What Is Heart Failure?

Heart failure does not mean the heart has stopped working. Rather, it means that the heart's pumping
power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate,
and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to
meet the body's needs. The chambers of the heart may respond by stretching to hold more blood to pump
through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart
muscle walls may eventually weaken and become unable to pump as efficiently. As a result, the kidneys
may respond by causing the body to retain fluid (water) and salt. If fluid builds up in the arms, legs,
ankles, feet, lungs, or other organs, the body becomes congested, and congestive heart failure is the term
used to describe the condition.
What Causes Congestive Heart Failure?
Many disease processes can impair the pumping efficiency of the heart to cause congestive heart failure.
In the United States, the most common causes of congestive heart failure are:

coronary artery disease

high blood pressure (hypertension)

longstanding alcohol abuse

disorders of the heart valves

unknown (idiopathic) causes, such as after recovery from myocarditis

Less common causes include viral infections of the stiffening of the heart muscle, thyroid
disorders, disorders of the heart rhythm, and many others.
It should also be noted that in patients with underlying heart disease, taking certain medications can lead
to the development or worsening of congestive heart failure. This is especially true for those drugs that
can cause sodium retention or affect the power of the heart muscle. Examples of such medications are
the commonly usednonsteroidal anti-inflammatory drugs(NSAIDs), which include ibuprofen (Motrin and
others) and naproxen (Aleve and others) as well as certain steroids, some medication for diabetes (such
asrosiglitazone [Avandia] or pioglitazone[Actos]), and some calcium channel blockers.

What Are the Types of Heart Failure?

Systolic dysfunction (or systolic heart failure) occurs when the heart muscle doesn't contract with
enough force, so there is less oxygen-rich blood that is pumped throughout the body.

Diastolic dysfunction (or diastolic heart failure) occurs when the heart contracts normally, but the
ventricles do not relax properly or are stiff, and less blood enters the heart during normal filling.
A calculation done during an echocardiogram, called the ejection fraction (EF), is used to measure how
well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. Your
doctor can discuss which condition you have.
How Is Heart Failure Diagnosed?
Your doctor will ask you many questions about your symptoms and medical history. You will be asked
about any conditions you have that may cause heart failure (such as coronary artery disease, angina,
diabetes, heart valve disease, and high blood pressure). You will be asked if you smoke, take drugs, drink
alcohol (and how much you drink), and about what drugs you take.
You will also get a complete physical exam. Your doctor will listen to your heart and look for signs of heart
failure as well as other illnesses that may have caused your heart muscle to weaken or stiffen.
Your doctor may also order other tests to determine the cause and severity of your heart failure. These
include:

Blood tests. Blood tests are used to evaluate kidney and thyroid function as well as to check
cholesterol levels and the presence of anemia. Anemia is a blood condition that occurs when there is not
enough hemoglobin (the substance in red blood cells that enables the blood to transport oxygen through
the body) in a person's blood.

B-type Natriuretic Peptide (BNP) blood test. BNP is a substance secreted from the heart in
response to changes in blood pressure that occur when heart failure develops or worsens. BNP blood
levels increase when heart failure symptoms worsen, and decrease when the heart failure condition is
stable. The BNP level in a person with heart failure -- even someone whose condition is stable -- is higher
than in a person with normal heart function. BNP levels do not necessarily correlate with the severity of
heart failure.

Chest X-ray. A chest X-ray shows the size of your heart and whether there is fluid build-up
around the heart and lungs.

Echocardiogram. This test is an ultrasound which shows the heart's movement, structure, and
function.

The Ejection Fraction (EF) is used to measure how well your heart pumps with each beat to
determine if systolic dysfunction or heart failure with preserved left ventricular function is present. Your
doctor can discuss which condition is present in your heart.

Electrocardiogram (EKG or ECG) . An EKG records the electrical impulses traveling through
the heart.

Cardiac catheterization. This invasive procedure helps determine whether coronary artery
disease is a cause of congestive heart failure.

Stress Test. Noninvasive stress tests provide information about the likelihood of coronary artery
disease.
Other tests may be ordered, depending on your condition.

What is the treatment of congestive heart failure?

