Congestive Heart Failure

The term “heart failure” makes it sound like the heart is no longer working at all and there’s nothing that can be done, but what heart failure actually means is that the heart isn’t pumping as well as it should be. With heart failure, the weakened heart can’t supply the cells in your body with enough oxygen rich blood so that even everyday activities such as walking, climbing stairs or carrying groceries becomes very difficult.

Approximately 5.8 million Americans have heart failure and 680,000 new cases are diagnosed every year. Heart failure is the number one reason for hospitalizations in individuals 65 years and older and is the only cardiovascular disease on the rise.

Heart failure can develop suddenly (the acute kind) or over time as your heart gets weaker (the chronic kind). Most often, heart failure is caused by another medical condition that damages your heart. Currently, heart failure is a serious condition that has no cure. However, treatment such as healthy lifestyle changes, medicines and cardiac procedures can help many people have a higher quality of life.

How does the heart work?

The normal healthy heart is a strong, muscular pump a little larger than a fist. It pumps blood continuously through the circulatory system:

  • The heart has four chambers – two on the right and two on the left
  • The 2 upper chambers are called the atria (one is called an atrium)
  • The 2 lower chambers are called the ventricles
  1. Oxygen-rich blood travels from the lungs to the left atrium (top of heart), then on to the left ventricle (bottom of heart) which pumps it to the rest of the body.
  2. The right atrium takes in blood from the rest of the body after the oxygen has been used and sends it through the right ventricle where it’s pumped through the lungs and picks up more oxygen.

The heart pumps blood to the lungs and to all the body’s tissues through a sequence of highly organized contractions of the four chambers. For the heart to function properly, the four chambers must beat in an organized way.

What happens when the heart can’t keep up with its workload?
  1. It enlarges – the heart stretches to contract more strongly and keep up with the demand to pump more blood.
  2. It thickens – the increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly, at least initially.
  3. It pumps faster – this helps increase the heart’s output.
  4. Blood vessels narrow –  to keep blood pressure up, trying to make up for the heart’s loss of power.
  5. Blood is diverted – the body diverts blood away from less important tissues and organs (like the kidneys)
The body’s compensation mechanisms help explain why some people may not become aware of their condition until years after their heart begins its decline.
Left-sided heart failure:
Your ejection fraction is the percent of the blood in your left ventricle that is pumped out of your heart with each heartbeat. Ejection fraction measures how well your heart pumps.

1.  Heart failure with a reduced ejection fraction – the left side of your heart is weak and can’t pump enough blood to the rest of your body.
2.  Heart failure with a preserved ejection fraction – the left side of your heart is too stiff to fully relax between heartbeats. That means it can’t fill up with enough blood to pump out to your body.

Right-sided heart failure:
  • In right-sided heart failure, your heart can’t pump enough blood to your lungs to pick up oxygen.
  • Left-sided heart failure is the main cause of right-sided heart failure.
Causes of heart failure:

  • Heart Attack –  damage to your heart muscle from a heart attack may mean that your heart can no longer pump as well as it should.
  • High blood pressure – If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, this extra exertion can make your heart muscle too stiff or too weak to properly pump blood.
  • Heart valve dysfunction –  a damaged valve forces the heart to work harder, which can weaken it over time.
  • Damage to the heart muscle – from certain diseases, infection, heavy alcohol use, cocaine and some chemotherapy treatments
  • Inflammation of the heart muscle (myocarditis) –  myocarditis is most commonly caused by a virus and can lead to left-sided heart failure.
  • Abnormal heart rhythms (arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast, creating extra work for your heart.
  • Sleep apnea – the inability to breathe properly while you sleep results in low blood-oxygen levels and an increased risk of irregular heartbeats. Both of these problems can weaken the heart.
  • Diabetes – increases your risk of high blood pressure and coronary artery disease.
  • Certain medications

Causes of sudden (acute) heart failure can include:

  • Allergic reactions
  • Any illness that affects the whole body
  • Blood clots in the lungs
  • Severe infections
  • Use of certain medications
  • Viruses that attack the heart muscle

The key to preventing heart failure is to reduce your risk factors. You can control or eliminate many of the risk factors for heart disease by making healthy lifestyle changes and by taking the medications prescribed by your doctor. Lifestyle changes you can make to help prevent heart failure include:

  • Not smoking
  • Controlling certain conditions, such as high blood pressure and diabetes
  • Staying physically active
  • Eating healthy foods
  • Maintaining a healthy weight
  • Reducing and managing stress

What are the symptoms of heart failure?

  • Shortness of breath.
  • Feeling tired (fatigue) and having leg weakness when you’re active.
  • Swelling in your ankles, legs and abdomen.
  • Weight gain.
  • Need to urinate while resting at night.
  • Rapid or irregular heartbeats (palpitations).
  • A dry, hacking cough.
  • A full (bloated) or hard stomach, loss of appetite or upset stomach (nausea).

Doctors can correct heart failure by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, treatment of heart failure involves a balance of the right medications and, sometimes, use of devices that help the heart beat and contract properly. You may be admitted to the hospital if you have a flare-up of heart failure symptoms. While in the hospital, you may receive additional medications to help your heart pump better and relieve your symptoms along with supplemental oxygen. Heart failure is a chronic disease needing lifelong management. However, with treatment, symptoms can lessen which will improve the quality of life.


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  2. Bathrooms are getting bigger, in part because we use them more often when we’re home all day. And every room of the house is more wired — builders are adding power outlets and USB ports to accommodate the devices essential to working or attending school from home.
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