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Congestive Heart Failure
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Congestive heart failure (CHF)

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HEART & BLOOD

Heart Attack & Failure

Congestive Heart Failure and Pulmonary Edema - Congestive heart failure (CHF) is an imbalance in pump function in which the heart fails to maintain the circulation of blood adequately. The most severe manifestation of CHF, pulmonary edema, develops when this imbalance causes an increase in lung fluid secondary to leakage from pulmonary capillaries into the interstitium and alveoli of the lung. CHF can be categorized as forward or backward ventricular failure. A diagnosis of heart failure sounds scary, as if your heart could stop at any moment. But the underlying heart conditions that commonly cause heart failure, such as coronary artery disease or high blood pressure, typically develop slowly over many years. The development of heart failure usually means that your heart's ability to pump blood has weakened, so it can't circulate enough blood to meet your body's needs. Shortness of breath, fatigue and leg swelling may result. When fluid builds up, heart failure is called congestive. Sometimes the heart becomes too stiff to fill properly, and that also can lead to heart failure.

Although sometimes there's no way to reverse damage to your heart, treatments can significantly improve signs and symptoms. You can also make lifestyle changes, such as exercising, reducing salt intake, and losing weight, to help your weakened heart work as efficiently as possible.

Your best defense against heart failure is to prevent or control risk factors that lead to coronary artery disease, such as high blood pressure, high cholesterol levels, diabetes, smoking, alcohol abuse, inactivity and obesity.

Signs and symptoms

Heart failure typically doesn't occur suddenly. It develops slowly, over time. It's usually a chronic, long-term condition. The first and often only symptom may be shortness of breath. Signs and symptoms of heart failure can include:

  • Fatigue and weakness

  • Shortness of breath (dyspnea) when you exert yourself or when you lie down

  • Persistent wheezing or cough with white or pink blood-tinged phlegm

  • Pronounced neck veins

  • Swelling (edema) in your legs, ankles and feet

  • Swelling of your abdomen (ascites)

  • Rapid weight gain from fluid retention

  • Lack of appetite and Nausea

  • Difficulty concentrating or decreased alertness

  • Irregular or rapid heartbeat

Causes

Your circulatory system includes arteries and veins. Arteries deliver oxygen-rich blood to the organs and tissues of your body. Veins bring oxygen-poor blood back to your heart to be cycled through your heart and lungs and back out to the rest of your body, via your arteries.

Your heart, the center of your circulatory system, consists of four chambers. Throughout your life, your heart beats approximately once a second. In a single day, your heart beats about 100,000 times. Your heart's two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood.

Blood returning to your heart enters the right upper chamber (right atrium) of your heart. From there, blood empties into the right ventricle underneath. The right ventricle pumps blood into your lungs, where blood is oxygenated. Oxygenated blood from your lungs then returns to your heart, but this time to the left side — to the left upper chamber (left atrium). Blood then flows into the left ventricle underneath — your heart's main pumping chamber. With each heartbeat, your left ventricle pumps blood into your body's largest artery (aorta) and onward to the rest of your body.

Your heart is composed of two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump ...

Heart failure can involve the left side, right side or both sides of your heart. Typically, heart failure begins with the left side — specifically the left ventricle, your heart's main pumping chamber. Your doctor may refer to your condition as left-sided or left ventricular heart failure. He or she may define it further as systolic heart failure (when the left ventricle loses its ability to contract vigorously) or diastolic heart failure (when the left ventricle loses its ability to relax or fill fully) or a combination of both. The distinction is important because the drug treatments for each type may be different. Right-sided heart failure can occur independently or be a consequence of left ventricular heart failure.

Heart failure often occurs because other cardiac conditions have damaged or weakened your heart, forcing it to work harder. A weakened heart can't pump blood efficiently throughout your body. This causes blood to pool in your legs, feet and ankles, your kidneys to retain excess water and sodium, and fluid to back up into your lungs, leading to shortness of breath. This buildup of fluid is called congestive heart failure.

