About congestive heart failure

What is congestive heart failure?

What is congestive heart failure (CHF)?

Heart failure describes the inability or failure of the heart to adequately meet the needs of organs and tissues for oxygen and nutrients. This decrease in cardiac output, the amount of blood that the heart pumps, is not adequate to circulate the blood returning to the heart from the body and lungs, causing fluid (mainly water) to leak from capillary blood vessels. This leads to the symptoms that may include shortness of breath, weakness, and swelling.

Understanding blood flow in the heart and body

The right side of the heart pumps blood to the lungs while the left side pumps blood to the rest of the body. Blood from the body enters the right atrium though the vena cava. It then flows into the right ventricle where it is pumped to the lungs through the pulmonary artery. In the lungs, oxygen is loaded onto red blood cells and returns to the left atrium of the heart via the pulmonary artery. Blood then flows into the left ventricle where it is pumped to the organs and tissues of the body. Oxygen is downloaded from red blood cells while carbon dioxide, a waste product of metabolism, is added to be removed in the lungs. Blood then returns to the right atrium to start the cycle again.

Left heart failure occurs when the left ventricle cannot pump blood to the body and fluid backs up and leaks into the lungs causing shortness of breath. Right heart failure occurs when the right ventricle cannot adequately pump blood to the lungs. Blood and fluid may back up in the veins that deliver blood to the heart. This can cause fluid to leak into tissues and organs.

It is important to know that both sides of the heart may fail to function adequately at the same time and this is called biventricular heart failure. This often occurs since the most common cause of right heart failure is left heart failure.

What are the symptoms for congestive heart failure?

Heart failure occurs when the heart muscle doesn't pump blood as well as it should. Blood often backs up and causes fluid to build up in the lungs (congest) and in the legs. The fluid buildup can cause Shortness of breath and Swelling of the legs and feet. Poor blood flow may cause the skin to appear blue (cyanotic). Some types of heart failure can lead to an enlarged heart.

Heart failure can be ongoing (chronic), or it may start suddenly (acute).

Heart failure signs and symptoms may include:

What are the causes for congestive heart failure?

Chambers and valves of the heart Open pop-up dialog box Close Chambers and valves of the heart Chambers and valves of the heart

A typical heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of the heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.

Enlarged heart, in heart failure Open pop-up dialog box Close Enlarged heart, in heart failure Enlarged heart, in heart failure

As the heart weakens, as it can in heart failure, it begins to enlarge, forcing your heart to work harder to pump blood on to the rest of your body.

Heart failure often develops after other conditions have damaged or weakened the heart. However, heart failure can also occur if the heart becomes too stiff.

In heart failure, the main pumping chambers of the heart (the ventricles) may become stiff and not fill properly between beats. In some people, the heart muscle may become damaged and weakened. The ventricles may stretch to the point that the heart can't pump enough blood through the body.

Over time, the heart can no longer keep up with the typical demands placed on it to pump blood to the rest of the body.

Your doctor can determine how well your heart is pumping by measuring how much blood is pumped out with each beat (ejection fraction). Ejection fraction is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is 50% or higher — meaning that more than half of the blood that fills the ventricle is pumped out with each beat.

But heart failure can occur even with a normal ejection fraction. This happens if the heart muscle becomes stiff from conditions such as high blood pressure.

Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, heart failure begins with the left side, specifically the left ventricle — your heart's main pumping chamber.

Type of heart failure Description Left-sided heart failure Fluid may back up in the lungs, causing shortness of breath. Right-sided heart failure Fluid may back up into the abdomen, legs and feet, causing swelling. Systolic heart failure (also called heart failure with reduced ejection fraction) The left ventricle can't contract vigorously, indicating a pumping problem. Heart failure with preserved ejection fraction The left ventricle can't relax or fill fully, indicating a filling problem.

Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:

  • Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. The disease results from the buildup of fatty deposits in the arteries, which reduces blood flow and can lead to heart attack.

    A heart attack occurs suddenly when a coronary artery becomes completely blocked. Damage to your heart muscle from a heart attack may mean that your heart can no longer pump as well as it should.

