink alcohol only in moderation and stay away from illegal drugs. When taking prescription medications, follow instructions carefully and never increase your dose without doctor supervision.

If you’re at high risk for heart failure or already have some heart damage, you can still follow these steps. Be sure to ask your doctor how much physical activity is safe and if you have any other restrictions. If you’re on medication for high blood pressure, heart disease, or diabetes, take them exactly as directed. See your doctor regularly to monitor your condition and report any new symptoms right away.

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