Lifestyle modifications
After congestive heart failure is diagnosed, treatment should be started immediately. Perhaps the most
important and yet most neglected aspect of treatment involves lifestyle modifications. Sodium causes an
increase in fluid accumulation in the body's tissues. Because the body is often congested with excess
fluid, patients become very sensitive to the levels of intake of sodium and water. Restricting salt and fluid
intake is often recommended because of the tendency of fluid to accumulate in the lungs and surrounding
tissues. An American "no added salt" diet can still contain 4 to 6 grams (4000 to 6000 milligrams) of
sodium per day. In individuals with congestive heart failure, an intake of no more than 2 grams (2000
milligrams) of sodium per day is generally advised. Reading food labels and paying close attention to total
sodium intake is very important. Severe restriction of alcohol consumption also is advised.
Likewise, the total amount of fluid consumed must be regulated. Although many people with congestive
heart failure take diuretics to aid in the elimination of excess fluid, the action of these medications can be
overwhelmed by an excess intake of water and other fluids. The maxim that "drinking eight glasses of
water a day is healthy" certainly does not apply to patients with congestive heart failure. In fact, patients
with more advanced cases of congestive heart failure are often advised to limit their total daily fluid intake
from all sources to 2 quarts. The above guidelines for sodium and fluid intake may vary depending on the
severity of congestive heart failure in any given individual and should be discussed with their physician.
An important tool for monitoring an appropriate fluid balance is the frequent measurement of body weight.
An early sign of fluid accumulation is an increase in body weight. This may occur even before shortness
of breath or swelling in the legs and other body tissues (edema) is detected. A weight gain of two to three
pounds over two to three days should prompt a call to the physician, who may order an increase in the
dose of diuretics or other methods designed to stop the early stages of fluid accumulation before it
becomes more severe.
Aerobic exercise, once discouraged for congestive heart failure patients, has been shown to be beneficial
in maintaining overall functional capacity, quality of life, and perhaps even improving survival. Each
person's body has its own unique ability to compensate for the failing heart. Given the same degree of
heart muscle weakness, individuals may display widely varying degrees of limitation of function. Regular
exercise, when tailored to the person's tolerance level, appears to provide significant benefits and should
be used only when the individual is compensated and stable.

Addressing potentially reversible factors

Depending on the underlying cause of congestive heart failure, potentially reversible factors should be
explored. For example:

In certain persons whose congestive heart failure is caused by inadequate blood flow to the heart
muscle, restoration of the blood flow through coronary artery surgery or catheter procedures
(angioplasty, intracoronary stenting) may be considered.

Congestive heart failure that is due to severe disease of the valves may be alleviated by valve
surgery in appropriate patients.

When congestive heart failure is caused by chronic, uncontrolled high blood pressure
(hypertension), aggressive blood pressure control will often improve the condition.

Heart muscle weakness that is due to longstanding, severe alcohol abuse can improve
significantly with abstinence from drinking.

Congestive heart failure that is caused by other disease states may be similarly partially or
completely reversible by appropriate measures.

Medications
Until recently, the selection of medications available for the treatment of congestive heart failure was
frustratingly limited and focused mainly on controlling the symptoms. Medications have now been
developed that both improve symptoms, and, importantly, prolong survival.
Angiotensin Converting Enzyme (ACE) Inhibitors

ACE inhibitors have been used for the treatment of hypertension for more than 20 years. This class of
drugs has also been extensively studied in the treatment of congestive heart failure. These medications
block the formation of angiotensin II, a hormone with many potentially adverse effects on the heart and
circulation in patients with heart failure. In multiple studies of thousands of patients, these drugs have
demonstrated a remarkable improvement of symptoms in patients, prevention of clinical deterioration, and
prolongation of survival. In addition, they have been recently been shown to prevent the development of
heart failure and heart attacks. The wealth of the evidence supporting the use of these agents in heart

failure is so strong that ACE inhibitors should be considered in all patients with heart failure, especially
those with heart muscle weakness.
Possible side effects of these drugs include:

a nagging, dry cough,

low blood pressure,

worsening kidney function and electrolyte imbalances, and

rarely, true allergic reactions.

