Living With Congestive Heart Failure (CHF)

If you have been told by your doctor that you have "heart failure," that doesn't mean that your heart has, well, failed. It does mean, however, that the heart muscle does not pump effectively. It may have stretched out of its normal size and shape. It may have stiffened over time and has to work harder to keep blood flowing through the heart valves and chambers.

In congestive heart failure, the heart’s pumping chambers, called ventricles, are unable to either contract or relax fully. The ventricle can become stretched, and the heart's ability to pump blood to the rest of the body is impaired.

Living with heart failure may be frightening, but having heart failure doesn't mean that your heart has stopped working or is about to break down. With treatment and careful attention, many people living with congestive heart failure can manage their condition and still be active and energetic.

“Certainly, the term ‘heart failure’ itself engenders a lot of concern among people because they think that my heart is failing,” said Vijay U. Rao, MD, PhD, a Franciscan Physician Network cardiologist in Indianapolis whose practice focuses on advanced heart failure. “The outcomes with folks with heart failure are getting better with new treatments and therapies. But it's definitely something that needs to be taken seriously."

What Causes Congestive Heart Failure?

Heart failure, also called congestive heart failure, often develops as the result of coronary artery disease or hypertension, which exact a toll on the heart’s ability to function properly. Other causes of CGF include coronary artery disease, atrial fibrillation or previous heart attack. People who have diabetes are more at risk of heart disease overall, including heart failure. But there are several other health conditions that may cause heart failure, including:

• Thyroid conditions
• Sleep apnea
• Diseased heart valves
• Treatments for cancer, thyroid disorders, alcohol abuse, HIV/AIDs, and using cocaine and other street drugs can also cause problems leading to heart failure.

Another leading diagnosis from discharge from the hospital for heart failure patients is due to stiff heart syndrome.

What Are Heart Failure Symptoms?

Heart failure symptoms include shortness of breath, fatigue, and fluid retention (although you may not have all of these, depending on the cause). Even a short trip up the stairs can leave you gasping. You also may have a cough that gets worse at night. And at bedtime, you may notice that it's hard to breathe when you lie down flat.

Symptoms of heart failure can be similar to some of the symptoms of a heart attack, but without the dramatic chest pain or discomfort. Usually, signs of heart failure are related to a buildup of fluid in the body, such as:

• Rapid weight gain
• Shortness of breath, especially when lying down
• Swelling in the hands, feet, legs or stomach
• Dizziness and confusion
• Fatigue

Can You Have Heart Failure Without Symptoms?

If your heart is only slightly weaker than it should be, you may not notice any heart failure symptoms at all. Some people can live with congestive heart failure for years without even suspecting that they have a problem. But if the heart loses enough strength, heart failure becomes impossible to ignore.

How Is CHF Diagnosed?

To diagnose congestive heart failure, your physician will take a detailed medical history and, with a stethoscope, listen for fluid buildup in the lungs and heart. Blood tests will be conducted to check for kidney function. An X-ray will show whether the heart is enlarged and whether fluid has accumulated around it. An electrocardiogram can identify heart rhythm issues, and an echocardiogram can determine which chamber is causing the problem. Another test, called ejection fraction, measures how much blood is being pumped from the chambers, and helps classify the type of heart failure.

What Are Treatment Options For Heart Failure?

Living with heart failure requires a lifelong management regimen. Several drugs may be prescribed to treat congestive heart failure, depending on the patient’s type of heart failure and severity of the symptoms. They include:

• angiotensin-converting enzyme inhibitors, which boost blood flow by widening blood vessels
• b-blockers, which slow the heart rate and cut hypertension
• digitalis, which helps the heart contract more strongly
• diuretics, which promote urination to prevent fluid retention in the body and especially the lungs.

Bypass surgery can help if blocked arteries are leading to heart failure, and heart valve replacement may also correct another leading cause. In extreme cases, patients will receive a heart transplant.

What Changes Should I Make After A Heart Failure Diagnosis?

If you've been diagnosed with congestive heart failure, you and your doctor will work on a plan of medications and diet that will cut down on the fluid buildup in your body. This will make it easier for your heart to do its job.

Diet changes for heart failure

“Once a patient has developed heart failure, one of the key components of management is dietary modifications,” Dr. Rao explained. “The more sodium we consume, the more likely a heart failure patient is to have fluid retention, and this is what often leads to the heart failure admissions and worse outcomes."

A low-salt diet is key to this goal as well, and a registered dietitian can teach you how to modify your food and meal choices.

“We try to focus on foods that are low in sodium," Dr. Rao said. "I often tell patients to focus not on eating foods such as TV dinners, canned soups and try not to use the salt shaker, which is very difficult to do, but ultimately will make a big difference for the patient in the long run.”

Exercise with heart failure

Most CHF patients can even continue to exercise or begin a new exercise routine. For people living with heart failure, the American Heart Association suggests gradually working up to 30 minutes of exercise a day, or whatever your doctor recommends. At the same time, you'll have to be careful not to overdo it. Your doctor can help you find an exercise routine that's right for you.

“We have a lot of evidence to support the fact that if people lose weight, if people maintain a regular exercise program, that they can actually improve their outcomes as well as stay out of the hospital,” Dr. Rao said. “So, we highly recommend that folks continue to exercise often in a monitored setting.”

Watching for fluid retention

Finally, you'll have to pay close attention to your body. Weigh yourself every morning before breakfast, but after a trip to the bathroom. Call your doctor if you gain more than three pounds in a day or five pounds in a week (without overeating). You should also call your doctor if you have any sudden swelling or breathlessness.

With medications and an improved diet, patients with heart failure can continue to lead long, full lives. For more information about living with heart failure, visit the American College of Cardiology's website.

Like all forms of heart disease, prevention is the best medicine. If any members of your family have had heart failure, a heart attack, stroke or other heart condition, make sure your doctor knows. He or she can help reduce your own risk of heart problems later in life.