Alternative Names heart failure, CHF, left-sided heart failure
Definition Congestive heart failure (CHF) is a condition in which a weakened heart cannot pump enough blood to body organs. Since the pumping action of the heart is reduced, blood backs up into certain body tissues, causing fluid buildup.
What is going on in the body? Congestive heart failure is caused by a variety of complex problems that cause the pumping chambers of the heart to fail.
The heart is divided into a left heart and right heart. The blood receives oxygen as it passes through the lungs. The left heart receives blood from the lungs and pumps this oxygen-rich blood to the organs, muscles, and tissues of the body. The right heart receives oxygen-poor blood from these organs and tissues, and pumps it to the lungs to receive a fresh supply of oxygen.
If the pumping chambers of the heart do not function properly, blood stays in the lungs or in the tissues of the body. The congestion of these areas with blood and fluid is the basis for the name congestive heart failure. The organs and tissues begin to suffer the effects of the insufficient blood supply.
What are the signs and symptoms of the condition? A person with congestive heart failure develops shortness of breath, often when lying flat or exercising. Shortness of breath can also interfere with sleep and limit an individual's ability to exercise. Severe swelling of the legs caused by the buildup of blood and fluid in the legs is also typical of CHF. As CHF worsens, an individual can develop severe fatigue, chest pain, and even shortness of breath while at rest.
What are the causes and risks of the condition? Congestive heart failure can be caused by many diseases and conditions. Multiple or severe heart attacks can lead to congestive heart failure because heart muscle is damaged or destroyed. This is one of the more common causes of heart failure. Other causes include:
heart valve damage, such as the scarring from a heart valve infection known as endocarditis
certain infectious diseases common in underdeveloped countries
some genetic disorders which lead to conditions known as cardiomyopathies
What can be done to prevent the condition? Prevention of congestive heart failure is not always possible. In some cases, controlling the conditions that lead to heart damage can help prevent this progression. For example, effective treatment of high blood pressure can help reduce the risk of CHF. Maintaining a healthy body weight, including physical activity in everyday life, and following a diet designed to minimise heart disease also can help a person avoid congestive heart failure.
How is the condition diagnosed? The diagnosis of congestive heart failure begins with a careful history and physical examination. It can be confirmed by tests such as an echocardiogram, which uses ultrasound waves to create a picture of heart muscle and valve function. Other tests include nuclear medication scans and cardiac catheterisation, a procedure that allows a view of the blood flow through the heart. Blood tests are also used to diagnose and to guide treatment.
What are the long-term effects of the condition? Left untreated, congestive heart failure can cause poor overall health and early death. New advances in treatment can help delay the progression of CHF and minimise symptoms.
What are the risks to others? Congestive heart failure is not contagious and poses no risk to others.
What are the treatments for the condition? Many medications are used to treat congestive heart failure, including:
diuretics, such as frusemide or spironolactone, which relieve the buildup of fluid in the tissues
digitalis, which strengthens the contraction of the heart muscles
angiotensin converting enzyme inhibitors (ACE inhibitors), such as enalapril or lisinopril. ACE inhibitors allow the heart muscle to work easier and promote improved pumping action of the heart.
the mixed alpha-beta adrenergic blocker, carvedilol, a newer medication that has shown beneficial effects on heart failure
"A special pacemaker called a biventricular pacemaker is useful in a select number of patients with heart failure
A person with severe congestive heart failure may need medications given with an intravenous line, a thin tube into a vein. For some individuals, a heart transplant is the only treatment that can cure the heart failure.
What are the side effects of the treatments? Side effects vary according to the medications used. For example, diuretics can cause dehydration and salt imbalance. ACE inhibitors can cause a chronic dry cough. Too much digitalis can cause significant side effects, including vomiting and visual impairment.
What happens after treatment for the condition? Most individuals with congestive heart failure are encouraged to begin a regular exercise program. A person with congestive heart failure should make every effort to reduce coronary risk factors. This may include smoking cessation, control of other diseases and conditions such as diabetes and high blood pressure, and eating a healthy diet for heart disease. Medications may need to be adjusted to achieve the best response.
How is the condition monitored? Periodic examinations, blood tests and imaging studies such as echocardiography are done to monitor congestive heart failure. Any new or worsening symptoms should be reported to the doctor.
Author: Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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