What is congestive heart failure? Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscles. While often referred to simply as “heart failure,” CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently. You have four heart chambers. The upper half of your heart has two atria, and the lower half of your heart has two ventricles. The ventricles pump blood to your body’s organs and tissues, and the atria receive blood from your body as it circulates back from the rest of your body. CHF develops when your ventricles can’t pump enough blood volume to the body. Eventually, blood and other fluids can back up inside your: lungs

abdomen

liver

lower body CHF can be life-threatening. If you suspect you or someone near you has CHF, seek immediate medical treatment.

What are the most common types of CHF? Left-sided CHF is the most common type of CHF. It occurs when your left ventricle doesn’t properly pump blood out to your body. As the condition progresses, fluid can build up in your lungs, which makes breathing difficult. There are two kinds of left-sided heart failure: Systolic heart failure occurs when the left ventricle fails to contract normally. This reduces the level of force available to push blood into circulation. Without this force, the heart can’t pump properly.

occurs when the left ventricle fails to contract normally. This reduces the level of force available to push blood into circulation. Without this force, the heart can’t pump properly. Diastolic failure, or diastolic dysfunction, happens when the muscle in the left ventricle becomes stiff. Because it can no longer relax, the heart can’t quite fill with blood between beats. Right-sided CHF occurs when the right ventricle has difficulty pumping blood to your lungs. Blood backs up in your blood vessels, which causes fluid retention in your lower extremities, abdomen, and other vital organs. It’s possible to have left-sided and right-sided CHF at the same time. Usually, the disease starts in the left side and then travels to the right when left untreated. Congestive heart failure stages Stage Main symptoms Outlook Class I You don’t experience any symptoms during typical physical activity. CHF at this stage can be managed through lifestyle changes, heart medications, and monitoring. Class II You’re likely comfortable at rest, but normal physical activity may cause fatigue, palpitations, and shortness of breath. CHF at this stage can be managed through lifestyle changes, heart medications, and careful monitoring. Class III You’re likely comfortable at rest, but there’s a noticeable limitation of physical activity. Even mild exercise may cause fatigue, palpitations, or shortness of breath. Treatment can be complicated. Talk with your doctor about what heart failure at this stage may mean for you. Class IV You’re likely unable to carry on any amount of physical activity without symptoms, which are present even at rest. There’s no cure for CHF at this stage, but there are still quality-of-life and palliative care options. You’ll want to discuss the potential benefits and risks of each with your doctor.

What are the causes of CHF, and am I at risk? CHF may result from other health conditions that directly affect your cardiovascular system. This is why it’s important to get annual checkups to lower your risk for heart health problems, including high blood pressure (hypertension), coronary artery disease, and valve conditions. Hypertension When your blood pressure is higher than normal, it may lead to CHF. Hypertension has many different causes. Among them is the narrowing of your arteries, which makes it harder for your blood to flow through them. Coronary artery disease Cholesterol and other types of fatty substances can block the coronary arteries, which are the small arteries that supply blood to the heart. This causes the arteries to become narrow. Narrower coronary arteries restrict your blood flow and can lead to damage in your arteries. Valve conditions Your heart valves regulate blood flow through your heart by opening and closing to let blood in and out of the chambers. Valves that don’t open and close correctly may force your ventricles to work harder to pump blood. This can be a result of a heart infection or defect. Other conditions While heart-related diseases can lead to CHF, there are other seemingly unrelated conditions that may increase your risk, too. These include diabetes, thyroid disease, and obesity. Severe infections and allergic reactions may also contribute to CHF.

How is CHF diagnosed? After reporting your symptoms to your doctor, they may refer you to a heart specialist, or cardiologist. Your cardiologist will perform a physical exam, which will involve listening to your heart with a stethoscope to detect abnormal heart rhythms. To confirm an initial diagnosis, your cardiologist might order certain diagnostic tests to examine your heart’s valves, blood vessels, and chambers. There are a variety of tests used to diagnose heart conditions. Because these tests measure different things, your doctor may recommend a few to get a full picture of your current condition. Electrocardiogram An electrocardiogram (EKG or ECG) records your heart’s rhythm. Abnormalities in your heart’s rhythm, such as a rapid heartbeat or irregular rhythm, could suggest that the walls of your heart’s chamber are thicker than normal. That could be a warning sign for a heart attack. Echocardiogram An echocardiogram uses sound waves to record the heart’s structure and motion. The test can determine if you already have poor blood flow, muscle damage, or a heart muscle that doesn’t contract normally. MRI An MRI takes pictures of your heart. With both still and moving pictures, this allows your doctor to see if there’s damage to your heart. Stress test Stress tests show how well your heart performs under different levels of stress. Making your heart work harder makes it easier for your doctor to diagnose problems. Blood tests Blood tests can check for abnormal blood cells and infections. They can also check the level of BNP, a hormone that rises with heart failure. Cardiac catheterization Cardiac catheterization can show blockages of the coronary arteries. Your doctor will insert a small tube into your blood vessel and thread it from your upper thigh (groin area), arm, or wrist. At the same time, the doctor can take blood samples, use X-rays to view your coronary arteries, and check blood flow and pressure in your heart chambers.

