If you or someone you care for has congestive heart failure (CHF), this Web site may help you learn more about the illness. It has been designed to provide basic information and tips for managing your condition. In addition, you will find other Web sites and resources that will give you more detailed information on managing CHF.

What is congestive heart failure?
What are the symptoms of congestive heart failure?
What causes congestive heart failure?

What is Congestive Heart Failure?

The heart is made of specialized muscle and acts as a powerful pump that sends blood flowing throughout the body. Our blood contains the oxygen and nutrients that the body needs in order to function. When the heart muscle is not pumping blood as strongly as it should, the body does not receive enough oxygen and nutrients to function properly. This poor pumping action by the heart is known as congestive heart failure.

The heart's weakened pumping action causes body fluid (water) to back-up into the lungs, kidneys, and other parts of the body such as the arms, legs, ankles, and feet. This congestion, combined with a poor supply of oxygen, causes you to feel very tired, short of breath, and to experience swelling. Everyday activities such as walking, household chores, and climbing stairs become difficult.

Congestive heart failure is a common illness among those 65 years and older. About 40,000 British Columbians have been diagnosed this condition.

Congestive heart failure has no cure. With proper care, including medication and a healthy lifestyle, you should be able to manage the symptoms and improve your health and quality of life.

Depending on how weak your heart is, these symptoms can range from moderate to severe. You may experience one or all of them, or possibly none of the symptoms. The number of symptoms you experience is not an indication of how weak your heart is.

• Shortness of breath - Because congestive heart failure causes body fluid to back-up into the lungs you may experience shortness of breath that worsens when you exert yourself or try to exercise. You may also experience difficulty breathing when you are lying flat, and at night when trying to sleep. This is because blood from elevated legs returns to the heart causing congestion in the lungs. During sleep, congestion can also occur due to depressed breathing. This discomfort can often be relieved by sitting up or sleeping on several pillows.
  
  
• Dry, hacking cough or wheezing - You may experience a dry, hacking cough or wheezing because fluid has backed-up into the lungs.



• Swollen ankles and legs - Swelling in the lower limbs can occur as a result of body fluid backing-up into body tissues. Referred to as edema, swelling in your ankles and legs is likely to be more pronounced later in the day because gravity increases the amount and pressure of blood in the veins of the leg.



• Acute pulmonary edema - This is a severe and sudden worsening of congestive heart failure. Symptoms include severe shortness of breath, a cough that is sometimes tinged with blood, profuse sweating, and anxiety. This condition is life-threatening and must be treated immediately as it leads to a dangerously low level of oxygen in the blood.



• Sudden weight gain - If the extra water and salt are not being removed by your kidneys, the excess fluid will result in sudden weight gain.



• Fatigue/low energy - Because the body's organs and muscles are not receiving enough oxygen and nutrients due to the reduced blood flow, you may feel tired and/or lack energy. Fatigue can also occur because the body is not removing waste products as quickly as it should.



• Mental confusion - Sometimes congestive heart failure can reduce blood flow to the brain, causing a person to feel confused. This symptom most often occurs among elderly persons.



• A loss or change in appetite - You may experience a loss or change in appetite due to body fluid backing-up between the stomach and intestines, or because your body does not have the energy to digest food. Even if you have only eaten very little you may nonetheless feel full. You might also experience nausea with abdominal pain or tenderness.



• Chest pain - Chest pain is a common symptom of angina and heart attack - the leading causes of congestive heart failure.



• Frequent urination - You may find that during the night you may have to urinate more frequently than usual. This is because extra body fluid is returning to the bloodstream while you are resting.



• Rapid and irregular heartbeat - Changes in the rhythm of your heart can occur because the heart has to beat faster to pump enough blood to the body.

Congestive heart failure develops gradually over time and results from underlying conditions. These conditions may include:

• High blood pressure - Hypertension or high blood pressure is the most common cause of congestive heart failure. The heart has to work harder because it must pump blood against resistance, this strains the heart muscle. Your blood pressure is high when the reading is equal to or greater than 140/90. It is important to keep blood pressure under control because it increases the risk of heart attack, stroke and other heart diseases.



• Previous heart attack - A previous heart attack can damage the heart muscle.



• Heart valve disease - Faulty heart valves can cause improper blood flow to the heart.This increases the heart's workload, which damages the heart muscle.



• Coronary artery disease - An inadequate oxygen supply to the heart resulting from coronary artery disease can damage or destroy heart muscle tissue.



• Heart infection - An infection of the heart can weaken the heart.



• Excessive use of alcohol or drugs can also cause the heart muscle to weaken.

To determine whether your symptoms are actually a sign of congestive heart failure, your doctor will need to conduct a number of tests. In addition to taking your history and conducting a physical examination, your doctor will likely request the following tests and procedures:

• Blood tests - Blood tests are used to assess kidney and thyroid function, check cholesterol levels, as well as determine whether you have anemia. Anemia is a blood condition in which there is not enough hemoglobin in the red blood cells to transport oxygen throughout the body. Blood tests will also check for B-type Natriuretic Peptide (BNP) - a substance secreted from the lower chamber of the heart. BNP increases when congestive heart failure worsens and decreases when your condition is stable.
• Chest x-ray - A chest x-ray determines if there is fluid build-up around your heart and lungs, or if your heart is enlarged.
• Electrocardiogram - An electrocardiogram measures your heart's electrical activity. It is a very helpful test because it can detect the presence of a heart attack, abnormal heart rhythms, an enlarged heart, or damage to the heart muscle tissue resulting from inadequate oxygen supply to the heart (cardiac ischemia).
• Graded test or stress test - This test determines how physical activity affects your heart.

Last Revised: December 17, 2007