When used carefully with proper monitoring, however, the majority of individuals with congestive heart
failure tolerate these medications without significant problems. Examples of ACE inhibitors include:

captopril (Capoten),

enalapril (Vasotec),

lisinopril (Zestril, Prinivil),

benazepril (Lotensin), and

ramipril (Altace).

For those individuals who are unable to tolerate the ACE inhibitors, an alternative group of drugs, called
the angiotensin receptor blockers (ARBs), may be used. These drugs act on the same hormonal pathway
as the ACE inhibitors, but instead block the action of angiotensin II at its receptor site directly. A small,
early study of one of these agents suggested a greater survival benefit in elderly congestive heart failure
patients as compared to an ACE inhibitor. However, a larger, follow-up study failed to demonstrate the
superiority of the ARBs over the ACE inhibitors. Further studies are underway to explore the use of these
agents in congestive heart failure both alone and in combination with the ACE inhibitors.
Possible side effects of these drugs are similar to those associated with the ACE inhibitors, although the
dry cough is much less common. Examples of this class of medications include:

losartan (Cozaar),

candesartan (Atacand),

telmisartan (Micardis),

valsartan (Diovan),

irbesartan (Avapro), and

olmesartan (Benicar).

Beta-blockers

Certain hormones, such as epinephrine (adrenaline), norepinephrine, and other similar hormones, act on
the beta receptor's of various body tissues and produce a stimulative effect. The effect of these hormones
on the beta receptors of the heart is a more forceful contraction of the heart muscle.Beta-blockers are
agents that block the action of these stimulating hormones on the beta receptors of the body's tissues.
Since it was assumed that blocking the beta receptors further depressed the function of the heart, betablockers have traditionally not been used in persons with congestive heart failure. In congestive heart
failure, however, the stimulating effect of these hormones, while initially useful in maintaining heart
function, appears to have detrimental effects on the heart muscle over time.
However, studies have demonstrated an impressive clinical benefit of beta-blockers in improving heart
function and survival in individuals with congestive heart failure who are already taking ACE inhibitors. It
appears that the key to success in using beta-blockers in congestive heart failure is to start with a low
dose and increase the dose very slowly. At first, patients may even feel a little worse and other
medications may need to be adjusted.
Possible side effects include:

fluid retention,

low blood pressure,

low pulse, and

general fatigue and lightheadedness.

Beta-blockers should generally not be used in people with certain significant diseases of the airways (for
example, asthma, emphysema) or very low resting heart rates. While carvedilol (Coreg) has been the
most thoroughly studied drug in the setting of congestive heart failure, studies of other beta-blockers have
also been promising. Research comparing carvedilol directly with other beta-blockers in the treatment of
congestive heart failure is ongoing. Long acting metoprolol (Toprol XL) is also very effective in individuals
with congestive heart failure.

Digoxin

Digoxin (Lanoxin) has been used in the treatment of congestive heart failure for hundreds of years. It is
naturally produced by the foxglove flowering plant. Digoxin stimulates the heart muscle to contract more
forcefully. It also has other actions, which are not completely understood, that improve congestive heart
failure symptoms and can prevent further heart failure. However, a large-scale randomized study failed to
demonstrate any effect of digoxin on mortality.
Digoxin is useful for many patients with significant congestive heart failure symptoms, even though longterm survival may not be affected. Potential side effects include:

nausea,

vomiting,

heart rhythm disturbances,

kidney dysfunction, and

electrolyte abnormalities.

These side effects, however, are generally a result of toxic levels in the blood and can be monitored by
blood tests. The dose of digoxin may also need to be adjusted in patients with significant kidney
impairment.
Diuretics

Diuretics are often an important component of the treatment of congestive heart failure to prevent or
alleviate the symptoms of fluid retention. These drugs help keep fluid from building up in the lungs and
other tissues by promoting the flow of fluid through the kidneys. Although they are effective in relieving
symptoms such as shortness of breath and leg swelling, they have not been demonstrated to positively
impact long-term survival.
Nevertheless, diuretics remain key in preventing deterioration of the patient's condition thereby requiring
hospitalization. When hospitalization is required, diuretics are often administered intravenously because
the ability to absorb oral diuretics may be impaired, when congestive heart failure is severe. Potential side
effects of diuretics include:

dehydration,

electrolyte abnormalities,

particularly low potassium levels,

hearing disturbances, and

low blood pressure.

