Congestive Heart Failure

What is congestive heart failure?

Congestive heart failure is a life-threatening disease that occurs when your heart becomes too weak to pump blood properly.

What causes congestive heart failure?

Heart failure is caused by damage to your heart. Over time, the damage causes your heart to work harder and grow larger. The harder your heart works, the weaker it becomes until it cannot work properly. The following are the more common causes of heart failure:

• Heart problems: Coronary artery disease is the most common cause. The arteries that bring blood to your heart become narrow, leading to poor blood flow. A heart attack or damage to heart valves may also cause heart failure. Abnormal heartbeats can weaken your heart. High blood pressure also makes your heart work harder.
  
  
• Diseases: Diseases such as arthritis, lupus, and diabetes can damage your heart. Kidney, lung, or thyroid disease can make your heart work harder.
  
  
• Sleep disorders: Sleep disorders such as obstructive sleep apnea may lead to heart failure because you do not get enough oxygen.
  
  
• Toxins: Toxins include alcohol, chemicals in cigarettes, and drugs such as cocaine. High levels of heavy metals such as lead and mercury can be toxic. Radiation therapy is also a toxin that can lead to heart failure.
  
  
• Medicines: Medicines used to treat heart conditions may weaken your heart. Chemotherapy medicines may damage your heart.
  
  
• Poor nutrition or obesity: Low levels of vitamins and minerals may damage your heart. High cholesterol levels may block your blood vessels and cause heart damage. Obesity causes your heart to work harder. Obesity also increases your risk for sleep apnea.

What are the signs and symptoms of congestive heart failure?

Signs and symptoms often get worse over time but can appear suddenly or get worse quickly.

• Fatigue and weakness
  
  
• Swollen legs, ankles, feet, and abdomen
  
  
• Shortness of breath that may get worse when you lie down
  
  
• Chest pain or palpitations (strong, fast heartbeats)
  
  
• Cold hands and feet
  
  
• Coughing up pink and foamy or bloody sputum
  
  
• Decreased appetite, nausea, abdominal pain, and weight loss
  
  
• Changes in urination

How is congestive heart failure diagnosed?

Your caregiver will ask when your symptoms started and what makes them worse. He will do a physical exam. A sample of your blood may be taken to check for imbalances in hormones and electrolytes. Blood tests can also check for diseases and test your liver and kidney function. Tell your caregiver if you have a family member with heart disease and about the medicines or herbal supplements you take. Also tell him if you smoke, drink alcohol, or take any illegal drugs.

• ECG: This is also called an EKG. An ECG is done to check for damage or problems in your heart. A short period of electrical activity in your heart is recorded. You may also need to wear a Holter monitor while you do your usual activities. The monitor will show how fast your heart beats, and if it beats in a regular pattern.
  
  
• Heart catheter: This is a procedure done to find the cause of your heart failure. A catheter (tube) is guided into your heart through a vein in your arm, neck, or groin. Your caregiver may use an x-ray to guide the tube to the right place.
  
  
• Exercise stress test: This test helps caregivers see the changes that take place in your heart during exercise. An ECG is done while you ride an exercise bike or walk on a treadmill. Caregivers will ask if you have chest pain or trouble breathing.
  
  
• Chest x-ray: The x-ray will show the size of your heart and if there is fluid around your heart and lungs.
  
  
• CT scan or MRI: Pictures are taken of your heart to check the size and thickness of your ventricles. The pictures may show if you have fluid around your heart and lungs. You may be given contrast dye through an IV. Tell your caregiver if you are allergic to iodine or shellfish. You may also be allergic to the dye.
  
  
• Echo: This type of ultrasound shows the movement and blood vessels of your heart. A transesophageal echo may be done if your heart cannot be seen well during a regular echo. Caregivers will put a tube in your mouth that is moved down into your esophagus. The tube has a small ultrasound sensor on the end that shows your heart.
  
  
• Heart scan: Pictures are taken to show how well your heart is pumping. You are given a small amount of dye in an IV to help the pictures show up better.
  
  
• Biopsy: A small sample of tissue is taken from your heart and tested to find the cause of your heart failure.

What medicines may be used to treat congestive heart failure?

• Heart medicines:
  
  
  • ACE inhibitors: These decrease your symptoms and slow your heart failure. You may need ARBs if you cannot take ACE inhibitors. ARBs help your heart beat more strongly.
    
    
  • Beta blockers: These help your heart pump strongly and regularly.
    
    
  • Cardiac glycosides: These help your heart beat strongly and decrease abnormal heartbeats.
    
    
  • Nitrates: These improve the blood flow through your heart.
    
    
  • Vasodilators: These improve blood flow by making the vessels in your heart and lungs wider.
  
  
• Diuretics: These help your body get rid of extra fluid and protect your heart from more damage. You may urinate more often while you are taking diuretics.
  
  
• Blood thinners: These prevent blood clots. They may make you bruise or bleed more easily. Use a soft toothbrush and an electric shaver to prevent bleeding.

How is congestive heart failure treated?

• Cardiac rehab: You learn how to live a more heart-healthy lifestyle, including nutrition and exercise.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. Oxygen can help decrease your shortness of breath.
  
