Congestive Heart Failure

• Congestive Heart Failure Overview
• Congestive Heart Failure Causes
• Congestive Heart Failure Symptoms and Signs
• When to Seek Medical Care
• Congestive Heart Failure Diagnosis
• Congestive Heart Failure Treatment
• Self-Care at Home
• Medical Treatment
• Congestive Heart Failure Medications
• Congestive Heart Failure Surgery
• Other Therapy
• Next Steps
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• Congestive Heart Failure Prevention
• Congestive Heart Failure Prognosis
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Congestive Heart Failure Overview

The heart is a pump that works together with the lungs. It pumps blood in 2 ways.

• It pumps blood from the heart to the lungs to pick up oxygen. The oxygenated blood returns to the heart.
  
  
• It then pumps blood out into the circulatory system of blood vessels that carry blood through the body.

The heart consists of 4 chambers.

• The upper chambers are called atria, and the lower chambers are called ventricles.
  
  
• The right atrium and ventricle receive blood from the body through the veins and then pump the blood to the lungs.
  
  
• The left atrium and ventricle receive blood back from the lungs and pump it out the aorta into the arteries, feeding all organs and tissues of the body.
  
  
• Because the left ventricle has to pump blood through the entire body, it is a stronger pump than the right ventricle.

Heart failure sounds frightening because it sounds like the heart just stops working. Do not be discouraged by the term heart failure-the heart has not stopped beating or pumping. Heart failure means the tissues of the body are temporarily not receiving enough blood and oxygen. With advancements in diagnosis and therapy for heart failure, patients are feeling better and living longer.

• Although heart failure is a serious medical condition, the heart does not just stop abruptly.
  
  
• Heart failure may develop gradually over several years, or move quickly after a heart attack or a disease of the heart muscle.

Heart failure is an illness in which the pumping action of the heart becomes less and less powerful. That is, the heart does not pump blood as well as it should. When this happens, blood does not move efficiently through the circulatory system and starts to back up, increasing the pressure in the blood vessels and forcing fluid from the blood vessels into body tissues.

• When the left side of the heart starts to fail, fluid collects in the lungs (pulmonary edema). This extra fluid in the lungs (congestion) makes it more difficult for the airways to expand as you inhale. Breathing becomes more difficult, and you may feel short of breath, particularly with activity or lying down.
  
  
• When the right side of the heart starts to fail, fluid collects in the feet and lower legs. As the heart failure becomes worse, the upper legs swell and eventually the abdomen collects fluid (ascites). Weight gain accompanies the fluid retention and is an excellent measure of how much fluid is being retained. Puffy swelling (edema) is a sign of right heart failure, especially if the edema is pitting edema. With pitting edema, a finger pressed on the swollen leg leaves a finger imprint. Nonpitting edema is not caused by heart failure.

Congestive heart failure (CHF) is generally classified as systolic or diastolic heart failure and becomes progressively more common with increasing age.

Systolic heart failure: The pumping action of the heart is reduced or weakened. A common clinical measurement is the ejection fraction (EF). The ejection fraction is a calculation of how much blood is ejected out of the left ventricle (stroke volume), divided by the maximum volume remaining in the left ventricle at the end of diastole or relaxation phase. A normal ejection fraction is greater than 50%. Systolic heart failure has a decreased ejection fraction of less than 50%.

Diastolic heart failure: The heart can contract normally but is stiff, or less compliant, when it is relaxing and filling with blood. This impedes blood filling into the heart and produces backup into the lungs and CHF symptoms. Diastolic heart failure is more common in patients older than 75 years, especially in women with high blood pressure. In diastolic heart failure, the ejection fraction is normal.

• Heart failure affects 1% of people aged 50 years, about 5% of those aged 75 years or older, and 25% of those aged 85 years or older.
  
  
• Heart failure is the most common reason for Medicare patients to be admitted to the hospital.
  
  
• As the number of elderly people continues to rise, the number of people diagnosed with this condition will continue to increase.

In the United States, nearly 5 million people have heart failure.

• Each year about 550,000 new cases are diagnosed.
  
  
• The condition is more common among African Americans than whites.
  
  
• The rate of death from heart failure is about 10% after 1 year. About half of those with CHF die within 5 years after their diagnosis. These statistics vary widely by a patient's exact diagnosis and therapy. Advances in research are providing more options and improving outcomes for people with CHF.