- Signs & Symptoms
- 4 Stages
- Risk Factors
- Lifestyle Changes
- Life Expectancy
What is congestive heart failure?
Heart failure describes the inability or failure of the heart to meet the needs of organs and tissues for oxygen and nutrients. This decrease in cardiac output, the amount of blood that the heart pumps, is not adequate to circulate the blood returning to the heart from the body and lungs, causing the fluid (mainly water) to leak from capillary blood vessels. This leads to symptoms that may include shortness of breath, weakness, and swelling.
Understanding blood flow in the heart and body
The right side of the heart pumps blood to the lungs while the left side pumps blood to the rest of the body. Blood from the body enters the right atrium through the vena cava. It then flows into the right ventricle where it is pumped to the lungs through the pulmonary artery, which carries deoxygenated blood to the lungs. In the lungs, oxygen is loaded onto red blood cells and returns to the left atrium of the heart via the pulmonary veins. Blood then flows into the left ventricle where it is pumped to the organs and tissues of the body. Oxygen is downloaded from red blood cells into the various organs while carbon dioxide, a waste product of metabolism, is added to be removed from the lungs. Blood then returns to the right atrium to start the cycle again. The pulmonary veins are unusual in that they carry oxygenated blood, while the pulmonary artery carries deoxygenated blood. This is a reversal of duties versus the roles of veins and arteries in the rest of the body.
Left heart failure occurs when the left ventricle cannot pump blood to the body and fluid backs up and leaks into the lungs causing shortness of breath. Right heart failure occurs when the right ventricle cannot adequately pump blood to the lungs. Blood and fluid may back up in the veins that deliver blood to the heart. This can cause fluid to leak into tissues and organs.
It is important to know that both sides of the heart may fail to function adequately at the same time and this is called biventricular heart failure. This often occurs since the most common cause of right heart failure is left heart failure.
What are the signs and symptoms of congestive heart failure?
Shortness of breath
The hallmark and most common symptom of left heart failure is shortness of breath and may occur:
- While at rest
- With activity or exertion
- While lying flat (orthopnea)
- While awakening the person from sleep (paroxysmal nocturnal dyspnea); or
- Due to fluid (water, mainly) accumulation in the lungs or the inability of the heart to be efficient enough to pump blood to the organs of the body when called upon in times of exertion or stress.
- Chest pain or angina may be associated, especially if the underlying cause of the failure is coronary heart disease.
Right heart failure, left heart failure, or both
- People with right heart failure leak fluid into the tissue and organs that deliver blood to the right heart through the vena cava.
- Backpressure in capillary blood vessels causes them to leak water into space between cells and commonly the fluid can be found in the lowest parts of the body.
- Gravity causes fluid to accumulate in the feet and ankles but as more fluid accumulates, it may creep up to involve all of the lower legs.
- Fluid can also accumulate within the liver causing it to swell (hepatomegaly) and within the abdominal cavity (ascites).
- Ascites and hepatomegaly may make the patient feel bloated, nauseated, and have abdominal pain with the feeling of distension.
- Depending upon their underlying illness and the clinical situation, patients may have symptoms of right heart failure, left heart failure, or both.
What are the main causes of 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:
- Coronary artery disease
- High blood pressure (hypertension)
- Longstanding alcohol abuse
- Disorders of the heart valves
- Unknown (idiopathic) causes, such as after recovery from myocarditis
Less common causes of congestive heart failure include:
- Viral infections of the stiffening of the heart muscle
- Thyroid disorders
- Heart rhythm abnormalities
In people with congestive heart failure with underlying heart disease, taking certain medications could lead to the development or worsening of the lung disease. Moreover, drugs can cause sodium retention or affect the power of the heart muscle. Examples of such medications are the commonly used nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen (Motrin and others) and naproxen (Aleve and others) as well as certain steroids, some medication for type 2 diabetes, for example, rosiglitazone (Avandia) or pioglitazone (Actos), and some calcium channel blockers (CCBs).
What are the stages of congestive heart failure?
The New York Heart Association has developed a scale that commonly is used to determine the functional capabilities of heart failure.
New York Heart Association (NYHA) Functional Classification of Heart Failure
- Class I: Patients without limitation of physical activity.
- Class II: Patients with slight limitation of physical capacity, in which marked increase in physical activity leads to fatigue, palpitations, dyspnea, or angina pain; they are comfortable at rest.
- Class III: Patients with marked limitation of physical activity in which minimal ordinary activity results in fatigue, palpitation, dyspnea, or angina pain; they are comfortable at rest.
- Class IV: Patients who are not only unable to carry on any physical activity without discomfort but who also have symptoms of heart failure or angina syndrome even at rest; the patient's discomfort increases if any physical activity is undertaken.
What are the risk factors for congestive heart failure?
Heart valve disease becomes a risk factor as the patient ages.
