What Is Congestive Heart Failure?

Heart failure does not mean that the heart suddenly stops. Rather, it means that the heart is failing to do its proper job as a pump.

Also in this article: What Happens in CHF? How Is It Diagnosed? How Is It Treated? How Long Do the Effects Last?

The right lower chamber (right ventricle) of the heart pumps blood from the veins to the lungs. The left ventricle pumps oxygen-carrying blood from the lungs to the rest of the body. Congestive heart failure occurs when the heart's left ventricle fails to pump properly.

Congestive heart failure is the most common cause of cardiovascular illness and death in the U.S. Although many diseases cause the left ventricle to pump poorly, the most common are coronary heart disease and long-term high blood pressure. Heart valve disease is another common cause of congestive heart failure.

Poor pumping of the left ventricle raises the blood pressure in the ventricle during the short rest period between heart contractions. It also causes increased blood pressure in the lungs. Small amounts of blood plasma are forced out of the lung's blood vessels into the lung tissue. In mild cases, the only symptom may be shortness of breath with exertion. In severe cases, the fluid fills the lung's air sacs and causes severe shortness of breath and cough, even when you are resting or lying down to sleep. Over time, the increased pressure in the lungs affects the pumping ability of the right ventricle. The blood pressure in the veins rises.

Eventually, the diseased or damaged left ventricle is unable to pump enough blood to the rest of the body. Other organs in the body, particularly the kidneys, sense this decrease in blood flow and attempt to make up for it by increasing the volume of blood. The combination of poor pumping by the heart and the extra fluid in the blood vessels leads to more leakage of plasma fluid through the vessel walls into the body tissues. Swelling of the legs and ankles, called edema, is the result. Edema may also affect other organs, such as the liver and intestinal tract, and hinder their function.

Your doctor will if you have shortness of breath with physical effort or upon waking from sleep, or swelling in your legs and ankles. If you have suddenly gained a lot of weight, it may be due the sudden buildup of fluid (edema) people can have with congestive heart failure.

The doctor will use a stethoscope to listen for faint sounds of abnormal heart function. He or she will also listen to your lungs for "crackles," which hint at escaped fluid. Your doctor will press on your abdomen to feel the size of your liver. Your neck veins will be examined for swelling, and your legs will be checked for edema.

Laboratory tests help confirm the diagnosis. A chest x-ray may show enlargement of your heart or signs of fluid in your lungs. An echocardiogram or a radioisotope study will show whether the left ventricle is working properly. These tests use ultrasound echoes or trace amounts of radioactivity to show the valves and muscle in the heart.

Treatment is aimed at reducing the workload of the heart and getting the heart muscle to squeeze more effectively. The best way to reduce the heart's workload is to rest it. The only time the heart can rest is between beats. Your doctor will probably recommend bed rest or reduced physical activity. The limits on activity will vary depending on how severe your heart failure is, but most people benefit from a gentle exercise program.

A simple but important way to ease the heart's work and decrease edema is to reduce salt in your diet. If you have congestive heart failure, salt causes your body to retain water, adding to the volume of blood. The increased blood volume causes the ventricle to work harder and contributes to edema. If you enjoy salty foods, eating foods with less salt may be hard for you to do, but it is very important.

Medications are used to reduce the workload of the heart. Blood pressure drugs (antihypertensives) can be used to reduce the pressure against which the heart has to pump. Diuretics (water pills) force the kidneys to excrete the extra water the body has built up. A special class of drugs called ACE inhibitors act on the kidneys to both affect blood pressure and reduce the retention of fluids. Lower blood pressure and lower blood volume ease the workload of the heart. Beta blockers are now recognized as medicines that improve the outlook, and are often given for treatment.

A major effort in treating congestive heart failure is to improve the heart muscle's ability to squeeze. Your body attempts to do this by enlarging each heart muscle cell. This strengthens your heart muscle. Like all muscles, there is a limit to the heart's strength. By itself this may not be enough to do the job.

One drug, digitalis, has been used for over 150 years as a "tonic" for the heart muscle. It acts on the individual muscle cells and causes them to contract with more force. It improves the pumping ability of the heart. It is the only drug available now that can be taken by mouth to directly improve the heart's ability to contract. Other medications work indirectly to improve the heart's function.

Despite treatment, congestive heart failure remains a common and serious disease. Congestive heart failure usually means a shorted life span. However, a proper mix of medicines, reduced salt in your diet, and reduced physical activity can greatly improve your symptoms and can usually allow you to return to a relatively normal lifestyle. The underlying disease that caused your congestive heart failure will continue to need close medical supervision.