Congestive Heart Failure
Medical Author: Daniel
Kulick, MD, FACC, FSCAI
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
Congestive Heart Failure
Congestive Heart Failure Symptoms and Signs
The symptoms of congestive heart failure vary among individuals according to the particular
organ systems involved and depending on the degree to which the rest of the body
has "compensated" for the heart muscle weakness.
The early symptoms are often shortness of breath, cough, or a feeling of not being able to get a deep breath.
In addition, the three major symptoms of congestive heart failure are:
- exercise intolerance (a person may be unable to tolerate exercise or even mild physical exertion that he or she may have been able to do in the past);
- shortness of breath (you may have difficulty breathing (dyspnea), especially when active, or even at rest); and
- fluid retention and swelling (edema in the legs, feet, and ankles).
Read more about the signs and symptoms of congestive heart failure »
What is congestive heart failure?
Congestive heart failure (CHF) is a condition in which the heart's function as a pump
is inadequate to deliver oxygen rich blood to the body.
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
adequate oxygen-rich blood.
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
(iron overload) 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
or anemia) may make it difficult for the heart to supply an adequate blood flow (called high output heart failure).
In some individuals 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 the 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.
- Fluid also may accumulate in the extremities, resulting in
edema (swelling) of the ankles
and feet.
Eventually, 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
What causes congestive heart failure?
Many disease processes can impair the pumping efficiency of the heart to cause
congestive heart failure. In the
United States, the most common causes of congestive heart failure are:
Less common causes
include viral infections of the stiffening of the heart muscle,
thyroid disorders,
disorders of the heart
rhythm, and many others.
It should also be noted that in patients with underlying heart disease, taking certain
medications can lead to the development or worsening of congestive heart failure. This is especially true for
those drugs that can cause sodium retention or affect the power of the heart muscle.
Examples of such medications are the commonly used nonsteroidal antiinflammatory drugs (NSAIDs),
which include ibuprofen (Motrin and others)
and naproxen (Aleve and
others) as well as certain steroids, some medication for
diabetes (such as
rosiglitazone [Avandia] or
pioglitazone [Actos]), and some calcium
channel blockers.
Next: What are the symptoms of congestive heart failure
(CHF)? »
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