Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2003;68(2):339-340

What is heart failure?

The term “heart failure” simply means that your heart is not pumping blood as well as it should. Heart failure does not mean that your heart has stopped working or that you are having a heart attack.

Heart failure is also called congestive heart failure, or CHF. “Congestive” means fluid is building up in your body because your heart is not pumping the right way.

What causes heart failure?

Heart failure has many different causes. Sometimes the cause cannot be found. The most common causes are listed below:

  • Coronary artery disease (narrowing of the blood vessels to the heart)—often people with heart failure have had a heart attack in the past

  • Problems with the heart muscle (this is called cardiomyopathy)

  • High blood pressure (also known as hypertension)

  • Problems with any of the heart valves

  • Abnormal heart rhythms (also called arrhythmias)

  • Toxic substances (such as alcohol abuse)

  • Congenital heart disease (a heart problem you were born with)

What are the symptoms of heart failure?

Some people with heart failure have few problems or symptoms. The following is a list of problems that people with heart failure might have:

  • Shortness of breath (perhaps when walking, climbing stairs, or when lying flat in bed)

  • Waking up during the night, suddenly breathless

  • General tiredness or weakness

  • Swelling of the legs (usually just the feet or ankles)

  • Rapid weight gain (one or two pounds a day for three days in a row)

  • Chronic cough

Call your doctor if you have any of these symptoms, especially if you have had a heart problem before.

What tests will I need?

Your doctor might suspect heart failure based on your medical history, symptoms, and a physical exam. He or she might also order other tests, such as a blood test, urine test, chest x-ray, an electrocardiogram (also called EKG or ECG), an echocardiogram, or an angiogram.

The last two tests often are used to make sure of the diagnosis. An echocardiogram is a test that causes no pain. A probe is moved across the surface of your chest. It sends out sound waves that give your doctor pictures of your heart. The pictures show your doctor how well your heart is pumping.

An angiogram involves injecting a very low dose of a radioactive substance into your blood. This substance travels to your heart and produces pictures that show your doctor how well your heart is pumping. The radioactive substance is safe and leaves your body completely after the test is finished.

What treatment will I need?

Much can be done to improve the heart's pumping and to treat the symptoms, but heart failure cannot be completely cured. An important part of treatment is taking care of any underlying problems, such as high blood pressure. Treatment also includes lifestyle changes and medicine. If you have heart failure, here are some important things you should talk about with your doctor:

  • Diet. You may be told to reduce the amount of salt you eat. Other changes in diet may be advised, depending on other health problems you have. Talk to your doctor before you use salt substitutes; they contain potassium and may not be good for you.

  • Alcohol. Drink less alcohol.

  • Exercise. Your doctor will help you decide how much exercise (and what kind) you can do.

  • Medicines. Talk to your doctor before you take any medicine, because some can cause fluid retention.

  • Support. Your family can be a big help to you, so involve them if possible. Your doctor can give you information about support groups. It sometimes helps to talk with other people who have the same health problem.

What medicines will I need to take?

Several kinds of medicines are commonly used to treat heart failure:

  • ACE inhibitors. ACE inhibitors help open (dilate) your arteries and lower your blood pressure, improving blood flow.

  • Diuretics. Diuretics sometimes are called water pills because they make you urinate more often and help keep fluid from building up in your body. They also can decrease fluid that collects in your lungs, which helps you breathe easier.

  • Beta blockers. Beta blockers can improve blood flow and may help prevent some heart rhythm problems.

  • Digoxin. Digoxin (also called digitalis) helps the heart pump better. It may be combined with other medicines.

You might need to take more than one medicine, or other medicines if you have other problems or if you have side effects with any of these medicines. It may take a while to find the best medicine for you and the best amount of it.

You will need to have blood tests to check your potassium level and kidney function. How often you need these blood tests depends on the kind of medicine you are taking and its strength. If you think you may be having side effects, you should talk to your doctor. It is important that you take your medicine exactly as your doctor says.

How often will I need to see my doctor?

You may need to see your doctor every week to check your reaction to the medicine. After you are feeling better, you might go less often.

When should I call my doctor?

You should call your doctor if you feel short of breath or have swelling in your ankles or feet. You also should call if you gain three to five pounds in one or two days. (To keep track of your weight, weigh yourself each morning after urinating but before you eat anything.)

You should call your doctor if you have any questions about your heart problem or your medicine.

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