congestive heart failure

Definition

By Mayo Clinic staff Heart failure, also known as congestive heart failure (CHF), means your heart can't pum

Symptoms

By Mayo Clinic staff Heart failure can be chronic — meaning your condition is ongoing — or acute, meaning your condition has started suddenly.
Chronic heart failure symptoms

• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Fatigue and weakness
• Swelling (edema) in your legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Swelling of your abdomen (ascites)
• Sudden weight gain from fluid retention
• Lack of appetite and nausea
• Difficulty concentrating or decreased alertness

Acute heart failure symptoms

• Symptoms similar to those of chronic heart failure, but more severe and start or worsen suddenly
• Sudden fluid buildup
• Rapid or irregular heartbeat (palpitations)
• Sudden, severe shortness of breath and coughing up pink, foamy mucus
• Chest pain, if your heart failure is caused by a heart attack

When to see a doctor
See your doctor if you experience any of the signs or symptoms associated with heart failure. These include:

• Chest pain
• Fatigue and weakness
• Rapid or irregular heartbeat
• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Swelling in your abdomen, legs, ankles and feet
• Difficulty concentrating or decreased alertness

You may first find out you have heart failure from an emergency room visit after worsening symptoms. Other heart and lung problems can cause symptoms that are similar to heart failure.
If you have a diagnosis of heart failure, and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. Contact your doctor promptly.

Causes Definition

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• Heart failure treatment at Mayo Clinic

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Refp enough blood to meet your body's needs. Over time, conditions such as narrowed arteries in your heart (coronary artery disease) or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.
You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure. Lifestyle changes, such as exercising, reducing the salt in your diet, managing stress, treating depression, and especially losing excess weight, can improve your quality of life.
The best way to prevent heart failure is to control risk factors and conditions that cause heart failure, such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.

Causes

By Mayo Clinic staff

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	Chambers and valves of the heart
	Enlarged heart, in heart failure

Heart failure often develops after other conditions have damaged or weakened your heart. Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body. The main pumping chambers of your heart (the ventricles) may become stiff and not fill properly between beats. Also, your heart muscle may weaken, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body. The term "congestive heart failure" comes from blood backing up into — or congesting — the liver, abdomen, lower extremities and lungs.
Heart failure can involve the left side, right side or both sides of your heart. Typically, heart failure begins with the left side — specifically the left ventricle, your heart's main pumping chamber.

Type of heart failure	Description
Left-sided heart failure	Most common form of heart failure. Fluid may back up in your lungs, causing shortness of breath.
Right-sided heart failure	Often occurs with left-sided heart failure. Fluid may back up into your abdomen, legs and feet, causing swelling.
Systolic heart failure	The left ventricle can't contract vigorously, indicating a pumping problem.
Diastolic heart failure (also called heart failure with normal ejection fraction)	The left ventricle can't relax or fill fully, indicating a filling problem.

Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:

• Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle weak and chronically deprived of oxygen-rich blood. In some cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaques formed by the fatty deposits in your arteries rupture. This causes a blood clot to block blood flow to an area of the heart muscle, weakening the heart's pumping ability.
• High blood pressure (hypertension). Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
• Faulty heart valves. The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve, due to a heart defect, coronary artery disease or heart infection, forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed if found in time.
• Damage to the heart muscle (cardiomyopathy). Some of the many causes of heart muscle damage, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems can damage heart muscle.
• Myocarditis. Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
• Heart defects you're born with (congenital heart defects). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to pump blood through your heart, which in turn may lead to heart failure.
• Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken, leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
• Other diseases. Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and buildup of proteins in your muscles (amyloidosis) also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.
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Risk factors

By Mayo Clinic staff A single risk factor may be enough to cause heart failure, but a combination of factors increases your risk.
Risk factors include:

• High blood pressure. Your heart works harder than it has to if your blood pressure is high.
• Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.
• Heart attack. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
• Irregular heartbeats. These abnormal rhythms can create extra work for your heart, weakening the heart muscle.
• Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.
• Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure. Don't stop taking these medications on your own, though. If you're taking them, discuss with your doctor whether you need to make any changes.
• Sleep apnea. The inability to breathe properly at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.
• Congenital heart defects. Some people who develop heart failure were born with structural heart defects.
• Viruses. A viral infection may have damaged your heart muscle.
• Alcohol use. Drinking too much alcohol can weaken heart muscle and lead to heart failure.
• Kidney conditions. These can contribute to heart failure because many can lead to high blood pressure and fluid retention.
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  Complications

  By Mayo Clinic staff If you have heart failure, your outlook depends on the cause and the severity, your overall health, and other factors such as your age. Complications can include:
  
• Kidney damage or failure. Heart failure can reduce the blood flow to your kidneys, which can eventually cause kidney failure if left untreated. Kidney damage from heart failure can require dialysis for treatment.
• Heart valve problems. The valves of your heart, which keep blood flowing in the proper direction through your heart, can become damaged from the blood and fluid buildup from heart failure.
• Liver damage. Heart failure can lead to a buildup of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for your liver to function properly.
• Heart attack and stroke. Because blood flow through the heart is slower in heart failure than in a normal heart, it's more likely you'll develop blood clots, which can increase your risk of having a heart attack or stroke.

Some people's symptoms and heart function will improve with proper treatment. However, heart failure can be life-threatening. It can lead to sudden death. People with heart failure may have severe symptoms, and some may require heart transplantation or support with an artificial heart device.