What is Congestive Heart Failure?

What is Congestive Heart Failure?

The heart is a critical organ. Without it, blood stops flowing, and death rapidly occurs. What is congestive heart failure?

Congestive heart failure – CHF – is a condition characterized by the inadequate ability of the heart to pump oxygen-containing blood through the body. It is primarily caused by diseases that stiffen or weaken the heart muscle or increase the levels of oxygen needed by parts of the body beyond the heart’s capacity to provide via pumped blood.

The heart contains upper and lower chambers, which are comprised of atria and ventricles. The atria comprise the upper chambers; the ventricles comprise the lower chambers of the heart. Ventricles are chambers made of muscle that pumps blood via muscular contractions – a movement called systole. The ventricles can be adversely affected by numerous diseases. Toxic agents such as excessive alcohol – even certain chemotherapy compounds – and heart attacks can damage the muscles.

When this occurs, their ability to pump blood through the body is reduced – a scenario called systolic dysfunction. After each “pumping” (contraction), the ventricles have to relax for blood to fill up the ventricles – an action called diastole. Certain conditions such as amyloidosis – a deposit of amyloid proteins – or hemochromatosis (an overload of iron in the body) can cause the heart muscle to stiffen and reduce the capacity of the ventricles to fill.

Congestive Heart Failure is a Systemic Problem

Left unchecked, this condition can affect many parts of the body.

The intestines can be affected by their ability to absorb medications and nutrients from food.

Lung congestion may occur – pulmonary edema – a condition in which they fill with fluid, decreasing an individual’s capacity for exercise.

Kidney function can be damaged due to a reduced blood supply, diminishing their ability to move water and sodium from the body, resulting in fluid retention.

The liver can also suffer fluid retention, reducing its capacity to produce proteins and metabolize and excrete toxins.

Edema – fluid retention of the extremities – especially feet and ankles – may occur.

Typical Causes of Congestive Heart Failure

Though many diseases can cause CHF through heart function impairment, the most common causes are:

  • Chronic alcohol abuse
  • Heart valve disorders
  • Hypertension
  • Coronary artery disease
  • Unknown causes

Less Common Causes

  • Disorders of the thyroid
  • Heart rhythm disorders
  • Viral infections of the heart muscle
  • Medications are taken by patients who already have heart disease, particularly prescriptions which affect the heart’s power or cause sodium retention, such as some calcium channel blockers, NSAIDs, and some diabetes medications. Patients on medication should talk to their doctor.

Does CHF Cause Symptoms?

Yes. Symptoms are variable and influenced by several factors, including organ system involvement and compensation for the heart muscles weakness by other systems in the body.

One of the early symptoms is fatigue. It is important to note that fatigue has almost innumerable emotional, mental and physical causes and is not in and of itself a sole clinical indicator of CHF. Fatigue may be accompanied by a reduction in the patient’s exercise capacity and an unconscious reduction in physical output to accommodate it.

Fluid accumulation can cause edema – swelling – especially in the feet or around the ankles and abdomen. This may indicate “right-sided heart failure” – the right side of the heart’s chambers may cause swelling in areas such as the legs, which depend on gravity to bring the blood to them. Other causes include intrinsic right heart muscle disease or severe lung disease.

Accumulation of fluid may also take place in the lungs. The symptoms are waking at night, gasping for breath, and shortness of breath lying flat or during exercise. Some patients may be unable to sleep except sitting up.

Fluid buildup can also cause an increase in nighttime urination.

If fluid accumulates in the kidneys or liver, pain, reduced appetite, and nausea can occur.

Diagnosis and Treatment

Because congestive heart failure can affect many parts of the body and the manifest symptoms are highly variable among patients, the diagnosis is often clinical and based on thorough physical examinations, carefully chosen laboratory tests, and the applicable portions of the individual’s medical history. Symptoms may make obvious the presence of CHF; a history of cardiac problems such as high blood pressure, alcohol abuse, and coronary artery disease can provide additional clues. A physical exam can reveal the accumulation of fluid and assist in a characterization of the heart’s physical condition.

Diagnostics tools such as X-rays and electrocardiograms can help detect physical abnormalities of the heart, irregular heartbeat, damage from prior heart attacks, and fluid in or close to the lungs. An echocardiogram utilizing ultrasound may also be employed. This test creates an image of the heart and can help doctors analyze the structure of the valves and the way that blood flows. It can also help detect other causes for weak heart muscles (major abnormalities of the valves or damage from earlier heart attacks). Nuclear medicine is sometimes used to determine how well the heart pumps and detect if inadequate blood reaches the heart muscle. Other tools used include heart catheterization, heart tissue biopsy, and b-type natriuretic peptide level tests (which look for elevated levels of this peptide). Testing is chosen based on the diagnosis suspected and the history of each patient.

CHF can have devastating ramifications if left untreated. Fortunately, congestive heart failure can be treated.

One of the most important steps a patient can take is to modify their lifestyle appropriately. Due to frequent symptoms of fluid accumulation, sodium intake often needs to be limited. (Sodium causes fluids to be retained.) When the fluid buildup is regular, the body becomes highly sensitive to water and sodium intake. The general advice given to CHF patients is to limit sodium to more than 2 grams (2,000 milligrams) daily. Sodium is added to virtually all processed foods. Patients are advised to read all labels and tabulate daily intake carefully. Additionally, overall fluid intake is suggested to be reduced to not more than 2 liters from all sources per day. A competent health practitioner can determine levels appropriate to each patient.

Because excessive alcohol can damage the heart, it is normally advised to reduce or eliminate drinking heavily.

The benefits of aerobic exercise for the heart are well established. Today, patients are advised to begin exercise regimes within their healthy capacity, improving their physical and emotional health and survival rates. Some patients may be severely limited based on the severity of their CHF – but regular exercise, appropriately prescribed, appears to offer considerable benefit when the patient is at a stable point in their recovery.

Heart surgery to treat congestive heart failure is sometimes employed. If the CHF is caused by poor blood flow to the heart, surgeries like angioplasty may be performed after careful consideration. If the cause is severely diseased heart valves, corrective valve surgery may be an option.

If hypertension is the root of the problem, aggressive treatment to lower blood pressure may be used.

As with other cardiac conditions, improving diet and reducing stress can significantly impact reversing heart diseases such as congestive heart failure.