Heart failure

Alternative names:

CHF; congestive heart failure

Treatment:

The goals of treatment include reduction of cardiac work load, control of excess salt and water retention (swelling), and improvement of heart functioning.

Heart failure requires monitoring of the condition by the health care provider. Hospitalization may be required if symptoms are severe or unstable; difficulty breathing occurs at rest or with minimal activity; or there is failure to respond to initial treatment.

Underlying disorders and precipitating factors should be treated. This may require medications, surgery, or other treatments. In advanced cases, bedrest or reduced physical activity may be recommended to minimize the heart's work load.

Vasodilator medications are used to reduce the work load, particularly if symptoms include difficulty breathing, excessive tiredness, and reduce tolerance of activity. Examples of vasodilator medications include captopril, enalapril, and hydralazine.

If swelling is severe, or there are signs of congestion in systemic (body) or pulmonary (lung) vessels, salt and water accumulation may need to be modified A low sodium diet is recommended and fluid may be restricted in some cases.

Diuretic medications may be used. This includes: loop diuretics (e.g., furosemide, bumetanide) for moderate symptoms; thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone, chlorothiazide) for mild symptoms; and combination diuretics. Digoxin may be given if vasodilators and diuretics do not completely relieve symptoms.

Weight loss may be recommended. Eliminate smoking and alcohol consumption (both decrease the pumping efficiency of the heart).

Aggressive treatment of hospitalized patients is frequently guided by a cardiac specialist. Intravenous medications may be used to give a faster response, including inotropic drugs, vasodilator drugs, and diuretics. Mechanical fluid removal (thoracentesis or paracentesis) may be necessary in some cases. In severe cases, dialysis may be performed to remove excess fluid. Circulatory-assist devices such as the intra-aortic balloon pump or left-ventricular assist device may be recommended to stabilize condition. A heart transplant may be considered.

Expectations (prognosis):

Heart failure is a serious disorder that carries a possibility of reduced life expectancy. Many forms of heart failure are well controlled with medication and correction of underlying disorders. It may become a chronic illness. Heart failure worsens with infection or other physical stressors.

Complications:

• pulmonary edema
• total failure of the heart to function (circulatory collapse)
• arrhythmias including lethal arrhythmias
• side effects of medications
  • low blood pressure (hypotension)
  • light headedness, fainting
  • lupus reaction
  • headache
  • gastrointestinal upset (such as nausea, heartburn, diarrhea)
  • digitalis toxicity

Calling your health care provider:

Call your health care provider if symptoms indicate congestive heart failure may be present.

Call your health care provider 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 911) if severe crushing chest pain, fainting, or rapid and irregular heartbeat occur (particularly if other symptoms accompany a rapid and irregular heartbeat).