How is it treated? You and your doctor may consider different treatments depending on your overall health and how far your condition has progressed. Congestive heart failure drugs There are several medications that can be used to treat CHF, including: ACE inhibitors Angiotensin-converting enzyme inhibitors (ACE inhibitors) open up narrowed blood vessels to improve blood flow. Vasodilators are another option if you cannot tolerate ACE inhibitors. You may be prescribed one of the following: benazepril (Lotensin)

captopril (Capoten)

enalapril (Vasotec)

fosinopril (Monopril)

lisinopril (Zestril)

quinapril (Accupril)

ramipril (Altace)

moexipril (Univasc)

perindopril (Aceon)

trandolapril (Mavik) ACE inhibitors shouldn’t be taken with the following medications without consulting with a doctor, because they may cause an adverse reaction: Thiazide diuretics can cause an additional decrease in blood pressure.

Potassium-sparing diuretics, such as triamterene (Dyrenium), eplerenone (Inspra), and spironolactone (Aldactone), can cause potassium buildup in the blood. This may lead to abnormal heart rhythms.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, and naproxen, can cause sodium and water retention. This may reduce the ACE inhibitor’s effect on your blood pressure. This is an abbreviated list, so always speak with your doctor before taking any new medications. Beta-Blockers Beta-blockers can reduce blood pressure and slow a rapid heart rhythm. This may be achieved with: acebutolol (Sectral)

atenolol (Tenormin)

bisoprolol (Zebeta)

carteolol (Cartrol)

esmolol (Brevibloc)

metoprolol (Lopressor)

nadolol (Corgard)

nebivolol (Bystolic)

propranolol (Inderal LA) Beta-blockers should be taken with caution with the following medications, as they may cause an adverse reaction: Antiarrhythmic medications, such as amiodarone (Nexterone), can increase cardiovascular effects, including reduced blood pressure and slowed heart rate.

Antihypertensive medications, such as lisinopril (Zestril), candesartan (Atacand), and amlodipine (Norvasc), may also increase the likelihood of cardiovascular effects.

The effects of albuterol (AccuNeb) on bronchodilation may be cancelled out by beta-blockers.

Fentora (Fentanyl) may cause low blood pressure.

Antipsychotics, such as thioridazine (Mellaril), may also cause low blood pressure.

Clonidine (Catapres) may cause high blood pressure. Some medications may not be listed here. You should always consult your doctor before taking any new medications. Diuretics Diuretics reduce your body’s fluid content. CHF can cause your body to retain more fluid than it should. Your doctor may recommend: Thiazide diuretics. These cause blood vessels to widen and help the body remove any extra fluid. Examples include metolazone (Zaroxolyn), indapamide (Lozol), and hydrochlorothiazide (Microzide).

These cause blood vessels to widen and help the body remove any extra fluid. Examples include metolazone (Zaroxolyn), indapamide (Lozol), and hydrochlorothiazide (Microzide). Loop diuretics. These cause the kidneys to produce more urine. This helps remove excess fluid from your body. Examples include furosemide (Lasix), ethacrynic acid (Edecrin), and torsemide (Demadex).

These cause the kidneys to produce more urine. This helps remove excess fluid from your body. Examples include furosemide (Lasix), ethacrynic acid (Edecrin), and torsemide (Demadex). Potassium-sparing diuretics. These help get rid of fluids and sodium while still retaining potassium. Examples include triamterene (Dyrenium), eplerenone (Inspra), and spironolactone (Aldactone). Diuretics should be taken with caution with the following medications, as they may cause an adverse reaction: ACE inhibitors, such as lisinopril (Zestril), benazepril (Lotensin), and captopril (Capoten), can cause decreased blood pressure.

Tricyclics, such as amitriptyline and desipramine (Norpramin), may cause low blood pressure.

Anxiolytics, such as alprazolam (Xanax), chlordiazepoxide (Librium), and diazepam (Valium), may cause low blood pressure.

Hypnotics, such as zolpidem (Ambien) and triazolam (Halcion), may cause low blood pressure.

Beta-blockers, such as acebutolol (Sectral) and atenolol (Tenormin), may cause low blood pressure.

Calcium channel blockers, such as amlodipine (Norvasc) and diltiazem (Cardizem), may cause a drop in blood pressure.

Nitrates, such as nitroglycerin (Nitrostat) and isosorbide-dinitrate (Isordil), may cause low blood pressure.

NSAIDS, such as ibuprofen, aspirin, and naproxen, may cause toxicity of the liver. This is an abbreviated list with only the most common drug interactions. You should always talk to your doctor before taking any new medications. Surgeries If medications aren’t effective on their own, more invasive procedures may be required. Angioplasty, a procedure to open up blocked arteries, is one option. Your cardiologist may also consider heart valve repair surgery to help your valves open and close properly.

What can I expect in the long term? Your condition may improve with medication or surgery. Your outlook depends on how advanced your CHF is and whether you have other health conditions to treat, like diabetes or high blood pressure. The earlier your condition is diagnosed, the better your outlook. Talk to your doctor about the best treatment plan for you.

CHF and genetics Q: Is congestive heart failure genetic? Can lifestyle changes help prevent it?

Anonymous patient A: Cardiomyopathy, or damage to the heart muscle, can be a cause of heart failure, and genetics could play a role in some types of cardiomyopathy. However, most of the cases of congestive heart failure (CHF) are not hereditary. Some risk factors for CHF, such as hypertension, diabetes, and coronary artery disease, can run in families. To reduce your risk of developing CHF, consider making lifestyle changes like eating a healthy diet and getting regular exercise. Elaine K. Luo, M.D. Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.