Congestive Heart Failure

The National Heart, Lung, and Blood Institute (NHLBI) says an estimated 5 million Americans have congestive heart failure (CHF). And the numbers are on the rise. CHF is a progressive cardiac illness in which the heart cannot pump enough oxygenated blood to meet the body's needs. (Read about "The Heart & Cardiovascular System") You also might hear it referred to as chronic heart failure or simply heart failure.

The American Heart Association (AHA) says CHF is often the result of cardiovascular disease (Read about "Coronary Heart Disease") that has weakened the heart over a period of time. AHA estimates there are over half a million new cases each year. The annual number of deaths directly from CHF is increasing too, and it's the most common diagnosis in hospital patients age 65 years and older. There is no cure for CHF but people do live with the condition. According to AHA, managing CHF involves medications and changes in diet and lifestyle (Read about "Exercise & Your Heart") along with treatment for the underlying conditions that caused the CHF.

A growing problem

Health experts at the National Institutes of Health expect the numbers to grow even more for two main reasons:

• cardiac patients are now able to survive and live longer with their disease, thus increasing their chances of developing CHF
• the elderly population continues to grow as a percentage of the overall population, making it likely that the number of people with this condition will increase as well

Although the statistics are frightening, there are things people can do to decrease their chances of having CHF in their later years. According to NHLBI, the early detection and aggressive treatment of high blood pressure and heart attack - the two leading causes of CHF - are essential. (Read about "Heart Risks")

Controlling blood pressure

AHA says you have high blood pressure if your top (systolic) number is 130 or higher or your bottom (diastolic) number is 80 or higher. (Read about "Hypertension: High Blood Pressure") Your blood pressure is considered elevated if it is greater than or equal to 120 mm/Hg systolic pressure and the diastolic number is less than 80. Although high blood pressure may not produce any symptoms you can feel, it still causes damage, which is why it's often called the "silent killer."

For example, AHA says high blood pressure can damage your blood vessels, as well as internal organs such as your heart or kidneys. (Read about "Blood Pressure & Kidney Disease") It also puts you at a higher risk of developing heart disease or having a stroke. (Read about "Stroke")

High blood pressure in the arteries of the lungs - pulmonary hypertension - results in an increased resistance to blood flowing through the vessels. (Read about "Pulmonary Hypertension") This increased resistance, in turn, places a strain on the right ventricle, which now has to work harder than usual against the resistance to move adequate amounts of blood through the lungs. As a result of the increased workload, the right side of the heart can become enlarged. The condition is known as cor pulmonale. Eventually, heart failure can develop.

How can you tell if you have high blood pressure if there are not symptoms? The only way to find out if you have high blood pressure is to have it measured by a healthcare professional. That's why it's important to see your doctor regularly, especially if you have a family history that warrants increased scrutiny. (Read about "Family Health History")

Controlling heart attack risk

As for the second leading cause of CHF - heart attack - it's essential to recognize the warning signs early and get help immediately. (Read about "Heart Attack") While the signs can vary, the American Medical Association says some of the most common ones include:

• Uncomfortable chest pain, pressure or a squeezing sensation in the chest that lasts for more than a few minutes
• Pain that radiates to the shoulders, neck, jaw or arms
• Chest pain accompanied by dizziness, sweating, nausea or shortness of breath (Read about "Sweating")

Not all of these symptoms will be present in all cases. AHA says the symptoms may also subside and then come back. But if you suspect a heart attack, it's essential to get immediate medical help. Clot-dissolving drugs and surgery are most effective when used in the early stages of a heart attack. But studies show that many heart attack victims wait several hours - even up to ten hours or more - before seeking help.

Although the early detection (Read about "Cardiovascular Tests") and aggressive treatment of heart attack and high blood pressure cannot guarantee against CHF, it's important for people to do all they can to prevent this highly lethal condition.

Treatment options

If CHF is present, treatment options include lifestyle changes and drugs, such as angiotensin-converting enzyme (ACE) inhibitors. NHLBI says ACE inhibitors, originally developed as a treatment for hypertension, can help heart failure patients by, among other things, decreasing the pressure inside blood vessels. As a result, the heart does not have to work as hard to pump blood through the vessels. Other drugs that relax tension in blood vessels to improve blood flow may also be used. AHA says beta blockers can be used to help the left ventricle work better. If CHF stems from defective valves (Read about "The Heart & Its Valves") or blockages, AHA says surgery may be needed to correct these conditions as well.

A newer type of treatment involves the combined use of an implantable defibrillator with cardiac resynchronization therapy. The implantable defibrillator is designed to correct potentially life-threatening rapid heart rhythms, preventing sudden cardiac death (Read about "Cardiac Arrest"), while cardiac resynchronization therapy helps the chambers of the heart beat in a coordinated manner.

In advanced cases, a heart transplant may be needed. (Read about "Transplants") The waiting period to find a suitable donor, however, can be a long one. NHLBI says that mechanical pumps, which are attached to the heart, are another option. Called left ventricular assist devices (LVADs), the machines take over part or virtually all of the heart's blood-pumping activity. NHLBI says studies are examining long-term benefits of LVADs. (Read about "Clinical Studies") A permanent artificial heart is also available for heart patients who have exhausted other options.

According to the National Institutes of Health, other studies are looking at ways to stop the loss of cell function that happens in CHF. Still other studies are developing drugs with multiple actions to treat CHF. Investigations also are being done to improve heart transplantation for CHF patients.

Related Information:

    Cardiac Rehabilitation

    Enlarged Heart

    Cardiomyopathy

    Homocysteine

    Glossary of Heart Terms