Congestive heart failure or CHF can be an ongoing, chronic process or it can be acute. In this article, we will focus on the chronic type which develops over time and may become worse. When the heart is no longer able to pump adequately, fluid buildup and shortness of breath develop. Fortunately there are medications that can help as well as coping mechanisms that can be taught to help patients.
Basic normal heart function
The human heart is a muscle with 4 chambers. Blood which is returning from the body to be reoxygenated enters the right upper chamber or atrium. It passes through the tricuspid valve into the right ventricle then is pumped into the lungs via the pulmonary artery. In the lungs, the blood discards carbon dioxide and picks up oxygen molecules via capillaries. Once it is loaded up with fresh oxygen, it flows into the pulmonary veins into the left atrium or upper chamber of the heart. From the left atrium, the blood flows into the left ventricle via the bicuspid (mitral) valve. The strong muscle contracts and pushes the oxygen rich blood through the aortic valve into the aorta which is the main artery in the human body.
What is congestive heart failure
Congestive heart failure or CHF occurs when the heart muscle can no longer handle its normal work load. There are many possible reasons that this can happen. When the heart is unable to keep up, it will make an attempt to compensate by enlarging. Both left and right sides of the heart muscle can fail but very often the problems begin on the left where the majority of the work is done.
When the left side of the heart becomes damaged or weak, it will eventually be unable to pump blood sufficiently. Output will decrease so the ventricle will distend due to increased blood backing up. When the condition worsens, the blood will start backing up into the lungs and the pulmonary capillaries will distend and begin to leak. As you can imagine, this will cause fluid buildup in the lungs. It is called pulmonary edema and can be life threatening.
See and compare the chest xrays below. The top one is a normal chest xray. The black color shows air in the lungs which is as it should be. The lower xray has lots of white markings throughout. This indicates a severe buildup of fluid in the lungs.
What kind of things cause or contribute to congestive heart failure?
There are many things that can lead to CHF. Coronary artery disease is the most common because the heart depends on these vessels for oxygen. Blocking or narrowing of the coronary arteries can lead to heart attack which can severely damage the heart muscle. When the muscle becomes damaged, it can no longer pump efficiently and blood will start backing up into the lungs.
Chronic high blood pressure will force the heart to work harder and over time, the heart muscle will enlarge and thicken. That will affect the heart's ability to fill and contract properly. Similarily, aortic valve stenosis (calcium deposits on the aortic valve leading from the heart) and atherosclerosis (hardening of the arteries) can cause the same scenario since both conditions force the heart to become overburdened trying to overcome resistance.
Other potential contributing factors leading to CHF are diabetes mellitus, some types of chemotherapy, sleep apnea, illicit drug use, myocarditis (inflammation of the heart muscle), alcohol abuse, lupus, heart defects or defects in the valves, thyroid problems and emphysema.
Symptoms of Congestive Heart Failure
The main symptoms of CHF are shortness of breath upon exertion or when lying down. Patients with CHF may wake up gasping for air and need to have their head elevated to catch their breath. Wheezing and gurgling may be noted. Coughing may produce frothy white or pink tinged secretions. The person will feel generally fatigued and may have an increased heart rate or an irregular heart rhythm.
Swelling is common with chronic heart failure. It is usually obvious at the ankles and may reach the point called pitting edema, when finger pressure on the area creates a dent that does not immediately go away.
There may also be abdominal swelling, chest pain and swelling of the hands and feet. Dizziness or fainting may be present. If a patient presents with symptoms like these, the doctor will most likely do a chest xray and an EKG first. If indicated, additional tests may be ordered such as stress testing, echocardiogram or a heart catherization.
Prevention and treatment
Prevention of CHF is the same as the prevention of heart disease in general, except in cases of a different underlying cause. Eating a heart healthy diet, exercise, avoiding the use of tobacco or the abuse of alcohol, controlling high blood pressure and annual checkups with the doctor are all things that people can do to help avoid heart disease.
Treatment of CHF depends on the severity and the cause. If faulty heart valves are to blame it may be necessary to surgically repair them. Medications are available to control blood pressure and others to increase urination to help remove excess fluid from the body. If the heart muscle is weak, digoxin may be prescribed to increase contractility. Oxygen may be prescribed to decrease the work of breathing.
Lifestyle changes may be needed. If applicable, smoking cessation, a low sodium diet, weight reduction, stress management and avoidance of caffeine and alcohol should be implemented. If symptoms are severe, it may be necessary for the person to stay in a nursing home for cardiac rehab where self care and coping skills can be taught. Once the heart muscle has sustained damage, the symptoms are very likely to reoccur, so it is extremely important to follow the guidelines that the physican has laid out and to take any prescribe medications.
Living with Congestive Heart Failure
CHF is a chronic condition for the majority of sufferers, however many people still enjoy life despite having limitations. It may be frustrating at times because a person with CHF must do things at a slower pace, possibly use supplemental oxygen and will have to take medications and watch their diet closely. Some former activities may no longer be possible and when this happens it must be accepted. Other, less strenuous activities will have to be substituted. It may be desirable to join a support group. Some communities have these and there are many online groups for people with heart disease. One such online community is Mdjunction Congestive Heart Failure Online Support Group. Associating with other CHF patients can be very beneficial and educational. Physicians may have information about local support groups as well.
See related articles written by Marilyn Eisele, Registered Respiratory Therapist
A Concise Handbook of Respiratory Diseases by Sattar Farzan, MD
Egan's Fundamentals of Respiratory Therapy by Charles B. Spearman, Richard L. Sheldon and Donald E. Egan
Comprehensive Respiratory Care by David H. Eubanks and Roger C. Bone