Congestive heart failure or “heart failure” is a term that is often perceived as a condition in which the heart suddenly stops. Instead, it is a common heart condition in which the heart cannot pump enough blood to the body’s other organs.


The heart is a pump with four chambers. Blood enters on one side and exits on the other. This pumping action maintains the circulation of blood throughout our bodies. When the heart is unable to expel sufficient blood to meet the body’s needs, the blood backs up and congestive heart failure (CHF) occurs. This results in a diminished blood flow to all the body’s tissues. Although heart failure can be acute, it most often develops slowly, with symptoms manifesting gradually.


The most important warning sign of CHF is edema — the retention of large amounts of fluid in the body. When the heart fails to do its pumping job correctly, blood is not properly circulated back through the veins. Fluids also accumulate in the body tissues because of poor blood circulation. This is the “congestion” aspect of CHF. This extra fluid collects all over the body, causing puffiness of the extremities. Most noticeable swelling is in the legs after standing. However, if swelling only occurs in the ankles this may be an indication of some other, less serious condition.

When a person with CHF lies down, fluid settles in the chest area, most noticeably in the lungs. There is difficulty in breathing that may sound like “rattling,” especially during physical exertion. Coughing, shortness of breath, or a feeling of heaviness in the chest is also common. Because the circulatory system is not doing its job properly, patients with CHF feel tired and weak.


Treatment of CHF involves four important goals:

  1. Easing the strain on the heart.
  2. Improving the pumping action of the heart muscle.
  3. Controlling salt and water balance in the body.
  4. Identifying and treating the cause of the CHF.

Bed rest may be an important first aspect of treatment to reduce the heart’s workload. Other treatment options include medications, such as ACE-inhibitors, and monitoring weight on a daily basis to ensure that excess fluid is not retained. Obese patients are encouraged to lose weight to eases strain on the heart. Once CHF is under control, the patient usually can return to normal activity, unless there are other complicating factors. Medications are available to improve and strengthen the heart muscle and make its contractions more powerful. Digitalis is the most common. This increases the cardiac output and slows the heart rate. Water and salt balance are controlled by changing the patient’s diet and using diuretic medications. These help the kidneys excrete excess salt and water.

Finally, it is also important to identify the underlying caused of CHF. There are many other diseases that can weaken the heart’s pumping ability. Most common are arteriosclerosis — “hardening” of the blood vessels, which may deprive the heart muscle of oxygen — and high blood pressure. Other causes include abnormality of the heart valves, infection or congenital malformation of the heart. In many cases, treatment of the underlying cause can provide excellent relief from CHF.

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