It is important to prevent low potassium levels by taking supplements, when appropriate. Such electrolyte
disturbances may make patients susceptible to serious heart rhythm disturbances. Examples of various
classes of diuretics include:

furosemide (Lasix),

hydrochlorothiazide (Hydrodiuril),

bumetanide (Bumex),

torsemide (Demadex),

spironolactone (Aldactone), and

metolazone (Zaroxolyn).

One particular diuretic has been demonstrated to have surprisingly favorable effects on survival in
congestive heart failure patients with relatively advanced symptoms. Spironolactone (Aldactone) has
been used for many years as a relatively weak diuretic in the treatment of various diseases. Among other
things, this drug blocks the action of the hormone aldosterone.
Aldosterone has many theoretical detrimental effects on the heart and circulation in congestive heart
failure. Its release is stimulated in part by angiotensin II (see ACE inhibitors, above). In patients taking
ACE inhibitors, however, there is an "escape" phenomenon in which aldosterone levels can increase
despite low levels of angiotensin II. Medical researchers have found that spironolactone (Aldactone) can
improve the survival rate of patients with congestive heart failure. In that the doses used in the study were
relatively small, it has been theorized that the benefit of the drug was in its ability to block the effects of
aldosterone rather than its relatively weak action as a diuretic (water pill). Possible side effects of this
drug include elevated potassium levels and, in males, breast tissue growth (gynecomastia).
Another aldosterone inhibitor is eplerenone (Inspra).

Heart transplant

In some cases, despite the use of optimal therapies as described above, the patient's condition continues
to deteriorate due to progressive heart failure. In selected patients, heart transplantation is a viable
treatment option. Candidates for heart transplantation are generally under age 70 and do not have severe
or irreversible diseases affecting the other organs. Additionally, a transplant is done only when it is clear
that the patient's prognosis is poor with continued medical treatment of the heart condition. Transplant
patients require close medical follow-up while taking the necessary drugs that suppress the immune
system, and because of the risk of rejection of the transplanted heart. They also must be monitored for
possible development of coronary artery disease in the transplanted heart.
Although there are thousands of patients on waiting lists for a heart transplant at any given time, the
number of operations performed each year is limited by the number of available donor organs. For these
reasons, heart transplantation is a realistic option in only a small subset of the large numbers of patients
with congestive heart failure.

Other mechanical therapies

Given the limitations associated with heart transplantation, much attention has recently been directed
towards the development of mechanical assist devices that are designed to assume part or all of the
pumping function of the heart. There are several devices available for clinical use and many more are
actively being developed. For instance, there are currently left ventricular assist devices that are approved
for use as a temporary mode of circulatory support in very ill patients until a transplant can be performed.
Studies examining the possible role of these mechanical assist devices on a long term basis as
permanent self-contained implants are ongoing. They may often be used for longer periods of time in
older patients who may not be heart transplant candidates. The current major limitation of these devices
is the risk of infection, especially at the site where the device exits the body through the skin to
communicate with its external power source.
A less invasive modality, which can be placed without surgery, is thebiventricular pacemaker. This device
has proved valuable in appropriate types of patients with heart failure and impaired ventricles by
improving the synchrony of contraction.

What is the long term prognosis for patients with congestive heart failure?

Congestive heart failure is generally a progressive disease with periods of stability punctuated by episodic
clinical exacerbations. The course of the disease in any given individual, however, is extremely variable.
Factors involved in determining the long term outlook (prognosis) for a given patient include:

the nature of the underlying heart disease,

the response to medications,

the degree to which other organ systems are involved and the severity of other accompanying
conditions,

the person's symptoms and degree of impairment, and

other factors that remain poorly understood.

With the availability of newer drugs to potentially favorably affect the progression of disease, the
prognosis in congestive heart failure is generally more favorable than that observed just 10 years ago. In
some cases, especially when the heart muscle dysfunction has recently developed, a significant
spontaneous improvement is not uncommonly observed, even to the point where heart function becomes
normal.
Heart failure is often graded on a scale of I to IV based on the patient's ability to function.
1.

Class I is patients with a weakened heart but without limitation or symptoms.

2.

Class II is only limitation at heavier workloads.

3.

