Congestive heart failure (CHF), congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood through the body. It is not to be confused with "cessation of heartbeat", which is known as asystole, or with cardiac arrest, which is the "cessation of normal cardiac function" with subsequent hemodynamic collapse leading to death.
Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.
You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life.
The best way to prevent heart failure is to control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.
Causes:
Any of the following conditions can cause heart failure, which can damage or weaken your heart over time. Some of these can be present without knowing it:
Coronary artery disease and heart attack- Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle weak and chronically deprived of oxygen-rich blood. In many cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaque formed by the fatty deposits in your arteries ruptures. This causes a blood clot to completely block blood flow to an area of the heart muscle, weakening the heart's pumping ability.
High blood pressure (hypertension)- Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
Faulty heart valves- The four valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed if detected in time.
Damage to the heart muscle (cardiomyopathy)- Some of the many causes of heart muscle damage, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems also can damage heart muscle. If a specific cause can't be found, it's referred to as idiopathic dilated cardiomyopathy.
Myocarditis- Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
Heart defects present at birth (congenital heart defects)- If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to compensate. Genetic defects contribute to the risk of certain types of heart disease, which in turn may lead to heart failure.
Abnormal heart rhythms (heart arrhythmias)- Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
Other diseases- Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and amyloidosis also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.
Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.
You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life.
The best way to prevent heart failure is to control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.
Causes:
Any of the following conditions can cause heart failure, which can damage or weaken your heart over time. Some of these can be present without knowing it:
Coronary artery disease and heart attack- Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle weak and chronically deprived of oxygen-rich blood. In many cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaque formed by the fatty deposits in your arteries ruptures. This causes a blood clot to completely block blood flow to an area of the heart muscle, weakening the heart's pumping ability.
High blood pressure (hypertension)- Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
Faulty heart valves- The four valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed if detected in time.
Damage to the heart muscle (cardiomyopathy)- Some of the many causes of heart muscle damage, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems also can damage heart muscle. If a specific cause can't be found, it's referred to as idiopathic dilated cardiomyopathy.
Myocarditis- Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
Heart defects present at birth (congenital heart defects)- If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to compensate. Genetic defects contribute to the risk of certain types of heart disease, which in turn may lead to heart failure.
Abnormal heart rhythms (heart arrhythmias)- Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
Other diseases- Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and amyloidosis also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.
Symptoms:
Heart failure typically develops slowly and is a chronic, long-term condition, although you may experience a sudden onset of symptoms, known as acute heart failure. The term "congestive heart failure" comes from blood backing up into — or congesting — the liver, abdomen, lower extremities and lungs.
Some of the signs and symptoms for chronic and acute heart failure are:
Chronic heart failure- Fatigue and weakness, Rapid or irregular heartbeat, Shortness of breath (dyspnea) when you exert yourself or when you lie down, Reduced ability to exercise, Persistent cough or wheezing with white or pink blood-tinged phlegm, Swelling (edema) in your legs, ankles and feet, Swelling of your abdomen (ascites), Sudden weight gain from fluid retention, Lack of appetite and nausea, Difficulty concentrating or decreased alertness, etc.
Acute heart failure- Signs and symptoms similar to those of chronic heart failure but more severe, and start or worsen suddenly, Sudden fluid buildup, Rapid or irregular heartbeat with palpitations that may cause the heart to stop beating, Sudden, severe shortness of breath and coughing up pink, foamy mucus, Chest pain if caused by a heart attack, etc.
Acute heart failure- Signs and symptoms similar to those of chronic heart failure but more severe, and start or worsen suddenly, Sudden fluid buildup, Rapid or irregular heartbeat with palpitations that may cause the heart to stop beating, Sudden, severe shortness of breath and coughing up pink, foamy mucus, Chest pain if caused by a heart attack, etc.
Diagnosis:
To diagnose heart failure, your doctor will take a careful medical history and perform a physical examination.
