Congestive Heart Failure

What Is It?

Contrary to its name, congestive heart failure does not mean the heart has failed completely. It means the heart no longer is able to meet the body's need for blood because it is pumping inefficiently. This inefficient pumping causes a backup of blood in the veins leading to the heart, and causes the kidney to retain fluid. This causes the body's tissues to swell. The swelling (edema) most commonly affects the legs, but it also can occur in the lungs, causing breathing difficulty, and in other tissues and organs.

Congestive heart failure often is the end stage of another form of heart disease. Its many causes include coronary artery disease, high blood pressure (hypertension), heart valve disorders (including rheumatic heart disease), congenital heart disorders, cardiomyopathy (disease of the heart muscle), heart attack, cardiac arrhythmias (problems with the heart rate and/or rhythm), and toxic exposures, including excessive intake of alcohol. Hyperthyroidism, diabetes and chronic lung disease also increase the risk of congestive heart failure.

In some people, congestive heart failure occurs because the heart muscles are weakened and cannot pump as well. In other people, the heart muscles become stiff, and the heart cannot fill with enough blood between heartbeats.

Cases of congestive heart failure continue to increase in the United States. This probably is the result of an aging population, together with medical advances that have prolonged the lives of people with other forms of heart disease, allowing congestive heart failure to develop.

Symptoms

The first symptom of congestive heart failure can be fatigue. As the condition progresses, there can be breathing difficulties during exertion, and eventually, shortness of breath and wheezing when you are resting. As fluid accumulates in the lungs, people with heart failure may begin to sleep propped up with pillows to make breathing easier. Fluid also can collect in the legs and ankles, causing swelling. In people who are less active, collected fluid can accumulate at mid-body level, eventually causing swelling of the lower back, together with an intestinal swelling that produces abdominal discomfort. Some people need to urinate several times during the night as the kidneys drain off some of the excess fluid that accumulates in the lower body during the day. As the body accumulates more and more fluid, the patient may notice significant weight gain. There also can be a chronic cough due to fluid accumulation in the lungs.

Although congestive heart failure usually affects both sides of the heart, in some people it may affect only the left or right side. In these cases, symptoms vary depending on which side is affected. For example, when heart failure affects mainly the left side of the heart, the symptoms are more likely to involve breathing difficulties. When the right side is primarily affected, leg swelling and abdominal discomfort may be the most prominent symptoms.