Class III is limitation at everyday activity.

4.

Class IV is severe symptoms at rest or with any degree of effort.

The prognosis of heart failure patients is very closely associated with the functional class.
An important issue in congestive heart failure is the risk of heart rhythm disturbances (arrhythmias). Of
those deaths that occur in individuals with congestive heart failure, approximately 50% are related to
progressive heart failure. Importantly, the other half are thought to be related to serious arrhythmias. A
major advance has been the finding that nonsurgical placement of automatic implantable
cardioverter/defibrillators (AICD) in individuals with severe congestive heart failure (defined by an ejection
fraction below 30%-35%) can significantly improve survival, and has become the standard of care in most
such individuals.

In some people with severe heart failure and certain ECG abnormalities, the left and right side of the heart
don't beat in rhythm, and inserting a device called a biventricular pacer can significantly reduce
symptoms.

What are the areas of new research in congestive heart failure?

Despite the significant advances in drug therapy for congestive heart failure over the past 20 years, many
exciting developments are under active study. New classes of medications are being tested in clinical
trials, including the calcium sensitizing agents, vasopeptidase inhibitors, and natriuretic peptides. As was
the case with the ACE inhibitors and beta-blockers, the potential use of these drugs is based on
theoretical considerations that have resulted from an increased understanding of the processes both
underlying and resulting from heart failure. Additionally, gene therapy that is targeted toward certain
genes thought to contribute to heart failure is being tested.
These developments have justified an unprecedented optimism in the treatment of congestive heart
failure. The majority of individuals, with appropriate lifestyle measures and medical regimens, can
maintain active, fulfilling lifestyles. The range of treatment options has been significantly strengthened by
drugs such as the ACE inhibitors and beta-blockers. In the future, we will surely see the addition of many
more and equally potent interventions.

Congestive heart failure (CHF) is a condition in which the heart cannot pump enough blood to meet the
needs of the body. The term heart failure should not be confused with heart attack. Heart failure occurs
after the heart muscle has been damaged or weakened by another primary cause, such as high blood
pressure , coronary artery disease , or certain kinds of infections. Depending on the cause, heart failure
can occur gradually, over many years, while the heart tries to compensate for its loss of function, or it may
occur more quickly if a lot of the heart muscle is damaged at once.
Blood Flow Through the Heart

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It is estimated that 5 million Americans are currently living with CHF. As the US population ages, and baby
boomers are getting older, that number is expected to climb.
Types of CHF
CHF occurs when the heart muscle cannot pump adequate amounts of blood to meet the bodys needs.
When the heart fails to keep up with demand, fluid can accumulate behind the failing heart chambers. In
order to understand the types of CHF, you should first understand how the heartthe center of the
circulatory systemsworks.
The heart has two sides (right and left), and each side has two chambers. The four chambers of the heart
have specific functions:
Two upper chambers (atria / atrium)Receive blood from the body and empty the blood to the lower
chambers
Two lower chambers (ventricles)Receive blood from the upper chambers and pump blood back out
to the body

The right atrium receives blood from the body and empties it into the right ventricle. The right ventricle
pumps the blood out to the lungs where carbon dioxide is exchanged for needed oxygen. The left atrium
receives blood rich in oxygen from the lungs and empties that blood into the left ventricle. The left
ventricle is the strongest muscle/chamber in the heart and is responsible for pumping the blood back out
to the body.
Heart failure can occur on either side of the heart and is classified as:

Left-sided failure: There are two main ways that the left ventricle can fail to keep up with the
demands of the body. When the left ventricular muscle is damaged, it fails to contract/pump with sufficient
force. That is called systolic failure. If the muscle is damaged in such a way that it becomes stiff and
cannot accept all the blood it needs from the left atrium, then it is called diastolic failure. The difference
between these two types of failure is important because the treatment approach for each type may be
different. In either type, when the left ventricle fails to circulate the blood, the blood can back up into the
lungs. Accumulation of fluid in the lungs causes one of the main symptoms of CHF, shortness of breath.
Doctors use the term pulmonary edema to describe severe fluid build-up in the lungs.