Blood tests- Your doctor may take a sample of your blood to check your kidney and thyroid function and to look for indicators of other diseases that affect the heart. In addition, your doctor may check your blood for specific chemical markers of heart failure, such as a hormone called brain natriuretic peptide (BNP). Although first identified in the brain, BNP is secreted by the heart at high levels when it's injured or overworked.
Chest X-ray- X-ray images help your doctor see the condition of your lungs and heart. In heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. Your doctor can also use an X-ray to diagnose conditions other than heart failure that may explain your signs and symptoms.
Electrocardiogram (ECG)- This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.
Echocardiogram- An important test for diagnosing and monitoring heart failure is the echocardiogram. An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure, in which the heart is stiff and can't fill properly. An echocardiogram uses sound waves to produce a video image of your heart. This image can help doctors determine how well your heart is pumping by measuring the percentage of blood pumped out of your heart's main pumping chamber (the left ventricle) with each heartbeat. This measurement is called the ejection fraction.
Ejection fraction- Your ejection fraction is measured during an echocardiogram. An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is about 60 percent — meaning 60 percent of the blood that fills the ventricle is pumped out with each beat.
Other imaging tests- They may be used to measure ejection fraction, including cardiac catheterization, multiple gated acquisition (MUGA) scanning of the heart, magnetic resonance imaging (MRI) and computerized tomography (CT).
Treatment:
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one, two or more of these drugs. Several types of drugs have proved useful in the treatment of heart failure. They include:
Angiotensin-converting enzyme (ACE) inhibitors- These drugs help people with heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens or dilates blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten).
Angiotensin II (A-II) receptor blockers (ARBs)- These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the beneficial effects of ACE inhibitors, but they don't cause a persistent cough. They may be an alternative for people who can't tolerate ACE inhibitors.
Digoxin (Lanoxin)- This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves your ability to live with the condition.
Beta blockers- This class of drug slows your heart rate and reduces blood pressure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta). These medicines also reduce the risk of some abnormal heart rhythms.
Diuretics- Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics for heart failure include bumetanide (Bumex) and furosemide (Lasix).
Aldosterone antagonists- These drugs include spironolactone (Aldactone) and eplerenone (Inspra). They're primarily potassium-sparing diuretics, but they have additional properties that help the heart work better, may reverse scarring of the heart and may help people with severe heart failure live longer.
***A medication called BiDil is a single pill that combines hydralazine and isosorbide dinitrate — both of which dilate and relax the blood vessels. BiDil increases survival when added to standard therapy in black people with advanced heart failure.***
Surgery and medical devices:
Researchers continue to search for new and better ways to treat heart failure. Some treatments being studied and used in certain people include:
Implantable cardioverter-defibrillators (ICDs)- An ICD is a device implanted under the skin and attached to the heart with small wires. The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, the ICD shocks it back into normal rhythm. Sometimes a biventricular pacemaker is combined with an ICD for people with severe heart failure.
Cardiac resynchronization therapy (CRT) or biventricular pacing- A biventricular pacemaker sends timed electrical impulses to both of the heart's lower chambers (the left and right ventricles), so that they pump in synchrony and in a more efficient, coordinated manner. As many as half the people with heart failure have abnormalities in their heart's electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction wastes the heart's limited energy and may cause heart failure to worsen. Sometimes a biventricular pacemaker is combined with an ICD for people at greatest risk of rhythm problems.
Heart pumps- These mechanical devices, called left ventricular assist devices (LVADs), are implanted into the abdomen and attached to a weakened heart to help it pump. Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. LVADs are now being considered as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people with end-stage heart failure who aren't eligible for or able to undergo heart transplantation or are waiting for a new heart.
To diagnose heart failure, your doctor will take a careful medical history and perform a physical examination.
