Congestive Heart Failure 

1. Your body holds on to salt and water. This increases the amount of blood in your bloodstream.
2. Your heart beats faster.
3. Your heart gets larger.

Congestive Heart Failure is classified as:

1. Systolic Congestive Heart Failure, which means your heart does not pump well enough.
2. Diastolic Congestive Heart Failure, which means your heart does not relax properly to fill up with blood.

Your body has an amazing ability to make up for Congestive Heart Failure. It may do such a good job that you don't know you have a disease. But at some point, your body will no longer be able to keep up. Your heart gets worn out. Then fluid starts to build up in your body, and you have symptoms like feeling weak and out of breath. This fluid buildup is called congestion. That is why Heart Failure is commonly referred to as Congestive Heart Failure. 

Risk Factors for Congestive Heart Failure

Congestive Heart Failure is generally the result of another disease, often coronary artery disease. Anything that increases your risk for developing that underlying disease is a risk factor for Congestive Heart Failure. This includes:

• Risk factors for coronary artery disease and heart attack for example smoking.
• Risk factors for high blood pressure for example sedentary life
• Risk factors for heart valve disease for example rheumatic fever.

Causes of Congestive Heart Failure

1. Coronary artery disease (CAD) and heart attack (most common causes).
2. Poorly controlled high blood pressure or diabetes.
3. Cardiomyopathy:  alcoholic cardiomyopathy, or infection or inflammation of the heart muscle (such as myocarditis).
4. Use of cocaine or other illegal drugs.
5. Disease of the sac surrounding the heart (pericardial disease).
6. Heart disease that is present from birth (congenital heart disease).
7. Heart valve disease.
8. Fast, slow, or irregular heart rhythms (arrhythmias).

Symptoms of Congestive Heart Failure:

In the earliest stages of Congestive Heart Failure, you may not have any symptoms. Shortness of breath with exertion and fatigue often develop when the weakened heart is not pumping enough blood to meet your body's needs for oxygen and nutrients. The body's efforts to make up for Congestive Heart Failure eventually cause symptoms to get worse. Symptoms of Congestive Heart Failure start to happen when your heart cannot pump enough blood to the rest of your body. In the early stages, you may:

1. Be short of breath when you are active.
2. Feel like your heart is pounding or racing (palpitations).
3. Feel weak, very tired, or dizzy.

As Congestive Heart Failure gets worse, fluid starts to collect in your lungs and other parts of your body. This may cause you to:

1. Feel short of breath even at rest.
2. Have swelling (edema), especially in your legs, ankles, and feet.
3. Gain weight. This may happen over just a day or two, or more slowly.
4. Cough or wheeze, especially when you lie down.
5. Need to urinate more at night.
6. Feel bloated or sick to your stomach.

Diagnosis of Congestive Heart Failure:

You will likely have several different tests over a period of time to help diagnose the cause of the disease and find out how severe it is:

1. A review of your medical history and a physical exam.
2. Lab tests: The brain natriuretic peptide (BNP) test is a newer test that can be used to diagnose Congestive Heart Failure. This blood test measures levels of BNP, which typically rise when Congestive Heart Failure develops or gets worse.
3. Electrocardiogram (EKG, ECG).
4. Chest Xray.
5. Echocardiogram (echo) : An echocardiogram is the best and simplest way to find out whether you have Congestive Heart Failure and whether it is systolic or diastolic Congestive Heart Failure.
6. Other tests :
1. Cardiac perfusion scan: This test can detect poor blood flow to the heart.
2. Cardiac catheterization. This test can be used to check for blocked or narrowed heart arteries and to measure pressures inside the heart. Test results can help diagnose  onditions that might cause Congestive Heart Failure symptoms or make them worse.

Treatment of heart failure:

The goal of treatment for early stage Congestive Heart Failure is to relieve symptoms and prevent additional heart damage.

1. Lifestyle Modification:

• Eat less salt (sodium): Sodium causes your body to retain water and makes it harder for your heart to pump.
• Get regular exercise
• Take rest breaks during the day.
• Lose weight if you are overweight. Even a few pounds can make a difference.
• Stop smoking. Smoking damages your heart and makes it hard to exercise.
• Limit alcohol

2. Medicines:

Most people with Congestive Heart Failure need to take several medicines which help to keep Congestive Heart Failure from getting worse and reduce symptoms so you feel better. ACE inhibitor medicines are the cornerstone of treatment for most people with Congestive Heart Failure. These drugs prolong life and reduce symptoms. If you have continued swelling, you may need to take a diuretic medicine, such as furosemide (Lasix) or bumetanide (Bumex). If you have moderate to severe Congestive Heart Failure, you may need to take the diuretic spironolactone (Aldactone), which has properties that can prevent Congestive Heart Failure from getting worse in addition to improving your symptoms. Betablocker medicines are often prescribed because they can keep Congestive Heart Failure from getting worse and, in some cases, will improve your heart function and prolong life. However, some people are not able to take them because of their side effects.

