Congestive cardiac failure (CHF) means the heart cannot pump enough blood to meet the body’s needs. The heart may be weak, stiff, or both. When the heart fails, fluid builds up in the lungs and body — that is why it’s called “congestive.”
Why it happens
The heart works like a pump and has to push blood out and then fill again. If the muscle is damaged (for example after a heart attack), becomes too stiff, or the body forces the heart to work too hard (high blood pressure, valve problems), the pump fails. The kidneys then hold on to water and salt, making swelling (edema) worse.
Main causes
- Coronary artery disease / heart attacks
- Long-standing high blood pressure (hypertension)
- Heart valve problems
- Cardiomyopathies (weak or damaged heart muscle — viral, alcohol, drugs)
- Arrhythmias and some systemic diseases (thyroid disease)
Types
- Systolic failure: heart can’t squeeze well — low ejection fraction.
- Diastolic failure: heart can’t fill well — stiff walls, normal ejection fraction.
- Acute: sudden severe failure (medical emergency).
- Chronic: slow-developing, long-term symptoms and fluid retention.
Common symptoms
- Shortness of breath (worse on exertion or when lying flat)
- Sudden nighttime breathlessness (paroxysmal nocturnal dyspnea)
- Swelling of legs, ankles; weight gain from fluid
- Fatigue, weakness, reduced exercise tolerance
- Palpitations, cough, or chest discomfort
How doctors confirm it
- Clinical exam: breath sounds, swollen legs, heart sounds
- Blood tests: kidney tests, electrolytes, BNP (often high in heart failure)
- Chest X-ray: fluid in lungs or enlarged heart
- ECG: rhythm problems or prior heart damage
- Echocardiogram (echo): key test — shows heart pumping and valve function
Treatment goals
Improve symptoms and quality of life, reduce hospital visits, slow disease progression, and prolong life.
Non-drug measures
- Daily weight checks to spot fluid gain early
- Salt restriction and fluid advice per doctor’s plan
- Stop alcohol and smoking; keep active as allowed
- Vaccinate against flu and pneumococcus when advised
PHARMACOTHERAPY
- Diuretics (e.g., furosemide): remove extra fluid — reduce breathlessness and swelling.
- ACE inhibitors (e.g., enalapril, captopril): relax blood vessels and reduce heart workload — improve symptoms and survival.
- ARBs (e.g., losartan): similar to ACE inhibitors, used if ACE causes cough.
- Beta-blockers (e.g., carvedilol, metoprolol): slow the heart and protect it long-term — reduce deaths in chronic heart failure.
- Digoxin: helps the heart pump stronger and controls fast heart rates — useful in some patients.
- Inotropes (e.g., dobutamine, milrinone): used in severe/acute cases in hospital to support the heart.
- Aldosterone antagonists (e.g., spironolactone): reduce fluid and help in certain patients; monitor potassium.
Important safety and monitoring
- Check kidney function and electrolytes (especially after starting ACE inhibitors, ARBs, diuretics or spironolactone).
- Watch for low blood pressure, high potassium, dizziness, cough (ACE), swelling, slow heartbeat (beta-blockers).
- Inform the doctor about other drugs — some interact or worsen heart failure.
Simple patient counselling
- Take medicines exactly as prescribed — don’t stop suddenly.
- Weigh yourself daily; report sudden gain of 1–2 kg (2–4 lb) in a day or 3 kg in a week.
- Reduce salt, follow fluid advice and attend follow-up visits.
- Learn when to seek urgent care: severe breathlessness, fainting, chest pain, or very rapid/slow pulse.
Detailed Notes:
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