Congestive Heart Failure

What is congestive heart failure?

Congestive heart failure (CHF) is a disease that develops when your heart becomes too weak to pump blood properly.

What causes CHF?

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 common causes of heart failure:

• Heart conditions such as a heart attack can weaken or damage your heart. Coronary artery disease (CAD) is the most common cause of heart failure. CAD narrows the arteries that bring blood to your heart, leading to poor blood flow.
  
  
• Diseases such as arthritis, lupus, and diabetes can damage your heart. High blood pressure, or kidney, lung, or thyroid disease can make your heart work harder. High cholesterol levels may block your blood vessels and cause heart damage.
  
  
• Sleep apnea may prevent you from getting enough oxygen while you sleep. This stresses your heart and causes it to work harder to pump oxygen to your body.
  
  
• Toxins put added stress on your heart and can raise your blood pressure. Examples are alcohol, chemicals in cigarettes, drugs such as cocaine, and radiation therapy.
  
  
• Medicines used to treat heart conditions may weaken your heart. Chemotherapy medicines may damage your heart.

What are the signs and symptoms of CHF?

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

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

How is CHF diagnosed?

Tell your caregiver about all medicines you take, and if you smoke, drink alcohol, or use any illegal drugs. You may also need any of the following tests:

• Blood tests check for electrolyte imbalances and diseases, and test your liver and kidney function.
  
  
• An ECG (or EKG) checks for damage or problems in your heart. 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 catheterization 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.
  
  
• An exercise stress 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 as you exercise.
  
  
• A chest x-ray, heart scan, CT, or MRI will show the size of your heart and how well it is pumping. The images will show the size and thickness of your ventricles, and if there is fluid around your heart and lungs. You may be given contrast dye through an IV. Tell the caregiver if you have ever had an allergic reaction to contrast dye.
  
  
• An echocardiogram (echo) is a type of ultrasound that shows the movement and blood vessels of your heart on a monitor.

What medicines may be used to treat CHF?

• ACE inhibitors decrease your symptoms and slow your heart failure. You may need a medicine called an ARB if you cannot take ACE inhibitors. ARBs help your heart beat more strongly.
  
  
• Beta-blockers help your heart pump strongly and regularly.
  
  
• Cardiac glycosides help your heart beat strongly and decrease abnormal heartbeats.
  
  
• Nitrates improve the blood flow through your heart.
  
  
• Diuretics help your body get rid of extra fluid and protect your heart from more damage. Diuretics may make you urinate more often.
  
  
• Blood thinners prevent blood clots. They may make you bruise or bleed more easily. To prevent bleeding, brush your teeth with a soft toothbrush, and shave with an electric shaver.

How is CHF treated?

The following are the most common treatments for CHF:

• Cardiac rehab is a program that teaches you how to live a more heart-healthy lifestyle, including nutrition and exercise.
  
  
• An implanted device may be put under your skin to help your heart beat properly. A pacemaker is an example of an implanted device.
  
  
• Surgery may be done to open blocked heart vessels. You may need to have a damaged valve replaced. You may need a heart transplant if all other treatments have failed.

What can I do to manage my CHF?

• Get regular activity. Exercise may help decrease your symptoms, improve your heart function, and help you control your weight. Never start an exercise program before you talk with your caregiver. Always warm up before you start and cool down to finish. 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. Do not travel to altitudes above 1500 meters (4921 feet).
  
  
• Maintain a healthy weight. This will help decrease how hard your heart has to work. If you are overweight, ask your caregiver about a healthy weight loss plan. Check your weight daily. Rapid weight gain can be a sign of fluid retention. This may mean your CHF is worsening. Weigh yourself at the same time every morning before you eat, and after you urinate. Use the same scale each day, if possible. Record your weights, and the time you weighed yourself. Bring the record to your caregiver visits.
  
  
• 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.
  
  
• Get flu or pneumonia vaccines as directed. The flu and pneumonia can be dangerous for a person with CHF. Vaccines can protect you against these diseases. You will need to get a flu vaccine each year. You may also need to get a pneumonia 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 liquids. You may need to drink less liquid to help balance your fluid level. Ask how much liquid you should drink each day. 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 sodium. You may need to limit sodium (salt) to 2 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 cause health problems. Ask your caregiver how much sodium and potassium salt are safe for you.
  
  
• Ask about sexual activity. Ask your caregiver if it is safe for you to have sex. During sex, stop if you feel chest pain or have shortness of breath. If you are a woman, prevent pregnancy. Pregnancy may cause health problems for you and your unborn baby. Certain medicines to treat heart failure should not be taken during pregnancy. Ask about safe ways to prevent pregnancy.

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.
  
  
• 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:
  
  
  • Squeezing, pressure, fullness, or pain in your chest that lasts longer than a few minutes or returns
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or arm
    
    
  • Shortness of breath or breathing problems
    
    
  • A sudden cold sweat, lightheadedness, dizziness, or nausea, especially with chest pain or trouble breathing
  
  
• Your fingers or toes are cold and pale or blue.
  
  
• You cough up pink, foamy, or bloody sputum, or you have a dry cough.
  
  
• Your heart is fluttering, or 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.

Learn more about Congestive Heart Failure