CONGESTIVE HEART FAILURE

General Information

DEFINITION--A complication of many serious diseases in which the heart loses its full pumping capacity. Blood backs up into other organs, especially the lungs and liver.

BODY PARTS INVOLVED--Heart; blood vessels; lungs; liver; extremities.

SEX OR AGE MOST AFFECTED--Both sexes and all ages, but more common after age 50.

SIGNS & SYMPTOMS

• Shortness of breath, especially with exertion or when lying flat in bed.
• Fatigue, weakness or faintness.
• Cough (usually with sputum).
• Swelling of the abdomen, legs and ankles.
• Rapid or irregular heartbeat.
• Low blood pressure.
• Distended neck veins.
• Enlarged liver.

CAUSES

• High blood pressure; heart-valve disease.
• Heart attack; coronary artery disease; heartbeat irregularities.
• Severe lung disease such as emphysema.
• Congenital heart disease; cardiomyopathy; hyperthyroidism.
• Severe anemia.
• Heart tumor (rare).
• Infections complicating underlying disease.

RISK INCREASES WITH

• Infections with high fever.
• Smoking.
• Obesity.
• Excess alcohol consumption. Alcohol depresses heart function.
• Use of certain drugs, such as beta-adrenergic blockers or excess digitalis.
• Diet that is high in fat and salt.

HOW TO PREVENT--If you have a condition that can lead to congestive heart failure, obtain medical care and adhere to your treatment program. Follow your dietary guidelines and don't drink alcohol or smoke.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory blood studies and urinalysis.
• ECG (See Glossary).
• Heart-catheterization studies (occasionally).
• X-rays of the heart, lungs and blood vessels (angiography).
• Radioactive studies of heart muscle efficiency.
• Echocardiogram (occasionally; See Glossary).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Surgery on heart valves, coronary arteries or ventricular aneurysms (sometimes).
• Hospitalization (severe cases).
• Cardiac transplantation for severe cases that do not respond to medical treatment (sometimes).

POSSIBLE COMPLICATIONS

Pulmonary edema; heartbeat irregularities.

PROBABLE OUTCOME--Life expectancy is reduced, but many forms are well-controlled for a while with medication and sometimes surgery. Other forms cause chronic illness. Any infection may worsen the condition.

How To Treat

GENERAL MEASURES--

• The aim of treatment is to improve the heart's pumping function usually with medications, rest, and other supportive measures.
• Weigh daily and keep a record.
• Don't smoke.
• Wear a Medic-Alert neck pendent or bracelet (See Glossary) that identifies your medical problem and the medications you take.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Diuretics to decrease fluid retention and swelling.
• Digitalis to strengthen and regulate heartbeat.
• Antiarrhythmic drugs to stabilize heartbeat.
• "Afterload" vasodilators to reduce blood pressure, even if it's normal.
• Potassium replacements, if you take diuretics or digitalis.

ACTIVITY-- In early stages, bed rest with the upper body elevated is as important as medication. Avoid unnecessary exertion (such as climbing stairs) until the condition is under control. You may need to alter your lifestyle to reduce symptoms.

DIET--

• Achieve your ideal weight to reduce the heart's workload.
• Eat a low-salt, low-fat, high-fiber diet (see diets in Appendix). Don't drink alcohol.

Call Your Doctor If

• You have symptoms of congestive heart failure.
• The following occurs during treatment: Symptoms of infection, such as fever, muscle aches, headache and dizziness. Worsening of symptoms, especially rapid or irregular heartbeat or wheezing at night. Cough with increased sputum or blood. Weight gain of 3 or 4 pounds in 1 or 2 days.
• New, unexplained symptoms develop.