  • High blood pressure. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, this extra exertion can make your heart muscle too stiff or too weak to properly pump blood.
  • Faulty heart valves. The valves of the heart keep blood flowing in the proper direction. A damaged valve — due to a heart defect, coronary artery disease or heart infection — forces the heart to work harder, which can weaken it over time.
  • Damage to the heart muscle. Heart muscle damage can have many causes, including certain diseases, infection, heavy alcohol use, and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy. Genetic factors also can play a role.
  • Inflammation of the heart muscle (myocarditis). Myocarditis is most commonly caused by a virus, including the COVID-19 virus, and can lead to left-sided heart failure.
  • A heart problem that you're born with (congenital heart defect). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to pump blood, which may lead to heart failure.
  • Abnormal heart rhythms (arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast, creating extra work for your heart. A slow heartbeat also may lead to heart failure.
  • Other diseases. Long-term diseases — such as diabetes, HIV, an overactive or underactive thyroid, or a buildup of iron or protein — also may contribute to chronic heart failure.

Causes of sudden (acute) heart failure also include:

  • Allergic reactions
  • Any illness that affects the whole body
  • Blood clots in the lungs
  • Severe infections
  • Use of certain medications
  • Viruses that attack the heart muscle

What are the treatments for congestive heart failure?

The goal of treatment for congestive heart failure is to have the heart beat more efficiently so that it can meet the energy needs of the body. Specific treatment depends upon the underlying cause of heart failure.

Treatment may try to decrease fluid within the body so that the heart does not have to work as hard to circulate blood through the blood vessels in the body.

Fluid restriction and a decrease in salt intake may be very helpful. Diuretic medications (water pills) may be prescribed if appropriate. Common diuretics include furosemide (Lasix), bumetanide (Bumex), and hydrochlorothiazide.

Medications are available that can make the heart pump more efficiently, increase cardiac output, and increase ejection fraction.

ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotension receptor blockers) are medicines that are also shown to increase survival by decreasing systemic resistance and favorable altering the hormonal milieu, which affects the cardiac performance; they are often used with other drugs. Beta blockers may control heart rate and increase cardiac output and ejection fraction, and providing a beneficial response to circulating epinephrine ("adrenalin"). Digoxin (Lanoxin) is an older medicine that may help increase cardiac output and control symptoms.

Cardiac risk factor modification is the cornerstone of prevention but may also benefit patients with established congestive heart failure.

Weight loss, establishing an exercise program, stopping smoking, and controlling high blood pressure, high cholesterol, and diabetes may help in the management of congestive heart failure.

End stage congestive heart failure (NYHA stage IV) patients may require aggressive treatments including left ventricular assist devices (LVAD), an implanted pump that helps increase the heart's ability to squeeze, or even heart transplantation.

What are the risk factors for congestive heart failure?

A single risk factor may be enough to cause heart failure, but a combination of factors also increases your risk.

Risk factors for heart failure include:

  • Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.
  • Heart attack. A heart attack is a form of coronary artery disease that occurs suddenly. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
  • Heart valve disease. Having a heart valve that doesn't work properly raises the risk of heart failure.
  • High blood pressure. Your heart works harder than it has to if your blood pressure is high.
  • Irregular heartbeats. These abnormal rhythms, especially if they are very frequent and fast, can weaken the heart muscle and cause heart failure.
  • Congenital heart disease. Some people who develop heart failure were born with problems that affect the structure or function of their heart.
  • Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease. Don't stop taking any medications on your own. Ask your doctor whether you should make changes.
  • Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure in some people. Don't stop taking these medications on your own, though. If you're taking them, ask your doctor if you need to make any changes.
  • Certain other medications. Some medications may lead to heart failure or heart problems. They include nonsteroidal anti-inflammatory drugs (NSAIDs); certain anesthesia medications; and certain medications used to treat high blood pressure, cancer, blood conditions, irregular or abnormal heartbeats, nervous system diseases, mental health conditions, lung and urinary problems, inflammatory diseases, and infections.
  • Alcohol use. Drinking too much alcohol can weaken the heart muscle and lead to heart failure.
  • Sleep apnea. The inability to breathe properly while you sleep results in low blood-oxygen levels and an increased risk of irregular heartbeats. Both of these problems can weaken the heart.
  • Smoking or using tobacco. If you smoke, quit. Using tobacco increases your risk of heart disease and heart failure.
  • Obesity. People who have obesity have a higher risk of developing heart failure.
  • Viruses. Certain viral infections can cause damage to the heart muscle.

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