Congestive Heart Failure
(CHF)
In this condition factsheet:
The Facts on Congestive Heart Failure
Congestive heart failure (CHF) occurs when the heart isn't able to pump blood normally. As a result, there is not enough blood flow to provide the body's organs with oxygen and nutrients. Although it is often used interchangeably with the term "heart failure" (or "HF"), CHF refers to a stage of heart failure where fluid builds up in different areas of the body, causing swelling (or "edema"). The term "heart failure" does not mean that the heart stops beating completely, but that the heart is not working as efficiently.
CHF is one of the most common causes of hospitalization for people over 55 years of age. Approximately 750,000 Canadians are living with congestive heart failure.
People of African descent are considerably more at risk than those of European descent and also have a higher risk of death.
There are 2 basic types of congestive heart failure:
- Heart failure with reduced ejection fraction (HFrEF), previously known as systolic dysfunction, occurs when the heart muscles are too weak, and can't pump enough blood to supply all the body's needs.
- Heart failure with preserved ejection fraction (HFpEF), previously known as diastolic dysfunction, occurs when the heart muscles are too stiff and cannot relax to accept all the blood being sent to it.
People with HFpEF can often develop HFrEF as their condition worsens.
Causes of Congestive Heart Failure
CHF is usually the result of other health problems and conditions that can lead to damage and weakening of the heart:
- coronary artery disease, a condition that causes narrowing of the arteries that supply the heart with blood
- heart valve disease, which may have been caused by abnormalities that have been present since birth or have developed over time
- persistent high blood pressure forces the heart to pump against higher pressure
- heart attack damages the heart muscle – people who have had heart attacks are at 5 times the average risk of developing HF
- diabetes
- arrhythmias (abnormal heart rhythms) can cause the heart to pump inefficiently, especially if the heartbeat is too fast
- infections of the heart muscle: for example, a virus can affect the heart muscle or rheumatic disease may damage the valves
- an enlarged wall between the heart chambers (a genetic condition) may prevent normal heart function
- certain kidney conditions that increase blood pressure and fluid buildup
- use of illicit drugs, such as cocaine
- excessive, long-term alcohol use
In addition, all the risk factors that normally increase the chances of heart disease, such as smoking, diabetes, and obesity, increase your risk of congestive heart failure.
Symptoms and Complications of Congestive Heart Failure
The appearance of symptoms of CHF can be delayed for years. This is because the heart tries to compensate when it is not pumping efficiently. The heart compensates in three ways:
- dilating (enlarging) to form a bigger pump
- adding new muscle tissue to pump harder
- beating at a faster rate
As the heart compensates, several things happen that can result in symptoms. The heart cannot pump well enough to pump the blood through the body and back to the heart again. Blood then backs up into the legs and the lungs, causing fluid buildup. This causes visible swelling of the ankles and legs and shortness of breath.
The most common symptoms of CHF include:
- breathing difficulties during the night or when lying down
- coughing and wheezing
- fatigue and weakness
- shortness of breath
- swollen ankles
Other symptoms of CHF include:
- abdominal pain, bloating, or loss of appetite
- accumulation of fluid in the abdomen
- pale skin and cold hands or feet
- frequent urination at night
