Published on Heart Care Centre (http://www.heartcarecentre.co.nz/core)

Heart Failure

Alternative names   

CHF; Congestive heart failure


Heart failure, also called congestive heart failure, is a life-threatening condition in which the heart can no longer pump enough blood to the rest of the body.

Causes, incidence, and risk factors   

Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly. This condition may affect the right side, the left side, or both sides of the heart.

As the heart's pumping action is lost, blood may back up into other areas of the body, including:

With heart failure, many organs don't receive enough oxygen and nutrients, which damages them and reduces their ability to function properly. Most areas of the body can be affected when both sides of the heart fail.

The most common causes of heart failure are hypertension (high blood pressure) and coronary artery disease (for example, you have had a heart attack). Other structural or functional causes of heart failure include the following:

Heart failure becomes more common with advancing age. You are also at increased risk for developing heart failure if you are overweight, have diabetes, smoke cigarettes or abuse of alcohol.


Some patients with heart failure have no symptoms. In these people, the symptoms may develop only with these conditions:

Signs and tests   

A physical examination may reveal either an irregular or a rapid heartbeat. There may be distended neck veins, enlarged liver, swelling of the limbs (peripheral oedema), and signs of fluid around the lungs (pleural effusion).

Listening to the chest with a stethoscope may reveal lung crackles or abnormal heart sounds. Blood pressure may be normal, high, or low.

An enlargement of the heart or decreased heart functioning may be seen on several tests, including the following:

This disease may also alter the following test results:

If excessive fluid has accumulated around the sac surrounding the heart (pericardium), you may need to have the fluid removed through a pericardiocentesis.


If you have heart failure, your doctor will monitor you closely. This means having follow up appointments at least every 3 to 6 months, figuring out any underlying cause and treating it, and periodic testing of your heart function. For example, an ultrasound of your heart, called an echocardiogram, will be done once in awhile to give an estimate of how well your heart is pumping blood with each stroke or beat.

It is also your responsibility to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis and limit the amount the fluid that you drink. Weight gain can be a sign that you are retaining fluid and that the pump function of your heart is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.

Other important measures include:

Here are some tips to lower your salt and sodium intake:

Your doctor may consider prescribing the following medications:

Sometimes, hospitalisation is required for acute CHF. Hospitalized patients may receive oxygen and intravenous medications such as vasodilators and diuretics.
Medicines called inotropic agents help improve the heart's ability to pump blood. They are given by IV.

Unstable patients receiving several medications usually need also hemodynamic monitoring with Swan-Ganz catheterization.

Severe cases of CHF require more drastic measures. For example, excess fluid can be removed through dialysis, and circulatory assistance can be provided by implanted devices such as the intra-aortic balloon pump (IABP) and the left ventricular assist device (LVAD). These devices can be life-saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.

A number of studies have shown that heart failure symptoms can be improved with a special type of pacemaker. It paces both the right and left sides of heart. This is referred to as biventricular pacing or cardiac resynchronization therapy. Ask if you think that you are a candidate for this.

Expectations (prognosis)   

Heart failure is a serious disorder that carries a reduced life expectancy. Many forms of heart failure can be controlled with medication, lifestyle change, and correction of any underlying disorder. Heart failure is usually a chronic illness, and it may worsen with infection or other physical stressors.


Possible side effects of medications include:

Calling your doctor   

Call your doctor if weakness, increased cough or sputum production, sudden weight gain or swelling, or other new or unexplained symptoms develop.

Go to the emergency room or call the local emergency number (such as 111) if you experience severe crushing chest pain, fainting, or rapid and irregular heartbeat (particularly if other symptoms accompany a rapid and irregular heartbeat).


Follow your doctor’s recommendations for treatment of conditions that may cause congestive heart failure. These recommendations may include:

Also, consider the following lifestyle habits, especially if you have a strong family history of CHF:

Update Date: 7/17/2006

Updated by: Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network.

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