Other causes of heart failure have their own set of risk factors and predispositions and it becomes a complication of those diseases. Such causes may include
- obstructive sleep apnea,
- alcohol and drug abuse,
- infections, and
- connective tissue disorders like systemic lupus erythematosus, sarcoidosis, and amyloidosis.
Many patients have stable congestive heart failure but can decompensate when a change occurs in their bodies. For example, a patient with congestive heart failure may be doing well but then develops pneumonia, an infection of the lungs, or suffers a heart attack.
The patient's heart may not be able to react to the body's changing environment and does not have the capability or reserve to meet the body's energy needs.
Acute decompensation may occur if the patient drinks excess fluid, has a large intake of salt that can retain water in the body, or forgets to take their routine medication.
What procedures and tests diagnose congestive heart failure?
Congestive heart failure can be a medical emergency, especially if it acutely decompensates and the patient can present extremely ill with the inability to breathe adequately. In this situation, the ABCs of resuscitation (Airway, Breathing, and Circulation) need to be addressed while at the same time, the diagnosis of congestive heart failure is made.
Common tests that are done to help with the diagnosis of congestive heart failure include the following:
- Electrocardiogram (EKG, ECG) to help assess heart rate, rhythm, and indirectly, the size of the ventricles and blood flow to the heart muscle.
- Chest X-ray to look at heart size and the presence or absence of fluid in the lungs.
- Blood tests may include a complete blood count (CBC), electrolytes, glucose, BUN, and creatinine (to assess kidney function).
- B-type natriuretic peptide (BNP) may help decide if a patient has shortness of breath from congestive heart failure or a different cause. It is a chemical that is located in the heart ventricles and may be released when these muscles are overloaded.
- Echocardiography or ultrasound testing of the heart is often recommended to assess the anatomy and the function of the heart. In addition to being able to evaluate the heart valves and muscle, the test can look at blood flow within the heart, watch the chambers of the heart contract, and measure the ejection fraction (percentage of blood ejected with each beat - normal = 50% to 75%).
Other tests may be considered to evaluate and monitor a patient with suspected congestive heart failure, depending upon the clinical situation.
Healthy Heart Resources
Health Solutions From Our Sponsors
What is the treatment for congestive heart failure?
The goal of treatment for congestive heart failure is to have the heart beat more efficiently so that it can meet the energy needs of the body. Specific treatment depends upon the underlying cause of heart failure, and include:
Medication to decrease body fluids (diuretic)
Treatment may try to decrease fluid within the body so that the heart does not have to work as hard to circulate blood through the blood vessels in the body. Fluid restriction and a decrease in salt intake may be very helpful.
Common diuretic medications (water pills) include:
- ACE inhibitors (angiotensin-converting enzyme inhibitors) and ARBs (angiotension receptor blockers) are medicines that are also shown to increase survival by decreasing systemic resistance and favorable altering the hormonal milieu, which affects cardiac performance; they are often used with other drugs.
- Beta-blockers may control heart rate and increase cardiac output and ejection fraction, and provide a beneficial response to circulating epinephrine ("adrenalin").
- Digoxin (Lanoxin) is an older medicine that may help increase cardiac output and control symptoms.
- A very mild newer diuretic, spironolactone, is of long-term benefit.
Cardiac risk factor modification
Cardiac risk factor modification is the cornerstone of the prevention of congestive heart failure, Moreover, it may benefit patients with congestive heart failure.
Management of congestive heart failure include:
People with end-stage congestive heart failure (NYHA stage IV) may require aggressive treatments including left ventricular assist devices (LVAD), an implanted pump that helps increase the heart's ability to squeeze, or even heart transplantation.
People with congestive heart failure are not transplanted candidates, LVAD may be a permanent treatment.
What lifestyle changes help treat and manage congestive heart failure?
Diet and exercise
Sodium causes an increase in fluid accumulation in the body's tissues. Because the body is often congested with excess fluid, patients become very sensitive to the levels of intake of sodium and water. Restricting salt and fluid intake is often recommended because of the tendency of a fluid to accumulate in the lungs and surrounding tissues.
- A "no added salt" diet can still contain 4 to 6 grams (4000 to 6000 milligrams) of sodium per day.
- In individuals with congestive heart failure, an intake of no more than 2 grams (2000 milligrams) of sodium per day is generally advised.
- Reading food labels and paying close attention to total sodium intake is very important.
- Severe restriction of alcohol consumption.
Aerobic exercise once discouraged for congestive heart failure patients, is beneficial in maintaining overall functional capacity, quality of life, and perhaps even improving survival. Each person's body has its unique ability to compensate for the failing heart. Given the same degree of heart muscle weakness, individuals may display widely varying degrees of limitation of function. Regular exercise, when tailored to the person's tolerance level, appears to provide significant benefits and should be used only when the individual is compensated and stable.
