Congestive heart failure is a condition in which the pumping ability of the heart is progressively impaired to the point that it no longer meets bodily needs. When blood flow from the heart slows, blood returning to the heart backs up and causes congestion in the tissues. Circulatory congestion may occur in the systemic venous circulation, resulting in peripheral edema in the legs and ankles. Alternatively, the congestion may occur in the pulmonary circulation, causing pulmonary edema, an acute, life-threatening condition. Heart failure also limits the kidneys’ ability to dispose of sodium and water, which further increases edema.
FIGURE. Congestive heart failure indicating signs and symptoms.
Either the left or right ventricle or both may be the source of the inadequate pumping action. Chronic CHF is the product of many cardiac and pulmonary disease processes, such as hypertension, CAD, and MI; degenerative conditions, such as cardiomyopathies, heart valve disease, and congenital birth defects; and any inflammation of the heart or its muscle.
Signs and Symptoms
Left ventricular failure may be manifested as dyspnea and fatigue and will result in primarily pulmonary symptoms. Right ventricular failure may cause distended neck veins and hepatomegaly and is more likely to result in systemic symptoms.
Symptoms of advanced CHF may include tachypnea, palpitations, edema, weight gain, diaphoresis, and cyanosis. As the disease progresses, there may be hemoptysis, cyanosis, and pitting edema of the ankle. Pitting edema describes edema in which an indentation in the skin remains a few minutes after the area is pressed with the finger.
An ECG, a chest x-ray, and an elevated central venous pressure will indicate the diagnosis. Echocardiography with ejection fraction (a measurement showing how well the heart is pumping), stress testing, cardiac CT and MRI, and cardiac catheterization may be ordered.
The goal of treatment is to improve the heart’s pumping function, relieve symptoms, and improve the client’s quality of life. Treatment may involve the use of diuretics to reduce circulatory congestion by reducing total blood volume. Bed rest may be recommended. Drug therapy may include vasodilators and digoxin to strengthen heart action. Salt intake may be restricted to combat edema.
Counseling and continuous monitoring of lifestyle and limitations may be needed to help clients cope with their condition. Activities may be limited.
Acute CHF usually responds quickly to therapeutic measures. The prognosis is good, although it depends on the cause. If the congestion is severe and chronic, the prognosis is poor. The person usually must continue medication indefinitely and be carefully supervised by a primary care provider.
Prevention consists of avoiding any predisposing factors. It is important to record weight daily and report any gain of 3 lb or more to a primary care provider, limit sodium and alcohol, participate in an approved exercise program, reduce stress, consider sleeping with the head elevated 45 degrees, and not to smoke.