  
• Implanted devices: An implanted device is put under your skin to help your heart beat properly. A pacemaker is an example of an implanted device.
  
  
• Surgery: Surgery may be done to open blocked heart vessels. You may have a damaged valve replaced. You may need a heart transplant if all other treatments have failed.
  
  
• Fluid balance: This is a procedure to remove extra fluid from your blood.

What can I do to manage my congestive heart failure?

• Check your weight daily: Weight gain can be a sign of extra fluid in your body. Weigh yourself at the same time every morning. Weigh yourself on the same scale, before you eat, and after you urinate. Record your weights, and the time you weighed yourself. Bring the record to your caregiver visits.
  
  
• Get regular exercise: Exercise may help decrease your symptoms and improve your heart function. Exercise also helps with weight control. Always warm up and cool down when you exercise. You may need to change your program if you feel more tired than usual the day after you exercise. Never start an exercise program before you talk with your caregiver.
  
  
• Maintain a healthy weight: This will help to decrease how hard your heart has to work. If you are overweight, ask your caregiver about a healthy weight loss plan.
  
  
• Take your medicines exactly as directed: Keep a written list of the medicines you take, the amounts, and when and why you take them. Put your medicines where you can see them. Use a timer to help you remember when to take your medicine. Do not stop taking your medicines unless directed. Ask your caregiver what to do if you miss a dose.
  
  
• Vaccines: The flu and pneumonia can be dangerous for a person with congestive heart failure. Vaccines can protect you against these diseases. You will need to get a flu vaccine each year. You may also need the pneumococcal vaccine to protect you from pneumonia. You will need this vaccine every 5 years.

What may I need to avoid or limit?

• Do not smoke or take illegal drugs: Cigarettes and illegal drugs can worsen your heart failure. Ask your caregiver for information if you are having trouble quitting.
  
  
• Limit or avoid alcohol: Alcohol can worsen your heart failure and raise your blood pressure. Women should limit alcohol to 1 drink a day. Men should limit alcohol to 2 drinks a day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
  
  
• Limit liquids: You may need to drink less fluids to help balance your fluid level. Ask how much liquid you should drink each day.
  
  
• Eat low-salt foods: You may need to limit the amount of sodium (salt) you eat to 2 to 3 grams each day. Check labels to find low-sodium or no-salt-added foods. Some low-sodium foods use potassium salts for flavor. Too much potassium can also cause health problems. Ask your caregiver what amounts of sodium and potassium salt are safe for you.
  
  
• Travel and be outdoors safely: Do not travel to altitudes above 1500 meters (4921 feet). Stay indoors when the weather is hot or humid, or there is heavy pollution in your area. High altitude, bad weather, and poor air quality can worsen your symptoms.
  
  
• Prevent pregnancy: During pregnancy and childbirth, the heart works harder than usual. Pregnancy may cause health problems for the mother and unborn baby. Certain medicines to treat heart failure should not be taken during pregnancy. Heart failure symptoms may get worse. Talk with your caregiver about safe ways to prevent pregnancy.

What are the risks of treatment for congestive heart failure?

• Medicines used to treat your heart failure may cause dizziness, low blood pressure, and kidney problems. You may develop abnormal heartbeats. Surgery may cause you to bleed into your chest, and make it hard for your heart to beat. Your nerves, heart, and lungs may be damaged. You may get an infection after surgery.
  
  
• You may get a blood clot that travels to your lungs or brain, which can be life-threatening. If you need a heart transplant, your body may reject the heart. If your body rejects your new heart, you may need another transplant. Even with treatment, your heart failure may get worse, and you may die.

Where can I find more information?

• American Heart Association
  7272 Greenville Avenue
  Dallas , TX 75231-4596
  Phone: 1- 800 - 242-8721
  Web Address: http://www.heart.org
  

• Heart Failure Society of America
  2550 University Avenue West
  St. Paul , MN 55114
  Phone: 1- 651 - 642-1633
  Web Address: http://www.abouthf.org
  

When should I contact my caregiver?

Contact your caregiver if:

• You are more tired than usual.
  
  
• You gain 2 or more pounds in 1 day, or 4 or more pounds in 1 week.
  
  
• You have more swelling in your legs, ankles, feet, or abdomen.
  
  
• You feel anxious or depressed.
  
  
• Your heart is fluttering or jumping.
  
  
• You have no appetite, or you lose weight without trying.
  
  
• Your blood pressure is higher or lower than your caregiver says it should be.
  
  
• You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

• You have any of the following signs of a heart attack:
  
  
  • Pain, pressure, or fullness in your chest that lasts more than a few minutes or returns
    
    
  • Pain or discomfort in your back, neck, jaw, stomach, or arm
    
    
  • Nausea
    
    
  • Shortness of breath
    
    
  • Lightheadedness, dizziness, or a sudden cold sweat
  
  
• Your fingers or toes are cold and pale or blue.
  
  
• You are coughing up pink and foamy, or bloody sputum, or you have a constant dry cough.
  
  
• Your heart is beating faster than normal for you.
  
  
• You have diarrhea or are vomiting and not able to eat or drink.
  
  
• Your neck veins are bulging.
  
  
• You are urinating very little, or not at all.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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