This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.
Congestive heart failure is a condition in which the heart has difficulty pumping enough blood to meet the body's needs. When the heart is not pumping effectively, blood can back up in the veins filling the lungs and other body tissues with fluid. This condition is called congestive heart failure (CHF). CHF is different from a heart attack although it may be caused by a heart attack. CHF can occur suddenly, but usually develops slowly with symptoms becoming more noticeable over months or years.
WHAT CAUSES CONGESTIVE HEART FAILURE?
CHF can be caused by anything that damages the heart muscle or interferes with its ability to pump blood through the body. Heart attacks can sometimes damage the heart muscle, as can prolonged high blood pressure. Damage to the heart valves through rheumatic fever or bacterial infections can also interfere with the heart's effectiveness. Chronic lung disease such as emphysema can also interfere with the heart's ability to pump.
WHO GETS CONGESTIVE HEART FAILURE?
Anyone with a damaged heart muscle can have congestive heart failure. It is more commonly found in older adults than in young people, but it can occur at any age depending on the underlying cause. Even babies who are born with heart defects can have congestive heart failure.
WHAT ARE THE SYMPTOMS?
One of the most common symptoms is difficulty breathing. This is a result of the fluid that has accumulated in your lungs. At first you may notice this only when you are physically active, but later it may occur even when you are at rest, and especially when you are lying down. If this becomes severe, you may notice that your lips, fingernails, and skin begin to look blue. This is a sign that your body is not getting the amount of oxygen it needs.
Swelling is another major symptom of congestive heart failure. It usually appears in the ankles and feet. If you weigh yourself often, you may notice that you have gained several pounds. This additional weight is not fat but is actually fluid that has collected in your body.
DIAGNOSING CONGESTIVE HEART FAILURE
In a physical exam, you will be asked questions about your symptoms and about any medications you have been taking. The doctor will take your blood pressure and listen to your heart and lungs with a stethoscope. Your doctor may request that you have a chest x-ray which can detect fluid in your lungs or can show an enlarged heart. You may also be given an electrocardiogram (EKG) to help identify what kind of heart problems you may have.
Samples of your blood may be drawn for tests, which may include an arterial blood gas (ABG) to determine whether you are getting enough oxygen. Your blood and urine may be tested to determine whether your kidneys are getting enough blood to remain healthy. A sputum sample may be helpful to see if you have developed an infection due to the fluid in your lungs.
TREATMENT
If this is the first time you have shown symptoms of congestive heart failure, your doctor may request that you be hospitalized for diagnostic tests and close observation in order to determine the underlying cause. He or she may also want you to be in the hospital if the symptoms are becoming severe so that you can be treated under medical supervision.
Several medications can help control congestive heart failure. Digitalis can help your heart beat more effectively. You will be taught how to check your pulse each day and have blood samples taken periodically to be sure you are getting the right amount. Diuretics (water pills) can help remove the fluid that has accumulated in your lungs and body tissues. One of the side-effects of some diuretics is frequent urination and low potassium, a mineral your heart needs to pump effectively. To avoid this, you may need to take potassium supplements or eat potassium-rich foods everyday.
Medications called ACE (Angiotensin Converting Enzyme) inhibitors are prescribed for patients with left-sided congestive heart failure. ACE inhibitors help your heart's pumping effort because they relax blood vessels and allow blood to flow more easily. These medications may also help in preventing the enlargement of the heart in what is called remodeling. ACE inhibitors not only improve the symptoms of congestive heart failure, but can also prolong life.
Oxygen may be prescribed if you are very short of breath or have signs of low oxygen in your blood.
WHAT YOU CAN DO
Your doctor may request that you change your diet to decrease the amount of salt and/or fluids that you consume. This may be difficult for some people who are used to adding salt to foods that they eat and who also drink large amounts of fluids. This diet may be especially hard to follow after you go home if you or the person who prepares your food is accustomed to adding salt to food. This diet change can sometimes affect the eating habits of your whole family. Although diet may not seem as important as your medication, decreasing your salt intake can help reduce the amount of fluid that your heart must pump.
Keeping your legs elevated whenever possible can also decrease the amount of swelling that may occur. Moving your legs often can increase your circulation and help
prevent blood clots from forming. Weighing yourself daily can also alert you to added fluid you may be taking on. If you are overweight, ask your doctor about a weight loss program so that your heart won't have to work as hard. If you have difficulty breathing at night, sleeping with several pillows to raise your head and back can help you breathe more comfortably. Frequent rest periods will also help you conserve energy.
COPING
Learning to live with an ongoing illness like CHF can be difficult for patients as well as for their families. Tasks that were once easy may become more difficult. This can lead to depression, anxiety, and guilt. Having a family member, friend, or counselor to talk to about these feelings can help. Many communities have support groups for people who have chronic heart problems and their families. These groups can reassure you that you are not alone and can provide information about how others have learned to live with congestive heart failure.
A good attitude is very important for maintaining your health and well-being. With a positive outlook, many people find that they do not have to give up activities that they enjoy such as a full social life, recreation, or sexual activities. With a good understanding of their illness, and with proper treatment, many people with congestive heart failure can lead active, enjoyable lives.
Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.
Planetree Health Fact Sheets are developed by Planetree, Inc., a non-profit consumer health organization, founded in 1978. The Planetree Alliance includes hospitals and libraries which, among many other patient-centered concepts, promote the importance of access to health information for patients, families, and community. For more information regarding affiliation with the international Planetree Alliance, call (203) 732-1365 or visit Planetree, Inc. at www.planetree.org.