About Congestive Heart Failure (CHF)

Heart failure is a major cause of disability and death for people over the age of 65. It results in more hospital admissions than any other diagnosis for seniors. Although deaths from CHF are declining, the number of heart failure cases appears to be rising as the general population grows older.

Read on for more information, or click on a topic in the list:

What is congestive heart failure?
What are the symptoms?
What are the causes?
How is it diagnosed?
How is it treated?

CHF is a condition that may occur suddenly or develop gradually. It is a medical condition in which the heart is unable to pump enough blood throughout the body. With CHF, the heart does not work as well as it should, causing the flow of blood from the heart to slow, which causes blood returning to the heart to back up. The slowed blood causes a buildup of fluid, called congestion, in the body.

The ventricles of the heart collect blood from the other chambers before pumping it out of the heart. CHF may involve the right, left, or both sides of the heart. The most common form of heart failure occurs in the left ventricle, the chamber that pumps blood to the body. Left ventricular heart failure is a condition in which the muscles of the left side of the heart have become weakened because of a heart attack or clogged arteries. This type of heart failure usually causes breathing difficulties.

Typically, the body tries to make up for the heart not working properly by retaining salt and water, speeding up the heart rate, or increasing the size of the heart. Symptoms of CHF include:

• Shortness of breath, especially when lying down or during mild activity
• Swelling of the abdomen, feet, and ankles
• Weight gain
• Feeling tired, weak, dizzy, or faint
• Irregular/rapid heart beat or pulse
• Coughing and wheezing, especially at night
• Kidney problems, which can lead to retention of fluid
• Difficulty concentrating or decreased alertness
• Difficulty sleeping
• Muscle wasting, paleness, and cold extremities in advanced disease

What are the causes?

Heart failure has many different causes, and in some cases, the exact cause is difficult to pinpoint. Sometimes, people who had a heart attack in the past develop CHF because of a damaged heart. The most common causes of heart failure are:

• Narrowing of the blood vessels to the heart (coronary artery disease)
• Acute myocardial infarction (heart attack)
• Problems with the heart muscle (cardiomyopathy)
• High blood pressure (hypertension)
• Problems with the heart valves
• Abnormal heart rhythms (arrhythmias)
• Toxic substances, such as alcohol abuse
• Problems with the heart since birth (congenital heart disease)

To diagnose CHF, a doctor listens for sounds of fluid in the lungs, faulty valves in the heart (a heart murmur), or a rapid heartbeat. By tapping on the patient’s chest, a doctor can tell if fluid has built up inside. The doctor might also order a chest x-ray to determine whether the heart is enlarged and fluid is present in and around the lungs.

The Centers for Medicare & Medicaid Services and Joint Commission for the Accreditation of Healthcare Organizations have determined that the following treatments are indicators of quality care for CHF:

• Tests on the left ventricle
• An ACE inhibitor
• Instructions for self-care upon discharge
• Advice to smokers on how to stop smoking
  

Hospital Leaders can find more information about treating CHF in Best Practices for Congestive Heart Failure.