Cardiology · Beaumont and St. Joseph Mercy
Congestive Heart Failure - Dr. James Heinsimer

About Congestive Heart Failure

Congestive Heart Failure

What is congestive heart failure?

Congestive heart failure is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body's other organs. The heart keeps pumping, but not as efficiently as a healthy heart. Usually, the loss in the heart's pumping action is a symptom of an underlying heart problem. It is often confused with a “heart attack” or a “cardiac arrest”. A “heart attack” (usually due to a blockage of the arteries by cholesterol and blood clots containing platelets) can cause “heart failure” (lack of pumping of the heart) if enough heart muscle has been damaged by the heart attack. A "cardiac arrest" refers to a heart rhythm disturbance where the heart either stops completely or goes so fast that it can't pump at all -- over 400 times per minute. Heart attacks can cause heart failure which in turn can cause a cardiac arrest but they are not synonymous and should not be used interchangeably. Another way of looking at this is like a car’s engine. If the car engine is not pumping normally, the car will not function normally and will not go as fast and will backfire etc. The car's engine depends upon normal functioning valves to work properly. So does your heart. The car's engine also depends upon normal fuel lines – if you are out of gas or have impaired fuel delivery because of plugged fuel lines -- and the car will not run normally. Similarly, if the fuel lines to your heart -- the so-called "coronary arteries" are blocked by cholesterol or platelets and you have a heart attack -- then your body's engine (the heart) will be damaged and will not pump normally. Heart rhythm disturbances leading to cardiac arrest are like wiring problems in your car. If the electrical system of your car is faulty, the engine will not work properly.

Understanding Heart Failure

So even though the term "heart failure" sounds pretty scary -- as if the heart has "failed" or stopped beating, it actually simply means that the heart isn't pumping as well as it should. Usually the heart has been weakened over time by an underlying problem, such as clogged arteries, high blood pressure, a defect in its muscular walls or valves, or some other medical condition.

Your body depends on the heart's pumping action to deliver oxygen- and nutrient-rich blood so it can function normally. In people with heart failure, the body doesn't get an adequate supply. As a result, they tend to feel weak, fatigued or short of breath. Everyday activities such as walking, climbing stairs, carrying groceries and yard work can become quite difficult.

How common is congestive heart failure?

If you've been diagnosed with congestive heart failure or know someone who has, you're not alone. Nearly 5 million Americans are currently living with this condition, with 550,000 new cases diagnosed each year. Congestive heart failure affects people of all ages, from children to young adults to the middle-aged to senior citizens. However, it's more common among older people. Therefore, as the older population grows over the next few decades, so will the number of people living with congestive heart failure or caring for a loved one who has it.

Can it be cured?
Heart failure is a serious condition, and there is usually no cure. But we deliberately use the phrase "living with heart failure" because that is what people who have it learn to do. In most cases, heart failure can be managed by taking medications and making healthy changes in habits such as diet and exercise. The help of families and friends can be beneficial as well. These changes are often the key to leading a full, enjoyable life.

What causes congestive heart failure?

Congestive heart failure may result from any/all of the following:

  • heart valve disease - caused by past rheumatic fever or other infections
  • high blood pressure (hypertension)
  • infections of the heart valves and/or heart muscle (i.e., endocarditis)
  • previous heart attack(s) (myocardial infarction) - scar tissue from previous attacks may interfere with the heart muscle's ability to work normally
  • coronary artery disease - narrowed arteries that supply blood to the heart muscle
  • cardiomyopathy - or another primary disease of the heart muscle
  • congenital heart disease/defects (present at birth)
  • cardiac arrhythmias (irregular heartbeats)
  • chronic lung disease and pulmonary embolism
  • drug-induced heart failure
  • excessive sodium intake
  • hemorrhage and severe anemia

How does congestive heart failure affect the body?

Congestive heart failure interferes with the kidney's normal function of eliminating excess sodium and waste from the body. In congestive heart failure, the body retains more fluid - resulting in swelling of the ankles and legs. Fluid may also collect in the lungs - resulting in shortness of breath.

What are the symptoms of congestive heart failure?

The following are the most common symptoms of congestive heart failure. However, each individual may experience symptoms differently. Symptoms may include:

  • weight gain
  • visible swelling of the legs and ankles (due to a build-up of fluid), and, occasionally, the abdomen
  • shortness of breath during rest or exercise or especially upon lying down or at night
  • fatigue
  • loss of appetite and nausea
  • persistent cough - often produces mucus or blood-tinged sputum

The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been lost.

The symptoms of congestive heart failure may resemble other conditions or medical problems.