Medication Choices

A combination of medicines is often needed to control symptoms and slow the progression of Congestive Heart Failure. Some medicines are used to treat pumping problems (systolic Congestive Heart Failure), and others are used to treat problems with filling (diastolic Congestive Heart Failure). The most commonly used and effective classes of medicines are as follows:

Medicines for pumping problems (systolic Congestive Heart Failure)

1. ACE inhibitors (angiotensinconverting enzyme inhibitors).
2. ARBs (angiotensin II receptor blockers). These block the action of certain chemicals in the body that narrow (constrict) the blood vessels. This improves blood flow and lowers blood pressure. These medicines can be used in place of an ACE inhibitor when you are not able to tolerate that medicine's side effects, although ACE inhibitors are preferred.
3. Diuretics: Aldosterone receptor antagonists (spironolactone and eplerenone, which are diuretics with additional properties that can prevent Congestive Heart Failure from getting worse and improve symptoms).
4. Digoxin.
5. Betablockers.
6. Vasodilators. These lower blood pressure and reduce the workload on the heart.

Medicines for filling problems (diastolic Congestive Heart Failure)

1. Betablockers
2. Diuretics
3. ACE inhibitors
4. Calcium channel blockers

Medicines for the problem that caused your heart failure: If your Congestive Heart Failure is related to a specific underlying cause or condition, such as irregular rapid heartbeats (arrhythmias), impaired blood flow to the heart muscle  ischemia), or high blood pressure, you make take specific drugs for these conditions.

• Anticoagulants thin the blood and make it less likely to clot. These drugs may help prevent strokes.
• Antiarrhythmics prevent rapid and sometimes irregular heart rhythms.
• Antianginals (nitrates) control chest pain (angina) caused by impaired blood flow to the heart muscle.
• Antihypertensives lower blood pressure.

3. Treatment of the problem that caused your Congestive Heart Failure:

Depending on the cause of your Congestive Heart Failure, you might need surgery to help your heart work better. For example, you might have bypass surgery or angioplasty to open clogged arteries or surgery to repair or replace a heart valve. If you have a problem with your heart rhythm, you might need to have a pacemaker or defibrillator placed in your chest. These help your heart keep a steady rhythm. Biventricular pacemakers, which pace the heart’s upper and lower chambers, may be an option for people who have Congestive Heart Failure and problems with the heart's electrical system. Another device called an implantable cardioverter defibrillator (ICD) shows ICDs can sense when the heart starts beating dangerously fast. The device then sends an electrical shock to the heart to bring it back to a normal rhythm. (Fast heart rhythms, such as ventricular tachycardia, are a common cause of death in people with Congestive Heart Failure.)

4. Treatment if the condition gets worse

In some cases when standard medical treatment does not help, other measures are considered. These include heart transplant and left ventricular assist devices (LVADs), which are mechanical pumping devices that are implanted into the chest. However, these are options only for a very small number of people.

5. Palliative care

As your condition gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a longterm illness, make future plans around your medical care, or help your family better understand your illness and how to support you.

Whether having a heart disease or not, the best way to prevent Congestive Heart Failure is to make changes in your lifestyle that lower your risk of developing heart disease. It is also important to control certain medical conditions, such as high blood pressure or diabetes, to lessen your chances of developing Congestive Heart Failure. Heart disease caused by narrowing and hardening of the arteries (atherosclerosis) in the blood vessels of the heart and by heart attack are leading causes of Congestive Heart Failure. To reduce your risk of atherosclerosis:

1. Do not smoke: If you smoke, quit. Smoking greatly increases your risk for heart disease.
2. Lower your cholesterol: Eating a low cholesterol diet, exercising, and quitting smoking will help keep your cholesterol low.
3. Control your blood pressure. If you have high blood pressure, your risk of developing heart disease increases. Lowering blood pressure to normal levels in people who have high blood pressure could reduce the cases of Congestive Heart Failure by half. Exercising, limiting alcohol intake, and controlling stress will help keep your blood pressure in a healthy range.
4. Get regular exercise. Exercise will help control your weight, blood pressure, and stress levels, all of which will help keep your heart healthy.
5. Control diabetes
6. Limit alcohol intake