Congestive Heart Failure

Congestive heart failure (CHF), sometimes known simply as heart failure, occurs when the heart muscle cannot pump blood well enough to meet the body’s demands.

The purpose of the heart is to pump blood to the body in order to provide oxygen and nutrients. The heart may fail to meet the body’s demands when the heart muscle itself is weaker than normal or when there is a defect in the heart that prevents blood from getting out into the circulation. When the heart does not circulate blood normally, the kidneys receive less blood and filter less fluid out of the circulation into the urine. The extra fluid builds up in the lungs, the liver, around the eyes, and sometimes in the legs. This is called fluid "congestion" and give CHF its name.

Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently. CHF can affect one or both sides of the heart.

Common causes of CHF include coronary artery disease, high blood pressure and diabetes. CHF is more common in people who are 65 years old or older, African Americans, people who are overweight, and people who have had a heart attack. Men have a higher rate of CHF than women.

Not all conditions that lead to CHF can be reversed, but treatments can improve the signs and symptoms of CHF and help you live a longer, better life. Lifestyle changes such as exercising, reducing salt in your diet, managing stress, and losing weight can improve your quality of life.

If lifestyle changes do not control CHF, medicines called diuretics ("water pills") can be used to remove the extra fluid from the body by increasing urination. Medications that relax the blood vessels may also be used to make it easier for the heart to pump, and other medications may help the heart contract with more force.

CHF often develops after other conditions have damaged or weakened your heart. Eventually, the heart can no longer keep up with the normal demands of pumping blood to the rest of the body.

Any of the following conditions can damage or weaken your heart and can cause CHF.

• Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of CHF. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits — a process called atherosclerosis. The buildup of plaques can cause reduced blood flow to your heart. A heart attack occurs if plaques formed by the fatty deposits in your arteries rupture. This causes a blood clot to form, which may block blood flow to an area of the heart muscle, weakening the heart's pumping ability and often leaving permanent damage. If the damage is significant, it can lead to a weakened heart muscle.
• High blood pressure (hypertension). Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
• Faulty heart valves. The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve — due to a heart defect, coronary artery disease, or heart infection — forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart.
• Damage to the heart muscle (cardiomyopathy). Heart muscle damage (cardiomyopathy) can have many causes, including several diseases, infections, alcohol abuse, and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy.
• Myocarditis. Myocarditis is an inflammation of the heart muscle. It is most commonly caused by a virus and can lead to CHF.
• Heart defects you are born with (congenital heart defects). If your heart and its chambers or valves have not formed correctly, the healthy parts of your heart have to work harder to pump blood through your heart, which, in turn, may lead to heart failure.
• Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast, which creates extra work for your heart. Over time, your heart may weaken, leading to CHF. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
• Other diseases. Chronic diseases such as diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron or protein may also contribute to heart failure.
• Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

Risk factors for CHF include:

• High blood pressure
• Coronary artery disease
• Heart attack
• Diabetes
• Some diabetes medications
• Sleep apnea
• Congenital heart defects
• Valvular heart disease
• Viruses
• Alcohol use
• Tobacco use
• Obesity
• Irregular heartbeats

See your doctor for shortness of breath, swelling in the legs or abdomen, rapid weight gain, or a persistent cough. Call 911 for severe breathlessness, chest pain, fainting, or coughing up pink, frothy mucus.