The total amount of fluid a patient consumes must be regulated. Although many people with congestive heart failure take prescription diuretics to aid in the elimination of excess fluid, the action of these medications can be overwhelmed by an excess intake of water and other fluids. The maxim that "drinking eight glasses of water a day is healthy" certainly does not apply to patients with congestive heart failure. Patients with more advanced cases of congestive heart failure are often advised to limit their total daily fluid intake from all sources to 2 quarts.
The above guidelines for sodium and fluid intake may vary depending on the severity of congestive heart failure in any given individual and should be discussed with their doctor.
- An important tool for monitoring an appropriate fluid balance is the frequent tracking of the patient's body weight.
- An early sign of fluid accumulation is an increase in body weight.
- This may occur even before shortness of breath or swelling in the legs and other body tissues (edema) is detected.
- A weight gain of 2 to 3 pounds over 2 to 3 days should prompt a call to a doctor, who may order an increase in the dose of diuretics or other methods designed to stop the early stages of fluid accumulation before it becomes more severe.
Support and Resources
Resources available for patients trying to cope with the long-term challenges of congestive heart failure include:
- Local support groups;
- Cardiac rehab programs designed for congestive heart failure (covered by many types of insurance); and
- Self-monitoring of weight and fluid intake.
What is the prognosis and life expectancy for congestive heart failure?
Congestive heart failure is generally a progressive disease with periods of stability punctuated by episodic clinical exacerbations. The course of the disease in any given individual, however, is extremely variable. Factors involved in determining the long-term outlook (prognosis) for congestive heart failure include:
- The nature of the underlying heart disease
- Response to medications
- The degree to which other organ systems are involved and the severity of other accompanying conditions
- The person's symptoms and degree of impairment
- Other factors that remain poorly understood
With the availability of newer drugs to potentially favorably affect the progression of the disease, the prognosis in congestive heart failure is generally more favorable than that observed just 10 years ago. In some cases, especially when the heart muscle dysfunction has recently developed, a significant spontaneous improvement is not uncommonly observed, even to the point where heart function becomes normal.
Heart failure is often graded on a scale of I to IV based on the patient's ability to function.
- Class I includes patients with a weakened heart but without limitation or symptoms.
- Class II describes patients whose only limitation is heavier workloads.
- Class III includes patients who experience limitations with everyday activity.
- Class IV describes patients with severe symptoms at rest or with any degree of effort.
The prognosis of heart failure patients is very closely associated with the functional class.
An important issue in congestive heart failure is the risk of heart rhythm disturbances (arrhythmias). Of those deaths that occur in individuals with congestive heart failure, approximately 50% are related to progressive heart failure. Importantly, the other half are thought to be related to serious arrhythmias.
A major advance has been the finding that nonsurgical placement of automatic implantable cardioverter/defibrillators (AICD) in individuals with severe congestive heart failure (defined by an ejection fraction below 30% to 35%) can significantly improve survival, and has become the standard of care in most such individuals.
In some people with severe heart failure and certain ECG abnormalities, the left and right side of the heart doesn't beat in rhythm and inserting a device called a biventricular pacer can significantly reduce symptoms.
Can congestive heart failure be prevented?
- Congestive heart failure is the result of an underlying illness, which is often atherosclerotic heart disease.
- Controlling those risk factors may help with congestive heart failure prevention.
- These include lifelong control of high blood pressure, high cholesterol, and diabetes and smoking cessation.
- High blood pressure and diabetes are independent risks for congestive heart failure.
- Alcohol and drug abuse may be a cause of heart failure.
Diastolic dysfunction: This is a form of CHF in which the heart muscle may be stiff, most often from hypertension or normal aging. The ejection fraction is normal and the prognosis is excellent. The problem is that a stiff heart muscle fills with blood at a higher pressure, which is transmitted to the lungs resulting in shortness of breath. It must be emphasized that the long-term outlook for patients with this condition is excellent.
Roger, Veronique L., et al. On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. "Heart disease and stroke statistics -- 2011 update: a report from the American Heart Association." Circulation 123.4 (2011): e18-e209.
Top Congestive Heart Failure (CHF) Overview Related Articles
Heart Healthy Diet: 25 Foods You Should EatWhat foods are heart healthy? Learn what foods help protect your cardiovascular system from heart attack, coronary heart disease, stroke, and cardiovascular disease. Plus, find easy meal recipes and menu ideas for more everyday heart benefit.
Chest X-RayChest X-Ray is a type of X-Ray commonly used to detect abnormalities in the lungs. A chest X-ray can also detect some abnormalities in the heart, aorta, and the bones of the thoracic area. A chest X-ray can be used to define abnormalities of the lungs such as excessive fluid (fluid overload or pulmonary edema), fluid around the lung (pleural effusion), pneumonia, bronchitis, asthma, cysts, and cancers.
