Congestive Heart Failure (CHF) Overview (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- What is congestive heart failure (CHF)?
- What causes congestive heart failure?
- What are the signs and symptoms of congestive heart failure?
- What are the risk factors for congestive heart failure?
- How is congestive heart failure diagnosed?
- What is the treatment for congestive heart failure?
- Lifestyle modifications
- What is the prognosis for congestive heart failure?
- Can congestive heart failure be prevented?
- Find a local Cardiologist in your town
What are the signs and symptoms of congestive heart failure?
The hallmark symptom of left heart failure is shortness of breath or dyspnea (dys=abnormal + pnea= breathing). This may occur while at rest, with activity or exertion, while lying flat (orthopnea), or may awaken a patient from sleep (paroxysmal nocturnal dyspnea). The shortness of breath may be due to fluid (water, mainly) accumulation in the lungs or the inability of the heart to be efficient enough to pump blood to the organs of the body when called upon in times of exertion or stress. Chest pain or angina may be associated, especially if the underlying cause of the failure is atherosclerotic heart disease.
The New York Heart Association has developed a scale that is commonly used to determine the functional capabilities of a patient with heart failure.
|I||Patients without limitation of physical activity.|
|II||Patients with slight limitation of physical capacity, in which ordinary physical activity leads to fatigue, palpitations, dyspnea, or angina pain; they are comfortable at rest.|
|III||Patients with marked limitation of physical activity, in which less than ordinary activity results in fatigue, palpitation, dyspnea, or angina pain; they are comfortable at rest.|
|IV||Patients who are not only unable to carry on any physical activity without discomfort but who also have symptoms of heart failure or the angina syndrome even at rest; the patient's discomfort increases if any physical activity is undertaken.|
Patients with right heart failure leak fluid into the tissue and organs that deliver blood to the right heart through the vena cava. Back pressure in capillary blood vessels cause them to leak water into the space between cells and commonly the fluid can be found in the lowest parts of the body. Gravity causes fluid to accumulate in the feet and ankles but as more fluid accumulates, it may creep up to involve all of the lower legs. Fluid can also accumulate within the liver causing it to swell (hepatomegaly) and also within the abdominal cavity (ascites). Ascites and hepatomegaly may make the patient feel bloated, nauseated, and have abdominal pain with the feeling of distension.
Depending upon their underlying illness and the clinical situation, patients may have symptoms of right heart failure, left heart failure, or both.
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