Blood tests- Your doctor may take a sample of your blood to check your kidney and thyroid function and to look for indicators of other diseases that affect the heart. In addition, your doctor may check your blood for specific chemical markers of heart failure, such as a hormone called brain natriuretic peptide (BNP). Although first identified in the brain, BNP is secreted by the heart at high levels when it's injured or overworked.
Chest X-ray- X-ray images help your doctor see the condition of your lungs and heart. In heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. Your doctor can also use an X-ray to diagnose conditions other than heart failure that may explain your signs and symptoms.
Electrocardiogram (ECG)- This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.
Echocardiogram- An important test for diagnosing and monitoring heart failure is the echocardiogram. An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure, in which the heart is stiff and can't fill properly. An echocardiogram uses sound waves to produce a video image of your heart. This image can help doctors determine how well your heart is pumping by measuring the percentage of blood pumped out of your heart's main pumping chamber (the left ventricle) with each heartbeat. This measurement is called the ejection fraction.
Ejection fraction- Your ejection fraction is measured during an echocardiogram. An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is about 60 percent — meaning 60 percent of the blood that fills the ventricle is pumped out with each beat.
Other imaging tests- They may be used to measure ejection fraction, including cardiac catheterization, multiple gated acquisition (MUGA) scanning of the heart, magnetic resonance imaging (MRI) and computerized tomography (CT).
Treatment:
Doctors usually treat heart failure with a combination of medications. Depending on your symptoms, you might take one, two or more of these drugs. Several types of drugs have proved useful in the treatment of heart failure. They include:
Angiotensin-converting enzyme (ACE) inhibitors- These drugs help people with heart failure live longer and feel better. ACE inhibitors are a type of vasodilator, a drug that widens or dilates blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten).
Angiotensin II (A-II) receptor blockers (ARBs)- These drugs, which include losartan (Cozaar) and valsartan (Diovan), have many of the beneficial effects of ACE inhibitors, but they don't cause a persistent cough. They may be an alternative for people who can't tolerate ACE inhibitors.
Digoxin (Lanoxin)- This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms and improves your ability to live with the condition.
Beta blockers- This class of drug slows your heart rate and reduces blood pressure. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta). These medicines also reduce the risk of some abnormal heart rhythms.
Diuretics- Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics for heart failure include bumetanide (Bumex) and furosemide (Lasix).
Aldosterone antagonists- These drugs include spironolactone (Aldactone) and eplerenone (Inspra). They're primarily potassium-sparing diuretics, but they have additional properties that help the heart work better, may reverse scarring of the heart and may help people with severe heart failure live longer.
***A medication called BiDil is a single pill that combines hydralazine and isosorbide dinitrate — both of which dilate and relax the blood vessels. BiDil increases survival when added to standard therapy in black people with advanced heart failure.***
Surgery and medical devices:
Researchers continue to search for new and better ways to treat heart failure. Some treatments being studied and used in certain people include:
Implantable cardioverter-defibrillators (ICDs)- An ICD is a device implanted under the skin and attached to the heart with small wires. The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, the ICD shocks it back into normal rhythm. Sometimes a biventricular pacemaker is combined with an ICD for people with severe heart failure.
Cardiac resynchronization therapy (CRT) or biventricular pacing- A biventricular pacemaker sends timed electrical impulses to both of the heart's lower chambers (the left and right ventricles), so that they pump in synchrony and in a more efficient, coordinated manner. As many as half the people with heart failure have abnormalities in their heart's electrical system that cause their already-weak heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction wastes the heart's limited energy and may cause heart failure to worsen. Sometimes a biventricular pacemaker is combined with an ICD for people at greatest risk of rhythm problems.
Heart pumps- These mechanical devices, called left ventricular assist devices (LVADs), are implanted into the abdomen and attached to a weakened heart to help it pump. Doctors first used heart pumps to help keep heart transplant candidates alive while they waited for a donor heart. LVADs are now being considered as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people with end-stage heart failure who aren't eligible for or able to undergo heart transplantation or are waiting for a new heart.
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