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Congestive Heart Failure

Congestive heart failure occurs when a weakened or stiff heart cannot pump enough blood, causing shortness of breath, fatigue, and fluid buildup in the legs and lungs.

Cardiovascular
Congestive heart failure is a chronic condition in which the heart cannot pump enough blood to meet the body's needs. It does not mean the heart has stopped working; rather, the heart muscle has become too weak or too stiff to keep up, so blood and fluid back up into the lungs, legs, and abdomen. Millions of American adults live with heart failure, and it is one of the most common reasons older adults are admitted to the hospital. Causes: Heart failure is usually the end result of other conditions that damage or overwork the heart muscle:
  • Coronary artery disease: Narrowed heart arteries and prior heart attacks are the leading cause; see coronary artery disease.
  • Long-standing high blood pressure: Years of pumping against elevated pressure thicken and stiffen the heart muscle.
  • Valve problems: Leaky or narrowed heart valves force the heart to work harder; see valvular heart disease.
  • Diseases of the heart muscle: Conditions described under cardiomyopathy, including damage from viral infections or excess alcohol.
  • Rhythm problems: A persistently rapid rhythm such as atrial fibrillation can weaken the heart over time.
  • Other contributors: Diabetes, obesity, sleep apnea, and certain chemotherapy medications also raise the risk. Finding and treating these contributors is part of a complete heart-failure plan.
Symptoms: Symptoms often develop gradually and are easy to blame on age or being out of shape:
  • Shortness of breath: With activity, when lying flat, or waking you from sleep at night.
  • Swelling (edema): In the feet, ankles, legs, or abdomen as fluid accumulates.
  • Rapid weight gain: Several pounds over a few days usually reflects retained fluid, not fat.
  • Fatigue and weakness: Everyday tasks feel harder because muscles receive less oxygen-rich blood.
  • Persistent cough or wheezing: Sometimes with white or pink-tinged mucus from fluid in the lungs.
Diagnosis: Your physician will listen to your heart and lungs, check for swelling, and order tests: a blood test called BNP that rises when the heart is under strain, an electrocardiogram, a chest X-ray, and an echocardiogram. The echocardiogram measures the ejection fraction — the percentage of blood pumped out with each beat — which distinguishes heart failure with reduced ejection fraction (a weak pump) from heart failure with preserved ejection fraction (a stiff pump). Identifying which type is present matters, because it guides which medications will help most. Treatment: Modern therapy can relieve symptoms, keep people out of the hospital, and help many live longer:
  • Diuretics: Water pills such as furosemide relieve congestion by helping the kidneys remove excess fluid.
  • ACE inhibitors: Medications such as lisinopril relax blood vessels and reduce the heart's workload.
  • Beta-blockers: Medications such as carvedilol and metoprolol slow the heart and help the muscle recover strength.
  • SGLT2 inhibitors: Medications such as dapagliflozin and empagliflozin improve outcomes in both major forms of heart failure.
  • Aldosterone antagonists: Medications such as spironolactone provide additional protection in selected patients.
  • Daily habits: Limiting sodium, weighing yourself every morning, staying active, and avoiding excess alcohol are essential parts of treatment, and many patients benefit from a written action plan describing what to do when weight or symptoms change.
When to Seek Immediate Care: Call 911 for severe shortness of breath at rest, chest pain, or fainting. Contact your physician promptly for weight gain of more than two to three pounds overnight or five pounds in a week, or worsening swelling. Heart failure requires careful, ongoing medication adjustment and monitoring. The internal-medicine team at Zimmer Medical Group manages heart failure in partnership with cardiology, keeping treatment on track between specialist visits. More patient resources are available from MedlinePlus.

Related Medications

Commonly prescribed medications for this condition

FurosemideSpironolactoneDapagliflozinEmpagliflozinCarvedilolMetoprololLisinoprilEnalaprilRamiprilValsartan

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