Electrocardiogram (ECG or EKG)An electrocardiogram is known by the acronyms "ECG" or "EKG" more commonly used for this noninvasive procedure to record the electrical activity of the heart. An EKG generally is performed as part of a routine physical exam, part of a cardiac exercise stress test, or part of the evaluation of symptoms. Symptoms evaluated include palpitations, fainting, shortness of breath, dizziness, fainting, or chest pain.
ElectrolytesElectrolytes are substances that become ions in solution and acquire the capacity to conduct electricity. The balance of the electrolytes in our bodies is essential for normal function of our cells and our organs. Common electrolytes include sodium, potassium, chloride, and bicarbonate. The functions and normal range values for these electrolytes are important, and if an electrolyte is at an extreme low or high, it can be fatal.
Heart Detail PictureThe heart is composed of specialized cardiac muscle, and it is four-chambered, with a right atrium and ventricle, and an anatomically separate left atrium and ventricle. See a picture of Heart Detail and learn more about the health topic.
Heart Disease QuizTake our Heart Disease Quiz to get answers and facts about high cholesterol, atherosclerosis prevention, and the causes, symptoms, treatments, testing, and procedures for medically broken hearts.
Heart Failure QuizWhat is heart failure? Learn about this dangerous condition, as well as who is at risk, and what to do about it.
Am I Having a Heart Attack? Symptoms of Heart DiseaseHeart attacks symptoms vary greatly for men and women, from anxiety and fatigue to nausea and sweating. Learn the warning signs of a heart attack and know the symptoms that may require an immediate trip to the hospital.
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms.
Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure.
The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater.
If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.
REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
High-Sensitivity Troponin TestThe high-sensitive troponin test can detect very low levels of troponin T in the blood. (There are three types of cardiac troponin proteins, I, T, and C.), which helps doctors diagnose a heart attack more quickly. If troponin levels are elevated high and the ECG (EKG, electrocardiogram) indicates an acute heart attack, immediate cardiac intervention such as catheterization, stents, or a coronary artery bypass graft (CABG). The high-sensitive troponin test can help diagnose heart conditions such as obstructive coronary disease (CAD), stable angina, congestive heart failure, cardiomyopathy, chronic heart failure, myocarditis, aortic dissection, cardiotoxic chemotherapy, blunt trauma to the chest, and strenuous exercise, for example, endurance athletes. You can prevent elevated troponin levels in the blood with a heart-healthy lifestyle a heart-healthy diet, maintaining your weight, limit alcohol, don’t smoke, practice stress reduction through stress reduction techniques, meditation, and yoga, manage your blood pressure and diabetes, and take all of your medications as your doctor has instructed you. Call 911 immediately if you have chest pain and have symptoms of a heart attack, which include nausea, vomiting, belching, indigestion, upper abdominal discomfort that feels like stomach pain in the middle of the upper abdomen, upper back and arm pain, feeling as though you are getting the flu, sweating, a vague feeling of illness, and sweating.
Liver DiseaseLiver disease can be cause by a variety of things including infection (hepatitis), diseases, for example, gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause and may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Low Blood Pressure (Hypotension)Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include light-headedness, dizziness, and fainting if not enough blood is getting to the brain. Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.
Low Blood PressureWhat is low blood pressure (hypotension)? Explore low blood pressure causes, symptoms, and signs. Discover what is considered low blood pressure.
Parathyroidectomy SurgeryParathyroidectomy is the removal of one or more of the parathyroid glands to treat hyperparathyroidism. Risks of parathyroidectomy include:
- paralysis of the vocal cords,
- difficulty swallowing thin liquids,
- difficulty breathing,
- and drug reactions.
- damage to the recurrent laryngeal nerve,
- bleeding or hematoma,
- problems maintaining calcium levels in the blood,
- need for further and more aggressive surgery,
- need for a limited or total thyroidectomy,
- prolonged pain,
- impaired healing,
- and recurrence of the tumor.
Shock (Medical)What is shock? A life-threatening condition with symptoms like low blood pressure, weakness, shallow breathing, clammy skin, fainting, anxiety, confusion, and chest pain. Learn about causes, types, and treatment.
Your Thyroid: Common Thyroid Problems and Diseases ExplainedLearn about thyroid problems such as hyperthyroidism, hypothyroidism, thyroid cancer, and more. Discover symptoms and treatments for various thyroid problems.
What Are The Four Heart Sounds?Heart sounds are generated by blood flowing in and out of the heart’s chambers through the valves as they open and close. Listening to the heart sounds through a stethoscope (auscultation) is one of the first steps a physician takes in evaluating a patient’s medical condition. Heart sounds provide the doctor valuable information about heart function. Auscultation is used to detect abnormal heart sounds and decide on further course of action.