Introduction

Congestive heart failure (CHF) develops when the heart cannot pump enough blood for the body. The most common causes of CHF are high blood pressure and coronary artery disease. CHF is usually a progressive long-term condition. Many forms of CHF can be controlled with lifestyle changes, medications, and treatment of underlying medical conditions. Select people with severe CHF may require implanted devices, such as a pacemaker, or a heart transplant.

Anatomy

The heart is the core of the cardiovascular system. Your heart is located to the left of the center of your chest. It is about the size of your fist. The heart is a muscle that pumps blood throughout your body. The blood carries oxygen-rich blood that your body cells require.

Your heart contains four chambers. The chambers are separated by the septum, a thick muscle wall. There are two chambers on each side of your heart. The top chambers, the atria, receive blood. The bottom chambers, the ventricles, send blood.

Your heart contains a right and left pumping system. Your left atrium receives oxygenated blood from the lungs, and your left ventricle sends it out to your body. Your right atrium receives deoxygenated blood from your body, and your right ventricle sends it to your lungs.

Four heart valves prevent the blood from back flowing as the blood moves forward through the heart chambers. The mitral valve and the tricuspid valve regulate blood flow from the atria to the ventricles. The aortic valve and the pulmonary valve control blood as it leaves the heart. The first sound of your heartbeat is from the mitral valve and the tricuspid valve closing. The second sound in your heartbeat occurs when the aortic valve and the pulmonary valve close after the blood leaves your heart.

Arteries are blood vessels that carry oxygenated blood away from your heart. The aorta is the largest blood vessel in your body. The aortic valve separates the left ventricle from the aorta. The coronary arteries branch off the aorta and supply the heart with oxygen rich blood and nutrients to keep it healthy. The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs.

Veins are vessels that carry blood from your body and lungs back to your heart. Your two largest veins are the superior and inferior vena cavae. They are located above and below your heart.

The large arteries and veins surrounding the heart branch out and become smaller throughout your body. Small capillaries connect the arteries and veins. Capillaries deliver oxygen and nutrients to all of the cells in your body. They also remove waste products, such as carbon dioxide.

Causes

CHF develops when the heart cannot pump enough blood to supply the body. Instead of being pumped forward, blood may back up and accumulate in other areas of the body, such as the lungs, gastrointestinal tract, arms, and legs. Vital organs may not receive enough blood to function. CHF is usually a chronic long-term condition that can affect both or either side of the heart. In some cases, it may develop suddenly.

The most common causes of CHF are high blood pressure and coronary artery disease. CHF can be caused by lung disease, heart tumors, arrhythmia, and structural abnormalities associated with heart valve disease, congenital heart disease, and dilated cardiomyopathy.

Symptoms

CHF can lead to weight gain and swelling in the arms, legs, and abdomen. Your arms and legs may feel cool at rest. Neck veins may protrude. You may experience shortness of breath after activities or lying flat. You may have indigestion, nausea, vomiting, and loss of appetite. You may feel weak, faint, or very tired. You may feel the beat of your heart (palpitations) and have an irregular or fast pulse. You may have difficulty sleeping, remaining alert, concentrating, and remembering things. You may sweat a lot. You may cough or suddenly gasp for breath, especially at night. You may produce smaller amounts of urine than usual and may need to urinate more frequently at night.

Some people with CHF may not have symptoms. They may experience symptoms if they develop infections with a high fever, anemia, arrhythmias, hyperthyroidism, and kidney disease. Infants may sweat while feeding or during other exertion.

Diagnosis

Your doctor can diagnose CHF by reviewing your medical history and examining you. You should tell your doctor about your symptoms. Your doctor will listen to your heart and lungs for any abnormal sounds or heart rhythms. The veins in your neck will be examined and your liver will be checked for enlargement. Lab tests on your blood and urine will provide your doctor with information about how your heart, liver, kidneys, and circulatory system are functioning.

A series of tests may be ordered to evaluate your heart. Common tests include electrocardiogram (ECG), echocardiogram, coronary angiography, and nuclear ventriculography (MUGA or RNV). An ECG records the heart’s electrical activity. An ECG may be repeated over several hours. An echocardiogram uses sound waves to produce an image of the heart on a monitor. Coronary angiography involves inserting a long narrow tube through a blood vessel and injecting dye into the heart to see how the heart and coronary arteries are working. A nuclear ventriculography involves using a safe radioisotope injection to produce an image of the heart with special scanners. The heart structures may also be viewed with computed tomography (CT) scans and magnetic resonance imaging (MRI) scans.
Treatment
Your doctor will classify the type of CHF that you have. Many forms of CHF can be controlled with lifestyle changes, medications, and treatment of underlying medical conditions. Treatment for CHF is focused on relieving symptoms and preventing progression of the disease. Your doctor will treat reversible causes of CHF such as anemia, infection, or high blood pressure.

You should make lifestyle changes to keep your heart healthy. This may include maintaining a healthy weight, not smoking, avoiding excessive amounts of alcohol, eating healthy foods, and regular aerobic exercise. Your doctor may advise you to restrict your salt and fluid intake. There are several types of medications prescribed for CHF. Follow up care is necessary to monitor your condition and treatments to avoid associated medical complications.

People that experience sudden CHF may require hospitalization. Some people may require several medications and special procedures. Fluid may need to be removed from the sac that surrounds the heart. Excess body fluid may be removed with dialysis. Implanted pumps, pacemakers, and defibrillators may be necessary to help the heart function. Select people may be candidates for a heart transplant surgery.

Prevention

You can reverse the risk factors for CHF that are treatable. It is helpful to monitor and maintain your correct blood sugar, cholesterol, and blood pressure levels. Exercise regularly and maintain a healthy weight. Do not smoke, consume alcohol, or use illegal drugs. Ask your doctor about recommendations for reducing your salt and fluid intake.

If you have been diagnosed with CHF, follow your doctor’s instructions carefully. Make and keep all of your appointments. Participate in your cardiac rehabilitation program. Be sure to take all of your medications as directed.

Am I at Risk

Risk factors may increase your likelihood of CHF, although some people that experience the condition do not have any risk factors.

Risk factors for CHF:

• High blood pressure
• Being overweight
• High cholesterol
• Diabetes
• An immediate family member has CHF
• Smoking
• Aging
• Illegal drug use
• Alcohol abuse
• Heart disease/heart attack

Complications

CHF is a progressive disease that can cause death and reduces life expectancy. CHF may become worse if infections or other medical disorders are present. Complications of CHF include fluid buildup in the lungs, kidney problems, and abnormal heart rhythms.

Advancements

Researchers are continually developing and perfecting implanted heart pacemakers, pumps, defibrillators, and transplant methods. Experiments are being done with artificial hearts. Researchers are evaluating trends among individuals that experience CHF to help identify prevention strategies.