Congestive Heart Failure
Medical Author: Daniel
Kulick, MD, FACC, FSCAI
Medical Editors: William C. Shiel, Jr., MD, FACP, FACR and Dennis Lee, MD
Heart Failure: What Killed George Carlin?
Medical Author: Benjamin Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
Dying of heart failure is not a pleasant way to go, but George Carlin never
took the easy route. George Carlin's fans expected nothing but the blunt truth
from him on stage; in his honor, here's a little blunt truth about heart
failure.
Symptoms of heart failure include shortness of breath, which occurs with
exertion as the disease progresses. Lying flat increases blood return to the
heart; thus patients may complain of shortness of breath (orthopnea) when lying
down. Another symptom is paroxysmal nocturnal dyspnea, a term used to describe
wakening in the middle of the night with shortness of breath that is more long-lasting than simple orthopnea. Patients often describe having to stand by a
window to try to catch their breath. Patients end up sleeping on two or three
pillows to elevate the head and chest, or in a recliner.
Increasing shortness of breath can be tempered by the medications; however,
over time, the symptoms worsen and quality of life suffers. Eventually, the
disease wins, breathing fails, and so does the patient.
What is congestive heart failure?
Congestive heart failure (CHF) is a condition in which the heart's function as a pump to deliver oxygen rich blood to the body is inadequate to meet the body's needs.
Congestive heart failure can be caused by:
- diseases that weaken the heart muscle,
- diseases that cause stiffening of the heart muscles, or
- diseases that increase oxygen demand by the body tissue beyond the capability of the heart to deliver.
The heart has two atria (right atrium and left atrium) that make up the upper chambers of the heart, and two ventricles (left ventricle and right ventricle) that make up the lower chambers of the heart. The ventricles are muscular chambers that pump blood when the muscles contract (the contraction of the ventricle muscles is called systole).
Many diseases can impair the pumping action of the ventricles. For example, the muscles of the ventricles can be weakened by
heart attacks or infections (myocarditis). The diminished pumping ability of the ventricles due to muscle weakening is called systolic dysfunction. After each ventricular contraction (systole) the ventricle muscles need to relax to allow blood from the atria to fill the ventricles. This relaxation of the ventricles is called diastole.
Diseases such as hemochromatosis or amyloidosis can cause stiffening of the heart muscle and impair the ventricles' capacity to relax and fill; this is referred to as diastolic dysfunction. The most common cause of this is longstanding high blood pressure resulting in a thickened (hypertrophied) heart. Additionally, in some patients, although the pumping action and filling capacity of the heart may be normal, abnormally high oxygen demand by the body's tissues (for example, with hyperthyroidism) may make it difficult for the heart to supply an adequate blood flow (called high output heart failure).
In some patients one or more of these factors can be present to cause congestive
heart failure. The remainder of this article will focus primarily on congestive
heart failure that is due to heart muscle weakness, systolic dysfunction.
Congestive heart failure can affect many organs of the body. For example, the weakened heart muscles may not be able to supply enough blood to the kidneys, which then begin to lose their normal ability to excrete salt (sodium) and water. This diminished kidney function can cause to body to retain more fluid. The lungs may become congested with fluid (pulmonary edema) and the person's ability to exercise is decreased. Fluid may likewise accumulate in the liver, thereby impairing its ability to rid the body of toxins and produce essential proteins. The intestines may become less efficient in absorbing nutrients and medicines. Over time, untreated,
worsening congestive heart failure will affect virtually every organ in the body.
Picture of the heart and valves, left and right ventricles, left and right atria
Next: What causes congestive heart failure? »
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