Heart failure often results from the stress of a heart attack, high blood pressure, or other forms of heart disease such as valve disorders. In fact, all of the behaviors that you probably associate with heart attack or heart disease — such as smoking, being overweight, eating foods high in cholesterol and fat, and not exercising — also cause or contribute to heart failure. Sometimes, your heart becomes weakened without explanation, a condition known as idiopathic dilated cardiomyopathy.

If you have heart failure, chances are you've had one or more of the following conditions, which can damage or weaken your heart. Some of these can be present without you even knowing it:

  • Coronary artery disease. Coronary artery disease is the most common form of heart disease. Over time, arteries that supply blood to your heart muscle can become narrowed from a buildup of fatty deposits (atherosclerosis). Blood moves more slowly through narrowed arteries. As a result, some areas of your heart muscle may be chronically deprived of oxygen-rich blood. These areas may become weak from the lack of oxygen and pump less vigorously. Sometimes this results in a heart attack with death of heart muscle, but in many cases the blood flow to the muscle is just enough to keep the muscle alive but not functioning well.

  • High blood pressure (hypertension). Blood pressure is the force of blood pumped by your heart through your blood vessels. 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 enlarge and become thicker to compensate for the extra work it must perform. Eventually your heart muscle may either become too stiff or too weak to effectively pump blood forward.

  • Heart attack. Heart failure can be a complication of a heart attack. A heart attack occurs when a blood clot forms in a narrowed coronary artery, blocking blood flow to a portion of your heart muscle and damaging it. The damaged portion of your heart can no longer pump as well as it should. The rest of your heart tries to make up for the loss, but may be unable to or may become weakened by the extra workload.

  • 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.

  • Cardiomyopathy. This is damage to the heart muscle. Some of the many causes of cardiomyopathy include infections, alcohol abuse, and the toxic effect of drugs such as cocaine and some drugs used for chemotherapy. In addition, systemic diseases such as lupus that may affect the body as a whole also can damage heart muscle. In many cases a specific cause can't be determined. This is referred to as idiopathic dilated cardiomyopathy. In some cases cardiomyopathy may be inherited.

  • Heart defects present at birth (congenital heart defects). If your heart and its chambers don't form 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, this extra work can weaken your heart muscle, producing heart failure. A heartbeat that's too slow also may prevent your heart from adequately circulating blood and lead to heart failure.

Other diseases — such as diabetes, severe anemia, hyperthyroidism, kidney or liver failure, and emphysema — also may precipitate heart failure.

Risk factors

A single risk factor may be sufficient to cause heart failure, but a combination of factors dramatically increases the risk.

Risk factors include:

  • Age. Advanced age adds to the potential impact of any heart failure risk. Heart failure is more common in people older than 65.

  • High blood pressure. Your heart works harder than it has to if your blood pressure is high.

  • Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakness.

  • Heart attack. Damage to your heart from a heart attack may mean your heart can no longer pump as well as it should.

  • Irregular heartbeats. These abnormal rhythms can create extra work for your heart and weaken it.

  • Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.

  • Kidney conditions. These can contribute to heart failure because many can lead to high blood pressure and fluid retention.

  • Congenital heart defects. Some people who develop heart failure were born with structural heart defects.

  • Viruses. A viral infection may have damaged your heart muscle.

Blacks are more likely to develop heart failure, and the prognosis is generally worse.

When to seek medical advice

See your doctor if you experience any of the signs or symptoms associated with heart failure. Often signs and symptoms of heart failure initiate an emergency room visit, where the condition may first be diagnosed. Other heart and lung problems can cause signs and symptoms that are similar to heart failure.

If you have a diagnosis of heart failure, and if any of the signs or symptoms suddenly become worse or you develop a new sign or symptom, it may indicate that known heart failure is getting worse or not responding to treatment. Contact your doctor promptly.

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Last Modified : 03/15/08 12:57 AM