Congestive Heart Failure Chf

Overview

Heart failure does not mean your heart has stopped or is about to stop. It means your heart is not pumping blood around your body as well as it used to. Because blood is not moving forward properly, fluid can build up in your lungs, legs and other parts of your body. The word 'congestive' simply refers to that extra fluid. Heart failure is usually a long-term condition, but there is a lot that can be done to ease symptoms and help you live well.

Yes. Heart failure is common. In the UK it affects roughly 1 in 100 adults, and the chance of developing it rises with age. It is one of the most frequent reasons older adults are admitted to hospital.

It mostly affects older adults, especially people over 65, and is slightly more common in men than women at younger ages. But it can affect younger people too, including people born with heart problems, people who have had certain treatments such as chemotherapy, and women around pregnancy in rare cases. Children can also have heart failure, usually because of a heart condition they were born with.

Symptoms

Common symptoms

• Feeling short of breath when you are active, or when lying flat
• Needing extra pillows to sleep, or waking up at night gasping for breath
• Feeling very tired or lacking energy for everyday tasks
• Swollen ankles, feet or legs (this is the 'congestion')
• Unexpected weight gain over a few days from extra fluid
• A dry, persistent cough, sometimes worse at night
• Feeling dizzy, lightheaded or having a racing or fluttering heartbeat
• Swelling or tenderness in your tummy, and losing your appetite
• Needing to pee more often at night

Symptoms in children

• Poor feeding or getting exhausted and sweaty during feeds
• Slow weight gain or growth
• Fast breathing, grunting, or pulling in between the ribs when breathing
• Sweating heavily, especially during feeds or play
• Being unusually sleepy or irritable
• Blue or grey lips, tongue or skin — this needs emergency help straight away

Symptoms in older adults

• Confusion, memory problems or feeling 'not yourself' — sometimes the only sign
• Falls or feeling unsteady
• Tiredness that gets put down to 'just getting older'
• Loss of appetite or weight loss
• Swelling in the legs that is easy to miss if you sit most of the day
• Breathlessness that makes everyday things like dressing or walking to the bathroom hard

Causes

Main causes

• Coronary heart disease — narrowed heart arteries, or damage after a heart attack
• Long-standing high blood pressure, which makes the heart work harder
• Cardiomyopathy — a condition where the heart muscle itself becomes weak or thickened
• Heart valve problems, where valves leak or become narrow
• Abnormal heart rhythms, such as atrial fibrillation (an irregular heartbeat)
• A virus infection that inflames the heart muscle
• Heavy, long-term alcohol use
• Some medical treatments, such as certain chemotherapy medicines or radiotherapy to the chest
• Congenital heart conditions — problems present from birth
• Other illnesses that put strain on the heart, such as thyroid disease, kidney disease or severe anaemia

Risk factors

• Being older — risk rises with age
• High blood pressure
• Having had a heart attack or having narrowed heart arteries
• Diabetes
• Smoking
• Being overweight
• Drinking a lot of alcohol over many years
• High cholesterol
• Kidney disease
• Sleep apnoea — loud snoring with pauses in breathing at night
• A family history of heart muscle disease or early heart disease
• Some medicines, such as certain painkillers used long term — ask your pharmacist or doctor

When to see a doctor

See a doctor urgently if:

• You gain weight quickly over a few days without changing what you eat
• Your ankles, legs or tummy swell more than usual
• You become more breathless, or breathless at rest
• You need extra pillows to breathe comfortably at night
• You feel dizzy, faint, or your heartbeat feels fast and irregular

Book a routine appointment if:

• You feel unusually tired or breathless with everyday activity
• You have a cough that will not go away
• You have swollen legs or ankles that come and go
• You have been told you have high blood pressure, diabetes or heart disease and want to know how to protect your heart
• You have a family history of heart muscle problems

Diagnosis

Your doctor will start by asking about your symptoms and your medical history, then examine you. They will listen to your heart and lungs, check your ankles and legs for swelling, check your blood pressure, and may weigh you. Based on this, they may arrange some simple tests. In the UK, your GP will usually follow national guidance, which often starts with a blood test and an urgent heart scan if heart failure is suspected.

Tests that may be done

• A blood test to measure a hormone the heart releases when it is under strain (often called a natriuretic peptide test)
• Other blood tests to check your kidneys, blood count, thyroid and blood sugar
• An echocardiogram — an ultrasound scan of the heart that shows how well it pumps and whether valves are working
• An ECG (electrocardiogram) — sticky pads on your chest that record your heart's electrical rhythm
• A chest X-ray to look for fluid in the lungs
• Sometimes a heart monitor worn at home to catch irregular rhythms
• Occasionally more detailed scans or a heart catheter test

What to expect at your appointment

Most of these tests are quick and painless. The echo scan is like the ultrasound scan used in pregnancy and takes around 20 to 45 minutes. You may get some results the same day, but others take a week or two. Waiting can feel worrying — it often helps to write down your questions and bring someone with you to appointments.

Treatment

Heart failure is usually a long-term condition, and in most cases it cannot be cured. But treatment today is much better than it used to be. The aim is to ease your symptoms, help your heart work as well as it can, keep you out of hospital, and help you live a full life. Treatment usually combines medicines, lifestyle changes and regular check-ups, and it is tailored to you.

