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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:
CHF can be life-threatening. If you suspect you or someone near you has CHF, seek immediate medical treatment.
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:
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.
|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.|
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.
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.
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.
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.
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.
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.
It can be difficult to recognize heart failure in infants and young children. Symptoms may include:
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.
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:
You and your doctor may consider different treatments depending on your overall health and how far your condition has progressed.
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:
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:
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:
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.
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.
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.
There are several things you can do to lower your risk of heart failure, or at least delay onset. You can:
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.
Written by: Brindles Lee Macon and Kristeen Cherney
Medically reviewed on: Dec 19, 2016: Debra Sullivan, PhD, MSN, RN, CNE, COI
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