Congestive heart failure (CHF) is a “syndrome”, which means that it is condition or combination of conditions that can be caused by a variety of diseases and processes. The heart is a pump. It is responsible for pumping forward the blood that comes to it from the lungs in a way that supplies the organs of the body adequately. It is also responsible for pumping to the lungs blood that returns to the heart from the body. When the heart is failing to do its job, the consequences are same as when any pump fails. The fluid to be pumped backs up and does not get delivered efficiently to where it is supposed to go. This causes congestion with fluid build up in the lungs or in the feet and legs of the body, or both. Fatigue and shortness of breath are the most common symptoms and in CHF the heart us usually enlarged on the chest x-ray. This is the picture of CHF, but the causes are of many different types and the basic reason(s) underlying CHF may require different treatments and can be expected to have different outcomes. Therefore, careful and thorough evaluation are needed when CHF is suspected, and because CHF can be a very serious condition, depending on its cause, one going treatment and periodic reevaluation by a cardiologist are important. The patient and the patient’s family also play a major role in the management of CHF because treatment plans are sometimes relatively complex and compliance is essential if repeated hospitalizations and progressive worsening of this condition are to be avoided.

There are many types of heart problems that can lead to the syndrome of congestive failure, and the degree of seriousness, the management, and the underlying disease(s) are different in each type. The most common basic mechanical cause of CHF is weakness of the heart muscle, but stiffness of the heart muscle, leakage or blockage in one or more heart valves, poor blood supply to the heart, sustained abnormality of the heart rhythm, and sometimes constriction of the heart by the membranes or fluid around the heart can produce the same clinical picture. A large variety of different kinds of heart disease may cause these mechanical disturbances to develop to the point that CHF appears. Many associated conditions of the other organs of the body may contribute to CHF, provoke it, or even result in a condition that mimics CHF without much being wrong with the heart itself. Kidney disease, liver disease, profound anemia, markedly abnormal thyroid function, lung disease, abnormal retention of salt and water, effects of various medications, and a variety of other conditions fall into this group. If you are diagnosed as having CHF, talk with your cardiologist to find out the mechanical reasons that CHF has developed and the underlying cause(s) if known.

The possible treatments for CHF are as varied as the number of possible conditions that cause or precipitate CHF, but in general the treatment of CHF is directed at the underlying cause if possible. In addition, there are a variety of measures that are very helpful in controlling congestion (fluid retention) regardless of the cause. This usually includes restriction of salt in the diet and most often medication to assist with the elimination of extra fluid from the body if present (diuretics). If the blood pressure is elevated, treatment becomes extremely important in CHF. A variety of other medications are useful in many cases, but the treatment must be individualized for each patient. The prognosis and long term treatment plans are difficult to determine without knowing the answers to these questions, and even with these answers the outcome is sometimes hard to predict. Medical science is constantly developing new medications and treatments for CHF. Because of our growing understanding about CHF and our ability to identify and treat the causes of this problem, patients with CHF today are doing much better than ever before. Many patients improve progressively with modern treatments. This would have been very rare two decades ago. Patients at risk for the development of CHF are now receiving evaluation and aggressive treatment directed at prevention of the actual syndrome of CHF.

Once a treatment plan has been determined, periodic re-evaluation is very important, including studies to determine whether the underlying causes of CHF have been controlled and re-evaluation of the condition itself by examination and testing in our offices. It is important that patients with CHF are followed by a heart specialist on a long term basis to insure that the treatment is optimal, effective, and up to date. Management is often complex and requires very careful surveillance and successful communication between patients and their families and their doctors and nurses. CHF is the most common cause for admission to the hospital for adults in the U.S. A large number of these admissions could be potentially prevented if patients had a better understanding of this condition and the great importance of careful management and strict compliance with medical therapy and dietary restrictions. Here are some basic recommendations that apply to CHF patients in general, but especially to those that have required hospitalization for this condition.

1. Bring your medications with you at each visit to the doctor’s office so your physician can make certain that he or she knows just what you are taking and that your medical records are correct in this regard. We can sometimes make serious mistakes if we do not have correct information on which to base our decisions. At each office visit tell the nurse when your medications are reviewed exactly how you are actually taking the medication in each bottle. Although bringing your medications each time may be inconvenient, it is the only way we have found to be sure we have correct information.
2. Make absolutely certain that you and your family know what medications you are supposed to be taking, in what dose, and how often. Absolutely positively do not allow yourself to run out of medication or fail to take your medication properly for even one day.
3. Weigh yourself daily and report any progressive weight gain or weight loss of more than 5-10 lbs. to your doctor.
4. Report any new or progressively increasing swelling in the feet or lower legs to your doctor.
5. Report any new or progressively increasing difficulty with breathing to your doctor. If you are awakening at night with either shortness of breath or sudden obstruction to your airway, report this to your doctor.
6. Do not add salt to your food.
7. Try to stay physically active with regular exercise (even if only a little) on a daily basis. Physical conditioning lessens the work load on the heart and increases functional capacity, even with no change in the heart per se.
8. If you have high blood pressure, take your blood pressure frequently at home or have it taken at a local pharmacy or food store. If your blood pressure is running frequently over 140/90 for either the upper or the lower number, report this information to your doctor. Diabetic patients should have even lower blood pressure readings in order to avoid damage to their vital organs over time.
9. Keep your appointments in your doctor’s office. Do not allow yourself to be late for scheduled tests or periodic reevaluations recommended by your physician.