Heart failure, also known as congestive heart failure (CHF), is a condition in which the heart cannot (fails to) pump enough blood to organs and tissues. One side of the heart (or both sides) cannot force enough blood out, so blood backs up. Congestion, or abnormal buildup of fluid, occurs in tissues or organs, and blood doesn’t move well through the vascular system.
If the left side of the heart fails, the system on the right side becomes congested. The congested side of the heart must work harder and may also fail. The same thing can happen on the right side.
Diseases that stress heart muscle can cause HF. These conditions include high blood pressure, heart attack, heart muscle and valve diseases, infections, arrhythmias (abnormal heart rhythms), anemia, thyroid disease, pulmonary disease, and too much fluid in the body.
When the left side of the heart fails, fluid leaks into the lungs. Fatigue (tiredness), difficulty breathing (especially at night when lying down), coughing, or shortness of breath can result.
In right-sided heart failure, the liver swells, which may cause pain in the abdomen (belly). Legs and feet may swell also.
A physical examination will show changes, such as swelling in the legs or crackling breath sounds, indicating excess fluid in the lungs.
A chest x-ray can show an enlarged heart and signs of fluid accumulation into the lungs. An echocardiogram (a test using sound waves to show the moving heart) can also reveal heart size and disease of the heart muscle or valve problems.
Initial symptoms should be managed so the failing heart doesn’t have to work as hard.
The cause of HF also needs treatment. For example, if a heart valve problem is the cause, surgery may be needed to repair or replace the valve. Lifestyle changes will be needed. Smoking lowers the blood oxygen level and makes the heart work harder, so avoid tobacco. Less fluid and salt in the diet reduces fluid in the body. Also, if overweight, losing weight will help. Dietitians and nutritionists can help plan a diet.
Oxygen may be given to reduce the workload on the lungs.
Medicines may be prescribed to reduce fluid in the body or help the ventricle contract better. Diuretics remove fluid. Nitrates open blood vessels so blood flows more easily. Angiotensin-converting enzyme (ACE) inhibitors help the ventricle contract. Beta-blockers help by slowing the heart rate. Other drugs reduce blood pressure. All may have side effects, including dehydration, cough, dizziness, fainting, and fatigue.
Pacemakers and implantable defibrillators may be used in some cases.
Heart transplantation is an option in some patients when other treatments fail.
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Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.
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