Right-sided failure: This occurs when the right ventricle fails to pump out enough blood to meet
the bodys demand. In this case, the right ventricle and atrium cannot accept all the blood returning to the
heart, and the blood backs-up into the veins and capillaries. The overflow of this fluid leaks out of the
capillaries to the tissue, causing edema. Edema, or fluid accumulation, usually shows up as swelling,
particularly in the legs. Right-sided failure usually occurs as a secondary result of left-sided failure, but it
may also be caused by primary conditions that increase the pressure in the lungs.
Pulmonary Edema

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Causes of CHF
There are several conditions that can cause CHF. It is important to accurately diagnose the underlying
cause, as it will guide the course of treatment.
The two most common causes of CHF are:

Hypertension (high blood pressure): If your arteries have become narrowed from fatty deposits
or are less flexible due to aging or other causes, then your heart will have to pump much harder to get the
blood through the arteries. This pumping effort is reflected in your blood pressure. If your heart muscle
has to continually pump much harder than normal, then eventually, this may lead to heart muscle
damage, and finally may cause heart failure.

Coronary artery disease (CAD ): Cholesterol and fat can build up in the arteries that supply the
heart with blood. This build-up narrows the blood vessels, causing reduced blood flow (ischemia) to the
heart muscle, and an inability to meet increased blood flow demands (like from exercise). If the blood flow
is completely cut off, a heart attack can occur. Heart attack means that an area of heart muscle has been
deprived of blood and nutrients long enough that the area of heart muscle dies. If enough heart muscle is
damaged in this way and the muscle cannot pump enough blood to meet the bodys needs, then heart
failure occurs.

Other conditions that cause CHF include:

Valvular heart disease: The four valves of the heart keep blood flowing efficiently and in the
correct direction. If these valves become damaged or infected (endocarditis), the heart is forced to work
harder. Over time, this can weaken the heart muscle.

Cardiomyopathy: The heart may become damaged due to infection, chronic alcohol abuse, use
of certain chemotherapy drugs, cocaine, or scarring from diseases. The damage results in inadequate
contraction of the heart muscle, which can lead to CHF.

Congenital heart defects: When there is a malformation of the heart muscle or valves at birth,
the heart is forced to work harder to produce the same output. Over time, this may cause CHF.

Diabetes: People who have diabetes are at increased risk of developing heart disease. They
often have other conditions that increase their risk of heart disease, like high cholesterol and increased
weight.

Abnormal heart rhythms (arrhythmia): If a heart beats too slowly (bradycardia), the heart may
not be able to pump out an adequate supply of blood. If the heart beats too quickly (tachycardia), there
may not be enough time for the heart to fill with blood. Both of these conditions produce strain and may
lead to CHF.

Hyperthyroidism: This condition, caused by an overactive thyroid gland, increases the metabolic
rate in the body. The increased levels of thyroid hormone signal the heart to pump faster and harder to
supply the body with blood, causing strain, which (if uncorrected) may lead to CHF.

Anemia: Red blood cells carry oxygen throughout the body. When the number of red blood cells
is reduced (anemia), the heart must circulate blood more frequently to supply enough oxygen to the
tissues. This is another type of strain that may lead to CHF.
What are the risk factors for congestive heart failure?
What are the symptoms of congestive heart failure?
How is congestive heart failure diagnosed?
What are the treatments for congestive heart failure?
Are there screening tests for congestive heart failure?
How can I reduce my risk of congestive heart failure?

What questions should I ask my doctor?

Where can I get more information about congestive heart failure?

Risk Factors for Congestive Heart Failure (CHF)

A risk factor is something that increases your likelihood of getting a disease or condition.
It is possible to develop congestive heart failure with or without the risk factors listed below. However, the
more risk factors you have, the greater your likelihood of developing congestive heart failure. If you have
a number of risk factors, ask your healthcare provider what you can do to reduce your risk.
Risk factors for congestive heart failure (CHF) include:
Medical Condition
The following medical conditions put you at increased risk for developing CHF:

Hypertension (high blood pressure)

Coronary artery disease

Diabetes

Obesity

Hyperthyroidism

Severe emphysema

Previous history of heart disease

Valvular heart disease

Specific Lifestyle Factor

These lifestyle factors can increase your risk of developing CHF:

