Congestive heart failure (CHF)
The heart's main function is to pump blood and nutrients to the body. Congestive heart failure is the inability to do that.

There are 2 basic types
  • Systolic dysfunction occurs when the heart can't pump enough blood to supply all the body's needs.
  • Diastolic dysfunction occurs when the heart cannot accept all the blood being sent to it.

The "failing" heart keeps working but not as efficiently as it should. People with heart failure can't exert themselves because they become short of breath and tired.

As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down.
        Causes CHF
     Source: Healthy Ontario.com

  CHF is usually the result of other health problems:

  • Coronary artery disease, a condition that causes narrowing of the arteries that supply the heart with blood, can damage and weaken areas of the heart.
  • Persistent high blood pressure forces the heart to pump against higher pressure, which causes it to weaken over time. People who have uncontrolled high blood pressure are more than twice as likely to develop CHF as those who don't.
  • Heart attack damages the heart muscle. People who have had heart attacks are at five times the average risk of developing CHF.
  • Diabetes also increases CHF risk.
  • Arrhythmias (abnormal heart rhythms) can cause the heart to pump inefficiently.
  • Heart valve disease may have been caused by abnormalities that have been present since birth or have developed over time.
  • Heart valve damage may have been caused by rheumatic disease or infection.
  • Viral infection of the heart muscle can seriously weaken the heart.
  • An enlarged wall between the heart chambers (a genetic condition) may be a cause.
  • Certain kidney conditions that increase blood pressure and fluid buildup can increase the risk of CHF by placing more stress on the heart.

In addition, all the risk factors that normally increase the chances of heart disease, such as smoking and obesity, also increase your risk of congestive heart failure.



        Diagnosis ?
     Source: Mayo Clinic

Typically, physicians diagnose heart failure by taking a careful medical history and performing a physical examination. The physician also checks for the presence of risk factors such as high blood pressure. Using a stethoscope, a physician listens as a patient breathes and can identify the sounds of lung congestion. The stethoscope also picks up abnormal heart sounds that may indicate heart failure.

In addition to a physical exam, the doctor may recommend any of a variety of tests to diagnose congestive heart failure. The patient may be referred to a cardiologist — a doctor who specializes in the study of the heart and its function — for tests such as:

Chest X-ray

X-ray images help the doctor see the condition of the lungs and heart. In congestive heart failure, a heart may appear enlarged on an X-ray and fluid accumulation may be visible in the lungs. An X-ray can also be used to diagnose conditions other than congestive heart failure that may explain a patient's symptoms.

Electrocardiogram (ECG)

ECG tests record the electrical activity of the heart through electrodes attached to the skin. Impulses are recorded as waves displayed on a monitor or printed on paper. This test helps the doctor diagnose heart rhythm problems and damage to the heart from a heart attack that may be underlying congestive heart failure.

Echocardiogram

An echocardiogram uses sound waves to produce a video image of the heart. This image can help doctors determine the capacity at which the heart is pumping. The percentage of blood pumped out of the heart's main pumping chamber (the left ventricle) with each heartbeat is referred to as the ejection fraction. This percentage can be measured by an echocardiogram or other imaging techniques. In a healthy heart, the ejection fraction is greater than 50 percent. An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure.

Coronary Catheterization (Angiogram)

In this test a thin, flexible tube (catheter) is inserted into a blood vessel at the groin or elbow and guided through the main artery, the aorta, into the coronary (heart) arteries. A dye injected through the catheter makes the arteries supplying the heart visible on an X-ray. This test helps doctors identify narrowed arteries to the heart (coronary artery disease) that can be a cause of congestive heart failure. The test also helps doctors determine the strength of the left ventricle — the heart's main pumping chamber — and the health of the heart valves.

Radionuclide Ventriculography or Multiple-gated Acquisition Scanning (MUGA)

This nuclear medicine test involves injecting a small amount of radioactive dye into a vein, then taking pictures of the heart as it pumps blood. Like an echocardiogram, this test shows how much blood the heart can pump with each beat.

Exercise Testing

Exercise or stress testing is frequently used to measure a heart's functional capacity. The exercise testing will assist the doctor with judging the response to therapy and the timing of more advanced treatments.

Blood tests

The doctor may use a   blood sample to check for indicators of other diseases that affect the heart. In addition, he or she may order a new blood test for congestive heart failure. The test checks for levels of a hormone called B-type natriuretic peptide (BNP). The heart secretes BNP in high levels when it's overworked. A large amount of BNP in the blood may indicate congestive heart failure.

Results of these tests help doctors determine the cause of a patient's signs and symptoms and develop a treatment plan. To determine the best course of treatment, doctors classify heart failure using a scale of one to four. Class I heart failure is the mildest. A person can perform everyday activities and not feel winded or fatigued. Class IV is the most severe, in which a person is short of breath even at rest.

                                

  

   Treatment Overview CHF:
heart rhythms

CHF usually is managed with lifestyle adjustments, and medications. If you have CHF, you may have to make some of the following lifestyle adjustments:

  • Cut back on fluids - weighing yourself daily is often necessary to help adjust fluid intake and medications.
  • Stay active, but short of triggering CHF symptoms.
  • Lower sodium intake to 2.4 g daily or less. Less sodium reduces fluid retention.
  • Wear special elastic stockings to reduce swelling in the legs caused by fluid retention.
  • Follow an appropriate weight-loss program (for those who need it).
  • drugs such as
    • ACE (angiotensin-converting enzyme) inhibitors
    • beta blockers
    • digitalis
    • diuretics
    • vasodilators

Various drugs are used to treat congestive heart failure. They perform different functions. ACE inhibitors and vasodilators expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart's work easier or more efficient. Beta blockers can improve how well the heart's left lower chamber (left ventricle) pumps. Digitalis increases the pumping action of the heart, while diuretics help the body eliminate excess salt and water.

Most people with mild and moderate congestive heart failure can be treated. Proper medical supervision can prevent them from becoming invalids. When a specific cause of congestive heart failure is discovered, it should be treated or, if possible, corrected. For example, some cases of congestive heart failure can be treated by treating high blood pressure. If the heart failure is caused by an abnormal heart valve, the valve can be surgically replaced.

     

 

    Also check out BODY from the left column