Congestive Heart Failure

CHF · Heart Failure

Symptoms and Complications

The appearance of symptoms of CHF can be delayed for years. This is because the heart tries to compensate when it is not pumping efficiently. The heart compensates in three ways:

  • by dilating (enlarging) to form a bigger pump
  • by adding new muscle tissue to pump harder
  • by beating at a faster rate

As the heart compensates, several things happen that can result in symptoms. The heart cannot pump well enough to pump the blood through the body and back to the heart again. Blood then backs up into the legs and the lungs, causing fluid buildup. This causes visible swelling of the ankles and legs and shortness of breath.

The most common symptoms of CHF include:

  • breathing difficulties during the night or when lying down
  • coughing and wheezing
  • fatigue and weakness
  • shortness of breath
  • swollen ankles

Other symptoms of CHF include:

  • abdominal pain, bloating, or loss of appetite
  • accumulation of fluid in the abdomen
  • bluish skin around the mouth
  • constipation
  • pale skin and cold hands or feet
  • frequent urination at night

Making the Diagnosis

If you have the symptoms mentioned in the previous section, along with one of the conditions that puts you at risk, your doctor may suspect CHF. Your doctor will examine you to see if your legs are swollen or if your lungs are filled with fluid.

Your doctor may also order tests to check your heart. Your doctor may send you for blood and urine tests, an electrocardiogram (ECG), or a chest X-ray, which can show the excess fluid in the lungs. An echocardiogram (an ultrasound of the heart) will help diagnose heart failure. An echocardiogram can also tell the doctor how much of the blood in your heart is actually being pumped out to the rest of the body. The proportion of blood that gets pumped out is called the ejection fraction.

Treatment and Prevention

All treatment for CHF should be carried out under the supervision of a doctor. CHF usually is managed with lifestyle adjustments and medications. If you have CHF, you may have to make some of the following lifestyle adjustments:

  • Cut back on fluids. Weighing yourself daily is often necessary to help adjust fluid intake and medications.
  • Stay active, but avoid triggering CHF symptoms.
  • Lower sodium intake. If possible, try for 1.5 g or less each day. Less sodium reduces fluid retention.
  • Wear special elastic stockings to reduce swelling in the legs caused by fluid retention.
  • Follow an appropriate weight-loss program (for those who need it).

Congestive heart failure can be treated with the following medications:

  • ACE inhibitors (e.g., enalapril*, lisinopril) expand blood vessels, allowing blood to flow more easily and making the heart's work easier or more efficient.
  • Angiotensin receptor blockers (ARBs; e.g., candesartan, valsartan) may be useful in place of ACE inhibitors when they cannot be used or sometimes in addition to ACE inhibitors.
  • Certain beta-blockers (e.g., bisoprolol, carvedilol, metoprolol) have been proven to help improve heart function.
  • Digoxin increases the force of the pumping action of the heart.
  • Diuretics (e.g., furosemide, hydrochlorothiazide) help the body eliminate excess salt and water.
  • Spironolactone, also a diuretic, maintains potassium stores. In severe cases of heart failure, spironolactone may prevent its worsening.
  • Hydralazine and nitrates (e.g., isosorbide dinitrate, nitorglycerin patch) may be useful in place of ACE inhibitors or ARBs when they cannot be used, or sometimes in addition to other therapies when symptoms are still present.

Your doctor may prescribe these medications, usually in combination, to manage your CHF. In some cases, surgery may be necessary to help improve heart function.

CHF can't always be prevented, but there are many things you can do to help. Try preventing CHF by practicing good heart health. This will also guard against heart attack, stroke, and coronary artery disease. Tips to follow include these:

  • Control high blood pressure.
  • Eat a healthy diet.
  • Exercise.
  • Stay in control of blood sugar levels (especially if you have diabetes).
  • Maintain good blood cholesterol levels.
  • Quit smoking.
  • Reduce alcohol consumption.


*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.


Glenn Gandelman, MD, MPH, FACC Assistant Clinical Professor of Medicine at New York Medical College, and in private practice specializing in cardiovascular disease in Greenwich, CT. Review provided by VeriMed Healthcare Network.

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