Andrey Nailor, M.D.·Published 24 January 2005·7 min read
Key points
Heart failure, also called congestive heart failure, is a disorder in which the heart loses its ability to pump blood efficiently.
Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly.
Some patients with heart failure have no symptoms.
If you have heart failure, your doctor will monitor you closely.
Alternative names
CHF; Congestive heart failure
Definition
Heart failure, also called congestive heart failure, is a disorder in which the heart loses its ability to pump blood efficiently. The term "heart failure" should not be confused with cardiac arrest, a situation in which the heart actually stops beating.
Causes, incidence, and risk factors
Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly. This condition may affect the right side, the left side, or both sides of the heart.
As the heart's pumping action is lost, blood may back up into other areas of the body:
The liver
The gastrointestinal tract and extremities (right-sided heart failure)
The lungs (left-sided heart failure)
With heart failure, many organs don't receive enough oxygen and nutrients, which damages them and reduces their ability to function properly. Most areas of the body can be affected when both sides of the heart fail.
The most common causes of heart failure are hypertension (high blood pressure) and coronary artery disease (for example, you have had a heart attack). Other structural or functional causes of heart failure include the following:
Valvular heart disease
Congenital heart disease
Dilated cardiomyopathy
Lung disease
Heart tumor
Heart failure becomes more common with advancing age. You are also at increased risk for developing heart failure if you are overweight, have diabetes, smoke cigarettes, abuse alcohol, or use cocaine. .
Symptoms
Weight gain
Swelling of feet and ankles
Swelling of the abdomen
Pronounced neck veins
Loss of appetite, indigestion
Nausea and vomiting
Shortness of breath with activity, or after lying down for a while
Difficulty sleeping
Fatigue, weakness, faintness
Sensation of feeling the heart beat (palpitations)
Irregular or rapid pulse
Decreased alertness or concentration
Written and revised by
Andrey Nailor, M.D.
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Infants may sweat during feeding (or other exertion).
Some patients with heart failure have no symptoms. In these people, the symptoms may develop only with these conditions:
Infections with high fever
Anemia
Abnormal heart rhythm (arrhythmias)
Hyperthyroidism
Kidney disease
Signs and tests A physical examination may reveal either an irregular or a rapid heartbeat. There may be distended neck veins, enlarged liver, swelling of the limbs (peripheral edema), and signs of fluid around the lungs (pleural effusion).
Listening to the chest with a stethoscope may reveal lung crackles or abnormal heart sounds. Blood pressure may be normal, elevated or low.
An enlargement of the heart or decreased heart functioning may be seen on several tests, including the following:
Echocardiogram
Heart catheterization
Chest x-ray
Chest CT scan
Cardiac MRI
Nuclear heart scans (MUGA, RNV)
ECG, which may also show arrhythmias
This disease may also alter the following test results:
CBC
Blood chemistry
Serum sodium
BUN
Creatinine
Liver function tests
Serum uric acid
Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)
If excessive fluid has accumulated around the sac surrounding the heart (pericardium), you may need to have the fluid removed through a pericardiocentesis.
Treatment
If you have heart failure, your doctor will monitor you closely. This means having follow up appointments at least every 3 to 6 months, figuring out any underlying cause and treating it, and periodic testing of your heart function. For example, an ultrasound of your heart, called an echocardiogram, will be done once in awhile to give an estimate of how well your heart is pumping blood with each stroke or beat.
It is also your responsibility to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that the pump function of your heart is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.
Other important measures include:
Take your medications as directed. Carry a list of medications with you wherever you go.
Limit salt and sodium intake.
Don't smoke.
Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan based on your degree of heart failure and how well you do on tests that check the strength and function of your heart. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.
Lose weight if you are overweight.
Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.
Tips to lower your salt and sodium intake
Look for foods that are labeled "low-sodium," "sodium-free," "no salt added," or "unsalted." Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels.
Don't cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).
Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese.
Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.
Use oil and vinegar, rather than bottled dressings, on salads.
Eat fresh fruit or sorbet when having dessert.
Medications that your doctor will consider prescribing include:
ACE inhibitors such as captopril and enalapril - these medications open up blood vessels and decrease the work load of the heart. These have become an important part of treatment
Diuretics - there are several types including thiazide, loop diuretics, and potassium-sparing diuretics; they help rid your body of fluid and sodium.
Digitalis glycosides - increase the ability of the heart muscle to contract properly; prevent heart rhythm disturbances
Angiotensin receptor blockers (ARBs) such as losartan and candesartan which, like ACE inhibitors, reduce the workload of the heart; this class of drug is especially important for those who cannot tolerate ACE inhibitors
Beta-blockers - this is particularly useful for those with a history of coronary artery disease
Sometimes, hospitalization is required for acute CHF. Hospitalized patients may receive oxygen and intravenous medications such as vasodilators and diuretics.
The heart's ability to pump blood can be directly increased by medications called inotropic agents. These include dobutamine and milrinone, which are given intravenously.
Unstable patients receiving several medications usually need also hemodynamic monitoring with Swan-Ganz catheterization.
Severe cases of CHF require more drastic measures. For example, excess fluid can be removed through dialysis, and circulatory assistance can be provided by implanted devices such as the intra-aortic balloon pump (IABP) and the left ventricular assist device (LVAD). These devices can be life-saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.
Expectations (prognosis)
Heart failure is a serious disorder that carries a reduced life expectancy. Many forms of heart failure can be controlled with medication, lifestyle change, and correction of any underlying disorder. Heart failure is usually a chronic illness, and it may worsen with infection or other physical stressors.
Complications
Pulmonary edema
Total failure of the heart to function (circulatory collapse)
Arrhythmias including lethal arrhythmias
Possible side effects of medications include:
Low blood pressure (hypotension)
Light-headedness and fainting
Lupus reaction
Headache
Gastrointestinal upset (such as nausea, heartburn, diarrhea)
Cough
Muscle cramps
Digitalis toxicity
Calling your health care provider
Call your health care provider if weakness, increased cough or sputum production, sudden weight gain or swelling, or other new or unexplained symptoms develop.
Go to the emergency room or call the local emergency number (such as 911) if you experience severe crushing chest pain, fainting, or rapid and irregular heartbeat (particularly if other symptoms accompany a rapid and irregular heartbeat).
Prevention
Follow your health care provider's recommendations for treatment of conditions that may cause congestive heart failure. These recommendations may include:
Treat your high blood pressure with diet, exercise, and medication if necessary.
Treat your high cholesterol with diet, exercise, and medication if necessary.
DO NOT smoke
Avoid alcohol use
Take an ACE inhibitor if you have heart disease, diabetes, or high blood pressure.
Treat arrhythmias (abnormal heart rhythms) and keep your heart rate under control.
Treat an underlying thyroid disorder.
Also, consider the following lifestyle habits, especially if you have a strong family history of CHF:
Alternative names Acute kidney failure; Kidney failure; Kidney failure - acute; Renal failure; ARF Definition Acute renal failure is sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, and…