Self-care at home

• Weigh yourself at the same time each morning, after using the toilet, before eating — and write it down
• Know your 'dry weight' (your weight when you feel well) and tell your care team about quick gains
• Follow any fluid advice your team gives you, and cut down on salt
• Take your medicines as prescribed, even when you feel well — do not stop without advice
• Stop smoking, and get help to do it if you can
• Stay active within what feels comfortable, and build up gradually
• Limit alcohol, and ask your team what is safe for you
• Keep your flu, pneumonia and COVID-19 vaccinations up to date — ask your doctor or pharmacist
• Rest with your legs raised if they swell, and avoid long periods standing still
• Plan ahead: keep a list of your medicines and your care team's contact details handy

Medical treatments

Doctors use several kinds of medicine, usually in combination. Some help your heart pump more strongly or beat more efficiently. Others lower blood pressure so the heart has less work to do, or help the body get rid of extra salt and water so swelling and breathlessness ease. Some protect the kidneys and heart over the long term. Your team will usually start low and build up slowly, checking your blood pressure, kidney function and blood tests along the way. Never change or stop medicines on your own — if you feel dizzy, unwell or think you are having a side effect, contact your doctor or pharmacist. You may also be offered a rehabilitation programme with supervised exercise and advice, which many people find very helpful.

When is surgery considered?

Some people benefit from procedures or devices. These can include a small implanted device that helps the heart beat in a more coordinated way, or one that can correct a dangerous rhythm; repair or replacement of a leaking or narrowed heart valve; treatment to unblock narrowed heart arteries; or, in a small number of people with severe heart failure, a heart transplant or a mechanical heart support device. Your specialist team will discuss whether any of these are right for you.

Living with this condition

Most people find that a steady routine helps a lot. Weighing yourself daily, taking medicines at the same time each day, and knowing your early warning signs mean you can act quickly if something changes. Pace yourself — spread chores across the day and rest between activities. Keep your home comfortable and cool, and avoid very hot baths or long hot showers if you feel dizzy. Many people find they can still work, travel and enjoy hobbies with some planning and advice from their team.

Lifestyle tips

• Eat a balanced diet with plenty of vegetables, fruit, wholegrains and lean protein
• Cut down on salt — avoid processed foods, ready meals, cured meats, salty snacks and stock cubes
• Ask your team whether you need to limit fluids, and how much
• Stay active in a way that suits you — walking, gardening, gentle cycling or a supervised programme
• Keep to a healthy weight and get support if you want to lose weight
• Stop smoking; avoid second-hand smoke
• Keep alcohol low or avoid it, and check with your team
• Get plenty of sleep, and try to keep a regular sleep pattern
• Avoid very hot or very cold places, and take it easy at high altitude until you have asked for advice
• Ask your pharmacist before taking any new medicine, including over-the-counter painkillers and herbal remedies

Diet and exercise

Food and movement are part of treatment, not an optional extra. Aim for less salt rather than a strict, joyless diet — herbs, spices, lemon and pepper can replace salt. If you are told to watch fluids, measure them out and include things like soup, ice lollies and jelly. For exercise, start gently and build up. A good rule is that you should be able to talk while you are active. If you get chest pain, severe breathlessness or dizziness, stop and seek advice. Ask your team about a supervised exercise and education programme — they help people feel stronger and more confident.

Mental health and emotional wellbeing

It is very common to feel anxious, low or frustrated when you are living with a long-term heart condition. You may worry about the future, feel you have lost some independence, or find that your sleep and mood have changed. These feelings are real and worth talking about — tell your GP, your heart team or someone you trust. Talking therapies, peer support and gentle activity can all help. If at any point you have thoughts of harming yourself or ending your life, please reach out right away: contact your local emergency number, go to your nearest emergency department, or call a crisis support line in your country. You do not have to cope alone, and help is available.

Prevention

Not all heart failure can be prevented, but many cases can be delayed or avoided by looking after your heart. The biggest steps are keeping blood pressure and cholesterol in a healthy range, not smoking, staying active, eating well, limiting alcohol, and getting conditions like diabetes and sleep apnoea treated. If you have already had a heart attack or have heart disease, good follow-up care and taking your medicines as prescribed greatly reduce your risk of developing heart failure.

Vaccines

Ask your doctor or pharmacist about recommended vaccinations. Flu, pneumonia and COVID-19 vaccines are commonly advised for people with heart conditions, because infections can put extra strain on the heart. Your team will know what is right for you and your local programme.

Screening programmes

There is no routine screening test for heart failure itself. However, regular blood pressure and blood sugar checks, and cholesterol testing where offered, help catch the problems that lead to heart failure. If you have a strong family history of heart muscle disease, tell your doctor — they may suggest checks for you and your relatives.

Complications

If left untreated

• Breathlessness and swelling getting worse, making everyday activity harder
• Fluid building up in the lungs, which needs urgent hospital treatment
• Irregular heart rhythms that can be dangerous
• Kidney problems, because the heart and kidneys affect each other
• Damage to the liver from long-term fluid build-up
• More frequent hospital stays
• Low mood, anxiety and loneliness linked with long-term illness

Long-term outlook

The outlook for heart failure has improved a great deal over the past 20 years, thanks to better treatment and better support. Many people live for many years with a good quality of life, staying active and doing the things they enjoy. How things go varies a lot from person to person, and depends on the cause, how well the heart is working, and how well other conditions are managed. Keeping to your treatment, spotting changes early and staying in touch with your team all make a real difference. It is also okay to ask your doctor honest questions about what to expect — good care includes planning for the future together.

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