Alternate Names: CHF; Congestive heart failure
Causes and Risks:
Heart failure may affect either the right side, left side, or both sides of the heart. As pumping action is lost, blood may back up into other areas of the body, including the liver, gastrointestinal tract, and extremities (right-sided heart failure), or the lungs (left-sided heart failure).
Structural or functional causes of heart failure include high blood pressure (hypertension), valvular heart disease, congenital heart diseases, cardiomyopathy, heart tumor, and other heart diseases. Precipitating factors include infections with high fever or complicated infections, use of negative inotropic drugs (such as beta-blockers and calcium channel blocker), anemia, irregular heartbeats (arrhythmias), hyperthyroidism, and kidney disease.
Other risk factors include obesity, excess alcohol consumption, and diet high in salt.
Heart failure occurs in approximately 10 out of 100 people, and becomes more prevalent with advancing age.
Prevention: Follow the health care provider’s advice for treatment of conditions that may cause congestive heart failure. Follow dietary guidelines. Minimize or eliminate smoking and alcohol consumption.
Symptoms:
Signs and Tests: A physical examination may reveal irregular or rapid heartbeat. There may be distended neck veins, enlarged liver, peripheral edema, and signs of pleural effusion (fluid around the lungs).
Listening to the chest with a stethoscope (auscultation) may reveal lung crackles or abnormal heart sounds. Blood pressure may be normal, elevated, or low.
Enlargement of the heart or decreased heart functioning may be seen on:
This disease may also alter the following test results:
Treatment:
The goals of treatment include reduction of cardiac workload, control of excess salt and water retention (swelling, decreased urinary output), and improvement of heart functioning.
Heart failure requires monitoring of the condition by the health care provider. Hospitalization may be required if symptoms are severe or unstable, difficulty breathing occurs at rest or with minimal activity, or there is failure to respond to initial treatment.
Underlying disorders and precipitating factors should be treated. This may require medications, surgery, or other treatments. In advanced cases, bedrest or reduced physical activity may be recommended to minimize the heart’s workload.
Vasodilator medications are used to reduce the work load, particularly if symptoms include difficulty breathing, excessive tiredness, and reduced tolerance to activity. Examples of vasodilator medications include captopril, enalapril, hydralazine, and losartan.
If swelling is severe, or if there are signs of congestion in systemic (body) or pulmonary (lung) vessels, salt and fluid intake may need to be modified. A low sodium diet is recommended and fluid may be restricted in some cases.
Diuretic medications may be used. This includes: loop diuretics (e.g., furosemide, bumetanide) for moderate symptoms; thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone, chlorothiazide) for mild symptoms; and combination diuretics. Potassium-sparing diuretics (spironolactone, triamterene) are frequently used as well to prevent excessive potassium losses. Digoxin may also be given.
Weight loss may be recommended. Eliminate smoking and alcohol consumption (both decrease the pumping efficiency of the heart).
A cardiac specialist frequently guides aggressive treatment of hospitalized patients. Intravenous medications may be used to give a stronger and faster response, including inotropic drugs, vasodilator drugs, and diuretics. Mechanical fluid removal (thoracentesis or paracentesis) may be necessary in some cases. In severe cases, dialysis may be performed to remove excess fluid. Circulatory-assist devices such as the intra-aortic balloon pump or left-ventricular assist device may be recommended to stabilize condition. A heart transplant may be considered.
Prognosis: Heart failure is a serious disorder that carries a reduced life expectancy. Many forms of heart failure are well controlled with medication and correction of underlying disorders. Heart failure is usually a chronic illness, and it may worsen with infection or other physical stressors.
Complications:
- Pulmonary edema
- Total failure of the heart to function (circulatory collapse)
- Arrhythmias including lethal arrhythmias
- Side effects of medications
Call your health care provider if symptoms indicate congestive heart failure may be present.
Call your health care provider if weakness, increased cough or sputum production, sudden weight gain or swelling, or other new or unexplained symptoms develop.
Go to the emergency room or call the local emergency number (such as 911) if severe crushing chest pain, fainting, or rapid and irregular heartbeat occur (particularly if other symptoms accompany a rapid and irregular heartbeat).
