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.
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:
- lower body
Nearly 5 million Americans are currently living with congestive heart failure (CHF). Approximately 550,000 new cases are diagnosed in the U.S. each year. CHF annual incidence approaches 10 per 1,000 population after 65 years of age. Approximately two thirds of people with CHF die within five years of their diagnosis. However, some patients do live long lives with CHF by making lifestyle changes and taking medication.
Congestive Heart Failure: Statistics
CHF is a very serious disease; the statistics are alarming:
- Congestive heart failure affects people of all ages, from children and young adults to the middle-aged and the elderly.
- Almost 1.4 million persons with CHF are under 60 years of age.
- CHF is present in 2 percent of persons age 40 to 59.
- More than 5 percent of persons age 60 to 69 have CHF.
- CHF annual incidence approaches 10 per 1,000 population after 65 years of age.
- The incidence of CHF is equally frequent in men and women, and African-Americans are 1.5 times more likely to develop heart failure than Caucasians.
- Heart failure is responsible for 11 million physician visits each year, and more hospitalizations than all forms of cancer combined.
- CHF is the first-listed diagnosis in 875,000 hospitalizations, and the most common diagnosis in hospital patients age 65 years and older.
- In that age group, one-fifth of all hospitalizations have a primary or secondary diagnosis of heart failure.
- More than half of those who develop CHF die within 5 years of diagnosis.
- Heart failure contributes to approximately 287,000 deaths a year.
- Sudden death is common in patients with CHF, occurring at a rate of six to nine times that of the general population.
Congestive Heart Failure: Causes
Heart failure is caused by many conditions that damage the heart muscle, including:
- Coronary artery disease. Coronary artery disease (CAD), a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.
- Heart attack. A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that does not function properly.
- Cardiomyopathy. Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse.
- Conditions that overwork the heart. Conditions including high blood pressure, valve disease, thyroid disease, kidney disease, diabetes, or heart defects present at birth can all cause heart failure. In addition, heart failure can occur when several diseases or conditions are present at once.
Congestive Heart Failure: Symptoms
You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms can include:
- Congested lungs. Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
- Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen (called edema), and weight gain. Symptoms may cause an increased need to urinate during the night. Bloating in your stomach may cause a loss of appetite or nausea.
- Dizziness, fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
- Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a rapid or irregular heartbeat.
Congestive Heart Failure: Types
Systolic dysfunction (or systolic heart failure) occurs when the heart muscle doesn’t contract with enough force, so there is less oxygen-rich blood that is pumped throughout the body.
Diastolic dysfunction (or diastolic heart failure) occurs when the heart contracts normally, but the ventricles do not relax properly or are stiff, and less blood enters the heart during normal filling.
A calculation done during an echocardiogram, called the ejection fraction (EF), is used to measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. Your doctor can discuss which condition you have.
Congestive Heart Failure: Tests And Diagnosis
Tests to determine the cause and severity of heart failure include the following:
- Blood tests. Blood tests are used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia. Anemia is a blood condition that occurs when there is not enough hemoglobin (the substance in red blood cells that enables the blood to transport oxygen through the body) in a person’s blood.
- B-type Natriuretic Peptide (BNP) blood test. BNP is a substance secreted from the heart in response to changes in blood pressure that occur when heart failure develops or worsens. BNP blood levels increase when heart failure symptoms worsen, and decrease when the heart failure condition is stable. The BNP level in a person with heart failure — even someone whose condition is stable — is higher than in a person with normal heart function. BNP levels do not necessarily correlate with the severity of heart failure.
- Chest X-ray. A chest X-ray shows the size of your heart and whether there is fluid build-up around the heart and lungs.
- Echocardiogram. This test is an ultrasound which shows the heart’s movement, structure, and function.
- The Ejection Fraction (EF) is used to measure how well your heart pumps with each beat to determine if systolic dysfunction or heart failure with preserved left ventricular function is present. Your doctor can discuss which condition is present in your heart.
- Electrocardiogram (EKG or ECG) . An EKG records the electrical impulses traveling through the heart.
- Cardiac catheterization. This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure.
- Stress Test. Noninvasive stress tests provide information about the likelihood of coronary artery disease.
Congestive Heart Failure: Treatments
- Coronary artery bypass grafting surgery. The most common surgery for heart failure caused by coronary artery disease is bypass surgery. Although surgery is more risky for people with heart failure, new strategies before, during, and after surgery have reduced the risks and improved outcomes.
- Heart valve surgery. Diseased heart valves can be treated both surgically (traditional heart valve surgery) and non-surgically (balloon valvuloplasty).
- Implantable left ventricular assist device (LVAD). The LVAD is known as the “bridge to transplantation” for patients who haven’t responded to other treatments and are hospitalized with severe systolic heart failure. This device helps your heart pump blood throughout your body. It allows you to be mobile, sometimes returning home to await a heart transplant. It may also be used as destination therapy for long-term support in patients who are not eligible for transplant.
- Heart transplant.A heart transplant is considered when heart failure is so severe that it does not respond to all other therapies, but the person’s health is otherwise good.
Congestive Heart Failure: Prevent Further Damage
Prevent further heart damage by:
- Stop smoking or chewing tobacco.
- Reach and maintain your healthy weight.
- Control high blood pressure, cholesterol levels, and diabetes.
- Exercise regularly.
- Do not drink alcohol.
Congestive Heart Failure: Improve Quality of Life
- Eat a healthy diet. Limit your consumption of sodium (salt) to less than 2,000 milligrams (2 grams) each day. Eat foods high in fiber. Limit foods high in trans fat, cholesterol, and sugar. Reduce total daily intake of calories to lose weight.
- Exercise regularly. A regular cardiovascular exercise program, prescribed by your doctor, will help improve your strength and make you feel better. It may also decrease heart failure progression.
- Don’t overdo it. Plan your activities and include rest periods during the day. Certain activities, such as pushing or pulling heavy objects and shoveling may worsen heart failure.
- Prevent respiratory infections. Ask your doctor about flu and pneumonia vaccines.
- Take your medications as prescribed. Do not stop taking them without first contacting your doctor.
- Get emotional or psychological support if needed. Heart failure can be difficult for your whole family. If you have questions, ask your doctor or nurse. If you need emotional support, social workers, psychologists, clergy, and heart failure support groups are a phone call away. Ask your doctor or nurse to point you in the right direction.