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    Understanding CHF (Congestive Heart Failure)

    Brian Wellington, DO Deaconess Clinic Henderson 06/07/2021

    Congestive heart failure, or CHF, is a very common, serious chronic condition and it’s a factor in 1 in 9 deaths. I want you to understand how your heart should work properly, and what happens when it doesn’t. This information can help you have important conversations with your doctor about CHF, and help you identify causes for concern in yourself and others.  

    What is Congestive Heart Failure (CHF)?
    One of the most common conditions I diagnose and help manage in my practice is congestive heart failure, or CHF. The most general definition of CHF, according to the American Heart Association, is a chronic condition in which the heart doesn’t pump blood as well as it should.

    CHF is most commonly associated with fluid collecting in and around the lungs and lower extremities (legs), which interferes with breathing and causes shortness of breath and swelling.  This fluid collection happens as blood flow out of the heart slows, and then blood returning to the heart through the veins backs up, causing congestion in the body's tissues. This is the congestive part of CHF.

    Heart failure is perhaps the most important concept to understand when discussing CHF. Heart failure occurs when the heart muscle is weakened and cannot pump enough blood to meet the body's needs for blood and oxygen. The term "heart failure" makes it sound like the heart is no longer working at all and there's nothing that can be done. Actually, heart failure means that the heart simply isn't pumping as well as it should.
    Your body depends on the heart's pumping action to deliver oxygen- and nutrient-rich blood to the body's cells. When the cells are nourished properly, the body can function normally.

    With heart failure, the weakened heart can't supply the cells with enough blood. This decrease in blood supply results in fatigue and shortness of breath, and some people experience coughing. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult. As the disease progresses, some patients are even short of breath at complete rest and require added oxygen to breathe.

    Heart failure also affects the kidneys' ability to dispose of sodium and water. This retained water also increases swelling in the body's tissues (edema), which is a vicious cycle.

    Risk factors for CHF
    While everyone loses some blood-pumping ability in our hearts as we age, heart failure results from the added stress of health conditions that either damage the heart or make it work too hard.  

    Most people who develop heart failure have (or had) another heart condition first. The most common conditions that can lead to heart failure are coronary artery disease, high blood pressure and previous heart attack. 

    All of the lifestyle factors that increase your risk of heart attack and stroke – smoking, being overweight, eating foods high in fat and cholesterol, and physical inactivity – can also contribute to heart failure.

    If you have heart failure, chances are you have (or had) one or more of the conditions listed below.

    • Coronary artery disease:  Cholesterol and fatty deposits build up in the heart’s arteries, causing the heart to work harder to pump.
    • Prior heart attack:  Damages the heart muscles.
    • High blood pressure:  Causes heart to enlarge, which makes the muscles weaker as well.
    • Abnormal heart valves:  Heart valves can be damaged by illness, infection or heart defects.
    • Heart muscle disease:  Damage to heart muscle, such as from drug/alcohol use, viral infections and other causes, can lead to heart failure.

    This animation from the American Heart Association shows how a damaged heart can develop heart failure.

    Diagnosing CHF
    It is always important to have regular check-ups with your doctor but it becomes critically important if you (or a family member) notice any of these potential signs of heart failure (HF).  

    • Shortness of breath
    • Persistent coughing or wheezing
    • Buildup of excess fluid in body tissues (edema)
    • Unusual fatigue
    • Lack of appetite
    • Nausea
    • Impaired thinking
    • Increased heart rate

    After an examination, your doctor may decide that tests and procedures are needed to help determine the nature of the possible heart problem. These tests may include blood tests, echocardiogram, and/or EKG. The doctor will use your test results to determine whether or not you have heart failure, the degree of severity and what treatments will be most effective.
    Treating CHF
    When it comes to treating CHF, it’s important to note that heart failure [caused by damage to the heart that has developed over time] can't be cured. However, heart failure can be treated, and symptoms can be improved.
    Successful treatment depends on your willingness to get involved in managing this condition. Whether you're the patient or a caregiver, you and your loved ones play an active part in the health care team.

    Patient treatment plans may include:

    • Lifestyle changes
      • Quitting smoking
      • Losing weight
      • Tracking your daily fluid and salt intake
      • Avoiding alcohol
      • Limiting caffeine
      • Eating a heart healthy diet
      • Being physically active
      • Monitoring your blood pressure
      • Getting adequate rest
      • Managing stress
      • Avoiding the flu and pneumonia by being vaccinated as recommended
    • Medications: Depending on the patient’s age, other health conditions and severity of CHF, medications like beta blockers, ACE inhibitors and diuretics may be prescribed.
    • Cardiac rehab can also be very effective in improving and managing CHF severity and symptoms. My colleagues in Cardiac Rehab at The Heart Hospital at Deaconess Gateway offer an excellent program.
    • Finally, in some cases, a referral to a heart specialist, such as my colleagues who practice at The Heart Hospital, may be needed for specific procedures or implants.

    If your loved one has CHF, supporting their lifestyle changes can go a long way in helping them manage this chronic condition.

    Regardless of your treatment plan, following all of your doctor's recommendations and making the necessary changes in diet, exercise and lifestyle will give you the highest possible quality of life.

    Ongoing Management of CHF
    Even with the best and most careful treatment, an important part of managing CHF is watching for symptoms to worsen, so they can be addressed quickly.

    Symptoms to watch for include:

    • Shortness of breath
    • Persistent coughing or wheezing
    • Buildup of excess fluid in body tissues (edema)
    • Watching your weight—a sudden increase of 5 pounds or more in 24 hours is concerning, as it’s a sign of fluid build-up.
    • Unusual fatigue
    • Lack of appetite
    • Nausea
    • Impaired thinking
    • Increased heart rate

    If you are noticing these symptoms, contact your doctor immediately.  If it’s over a weekend, go to Urgent Care or the emergency department.
    Additional resources
    Your primary care provider or cardiologist is a great source of information relating to CHF, and is your partner in care.  Work with him or her closely.

    Click here to find information on regarding understanding and managing CHF.

    The American Heart Association website is also a great source for additional information, and includes a variety of animations and videos that may be of interest to you. 


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