Excessive alcohol consumption

Smoking

Long-term use of anabolic steroids

Age
CHF is most common in people who are older; most people who have CHF are age 65 or older. CHF is
the leading cause of hospital admission in patients older than 65.
Gender
Both men and women can develop CHF. However, men are at a slightly higher risk of developing CHF.
Congestive heart failure (CHF) is a condition that is usually the result of other underlying conditions. It is
important to diagnose the underlying cause, so that the proper treatment can be given.
Swollen Feet

2008 Nucleus Medical Art, Inc.

There are not always noticeable symptoms for CHF as it develops. When symptoms do occur, they may
include:

Shortness of breath, especially with activity, or when lying down

Swelling of feet and ankles

Fatigue and weakness

Persistent cough or wheezing cough that may be accompanied by white or blood-tinged phlegm

Rapid weight gain

Irregular or rapid heartbeat

Change in urine production (increase or decrease, need to urinate at night)

Nausea

Loss of appetite

Decreased alertness
Diagnosis of Congestive Heart Failure (CHF)
The first step your doctor will take to assess whether you have CHF is to discuss your medical history and
conduct a complete physical exam. Afterwards, your doctor may recommend some or all of the following
tests to make the diagnosis and assess the degree of damage:
Chest X-rayAn x-ray image will show whether the heart is enlarged, or congestion is present in the
lungs.
Blood TestsTo check for anemia, thyroid disease, elevated cholesterol and blood lipids, and to
evaluate kidney and liver function, electrolytes, and calcium and magnesium levels. In addition, your
doctor will check plasma levels of BNP (brain natriuretic peptide) as those are elevated in patients with
heart failure.
Electrocardiogram (EKG or ECG)Records the electrical activity of your heart through electrodes
attached to the skin. This test will help diagnose heart rhythm problems and damage to the heart from
a heart attack .
EchocardiogramUses sound waves to produce an image of the working heart. This test helps evaluate
the function of the valves and chambers of the heart and determines the amount of blood ejected from the
heart with each heartbeat (ejection fraction). An echocardiogram also can detect structural damage,
tumors, or excess fluid around the heart.
Exercise Stress TestRecords the heart's electrical activity during increased physical activity. It may be
coupled with echocardiogram. Patients who cannot exercise may be given medication intravenously that
simulates the effects of physical exertion.

Coronary CatheterizationContrast dye is injected via a thin, flexible tube (catheter) that is threaded
into the aorta or heart. X-rays are then taken to view blood flow and highlight the arterial blood vessels.
This test helps to detect obstruction in the arteries and assess heart function.
Coronary AngiographyTesting to check for blockage in the coronary arteries is recommended for
some individuals with heart failure, especially younger patients and patients with symptoms of chest pain
andangina .
Nuclear ScanningRadioactive material (such as value) is injected into a vein and observed as it is
absorbed by the heart muscle. Areas with diminished flow (and uptake of the radioactive material) show
up as dark spots on the scan.
Electron-beam CT Scan (CT Angiography)A type of x-ray that uses a computer to make detailed
pictures of the heart, coronary arteries, and surrounding structures. This type of CT scan detects calcium
and cholesterol deposits in the coronary arteries. Based on that and other health information, your doctor
will attempt to determine the risk of heart disease, including heart attacks. The American Heart
Association published guidelines in 2006, indicating that heart scans are not for everyone and those most
likely to benefit from the procedure are patients with intermediate risk of coronary artery disease.
Cardiac Magnetic Resonance ImagingThis test uses high intensity magnetic fields to generate high
resolution images. It can help evaluate large blood vessels, coronary arteries, heart walls, and
pericardium. It is also helpful in measuring ejection fraction and evaluating patients for the presence of
cardiomyopathy.
Diagnostic Indicators
As your doctor examines you, he or she will be looking for some characteristic signs of CHF on the
physical exam, including:

Sound of fluid in the lungs (rales)

Enlargement of the jugular vein in the neck (jugular venous distention)

Enlargement of the liver (hepatomegaly)

High blood pressure (hypertension)

Low blood pressure (hypotension)

Fast heart rate (tachycardia)

Edema (swelling of the ankles, legs, feet)

Fluid in the abdominal cavity ( ascites )

Fluid in the space between the lungs and ribs ( pleural effusion )