How is congestive heart failure diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for congestive heart failure may include any, or a combination of, the following:

  • laboratory tests (especially the BNP level). BNP stands for beta naturetic peptide. This hormone is secreted by the heart if the patient has heart failure. A BNP level of less than 100 means no heart failure. Over 1000 means significant heart failure.
  • chest x-ray - used to see the size of the heart and fluid (bigger heart or increased fluid= worse heart failure)
  • electrocardiogram (“ECG” or “EKG”) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
  • echocardiogram (Also called “cardiac echo” or “ultrasound of the heart”) - a test using high frequency sound waves to allow us to see the valves and the pumping of the heart.
  • MUGA (MU lti Gated Acquisition) – a test using a small amount of a radioactive chemical to see how the heart is pumping

Treatment for congestive heart failure:

The cause of the congestive heart failure will dictate the treatment protocol established. If the heart failure is caused by a valve disorder, then surgery is usually performed. If the heart failure is caused by a disease, such as anemia, then the disease is treated. And, although there is no cure for heart failure due to a damaged heart muscle, many forms of treatment have proven to be successful.

The goal of treatment is to improve a person's quality of life by making the appropriate lifestyle changes and implementing drug therapy.

Treatment of congestive heart failure may include:

  • controlling risk factors
    • losing weight (if overweight)
    • restricting salt and fat from the diet
    • stop smoking
    • abstaining from alcohol
    • proper rest


Also Called . . . generic name (Brand name)

They Work By . . .

Possible Side Effects

ACE Inhibitors

Captopril (Capoten), enalapril (Vasotec), ramipril (Altace), lisinopril (Zestril, Prinivil), quinapril (Accupril), fosinopril (Monopril), benazepril (with Norvasc= Lotrel)

preventing the body from creating angiotensin, a substance in the blood that causes vessels to narrow and raises blood pressure

persistent cough; kidney problems; weakness or dizziness; skin rashes; altered taste, too-high potassium levels, low blood pressure


hydrochlorothiazide (Hydrodiuril), chlorothiazide, furosemide (Lasix), bumetanide (Bumex ), spironolactone (Aldactone), triamterene (Dyazide Maxzide when combined with hydrochlorothiazide), metolazone, other combination agents

helping the kidneys remove more sodium and water from the bloodstream than usual

fatigue; low blood pressure; poor kidney function; low potassium levels


Isosorbide mononitrate (ImDur, Ismo), isiosorbide dinitrate (Sorbitrate, Isordil) hydralazine, nitrates ( Nitrobid)

causing the blood vessels to widen or relax

fainting or dizziness; headaches; flushing; heart palpitations; nasal congestion

Digitalis Preparations

Digoxin (Lanoxin, Digitek); digitoxin

increasing the force of the heart's contractions and slowing certain types of irregular heartbeats

loss of appetite; a bad taste in the mouth; nausea or vomiting; impaired kidney function; headaches; skipped heartbeats

Beta Blockers

Carvedilol (Coreg) , metoprolol-extended release (Toprol XL), betaxolol (Kerlone), atenolol (Tenormin)

reducing the effects of chemical messengers that increase heart rate

Fatigue, low blood pressure and/or pulse; worsening of asthma symptoms

Blood Thinners

Oral- warfarin (Coumadin), ximelagatran (Exanta)

IV or into skin - heparin, enoxaparin (Lovenox)

preventing the formation of blood clots that can lead to stroke

increased risk of bleeding; easy bruising (see doctor if serious fall, head trauma, etc)-apply ice, pressure

Angiotensin II Receptor Blockers

losartan (Cozaar), ), losartan+ hydrochlorothiazide = (Hyzaar), valsartan (Diovan)or with diuretic = (Diovan HCT) candesartan (Atacand)

blocking the effect of a chemical –angiotensin II -that causes the small blood vessels to constrict

low blood pressure; poor kidney function (especially if diuretic and non-steroidal antinflammatory meds are also used)

Calcium Channel Blockers

Amlodipine (Norvasc) – when combined with ACE inhibitor benazepril = Lotrel

interfering with calcium's role in the contraction of the heart and blood vessel muscles, which causes them to relax

headaches; facial flushing; dizziness; ankle swelling


K-Dur, K-Lyte, Micro-K, K-Lor

increasing potassium that is lost when taking diuretics

too much potassium in the blood, which usually occurs when there are problems with kidney function or ACE inhibitors are used

How can I help myself ? (when to call the doctor):

1. If increasing shortness of breath – especially at night or if needing to sit up to breath

2. If weight gain over several days – especially if accompanied by swelling of the legs (‘edema”) – Weigh yourself daily –morning and night and write it down

3. If blood pressure is consistently over 130 systolic or 10-15 points less than usual for you

4. Don’t start or stop medicines including over the counter medications such as Motrin, Advil, etc without discussing it with me first

5. Don't start or stop taking Lasix or other diuretics without talking it over with me first

6. Learn as much as you can about heart failure and how to manage it

7. Work with me to try to fix the problems that caused the heart failure in the first place such as fixing high blood pressure or avoiding further heart attacks

8. Learn your medications and carry a list with you at all times