CONGESTIVE HEART FAILURE (CHF)

General Information:

What is it? Congestive (kon-JES-tiv) heart failure is also called CHF or heart failure. It occurs when the heart muscle is weak and has trouble pumping out blood. Fluid collects in the lungs or other parts of the body. This is because the heart is not pumping as well as it should. This causes your body to not get enough oxygen-rich blood to keep you healthy and strong. CHF starts slowly and gets worse over time.

What causes CHF? A heart attack, heart disease, or high blood pressure may cause CHF. Other causes may be heart valve problems, heart muscle disease, or diabetes. Narrowed arteries that supply blood to the heart muscle may also cause CHF. Some medicines and lung or thyroid disease may also cause CHF.

What are the signs and symptoms of CHF? You may have trouble breathing that is worse during exercise or when lying down. Other signs may be edema (swelling) in your ankles, legs, or abdomen. You may feel restless, tired, or weak. You may gain weight. You may not be hungry, or you may feel full quickly when you eat. You may have a dry cough that does not go away. You may cough up white frothy phlegm.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.

IV: An IV (intravenous) is a tube placed in your vein that is used to give you medicine or liquids.

Oxygen: You may need to get oxygen through a plastic mask or nasal cannula. A nasal cannula is a pair of short, thin tubes that are placed inside your nose. Tell your caregiver if the mask or prongs bother you, or if your nose gets dry. Ask your caregiver before taking off your oxygen mask, or removing your nasal cannula.

Pacemaker: This is a small device that helps your heart beat more regularly. Special cells inside the heart send electrical signals to the heart muscles telling the heart to beat. These cells are called pacemaker cells. If something stops the pacemaker cells or your heart from working correctly, your heart may not beat normally. Caregivers may put a temporary or permanent pacemaker inside your chest to help your heart beat more regularly. This pacemaker is made of electrodes (thin flexible wires) and a generator (battery).

Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.

Rest: You may need a lot of rest while in the hospital. Resting with your head on 2 or 3 pillows may help you breathe easier.

Weight: You may be weighed at about the same time every day. Caregivers will compare your weight from day to day. This helps caregivers see how much body fluid you have. CHF causes your body to have too much fluid. If you have too much body fluid, you may have trouble breathing or have swollen ankles. Medicine will be used to help get rid of this extra fluid. If you lose too much body fluid you can become dehydrated. Your body cannot work very well when it has too much or too little fluid.

Tests: 

• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
• Blood gases: This test is also called an arterial blood gas or ABG test. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
• Cardiac catheterization: This is a test to see if your arteries (blood vessels) are blocked and causing your heart failure. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen. Tell your caregivers if you have an allergy to iodine or shellfish.
  
• Cardiac stress test: This test helps caregivers see the changes that take place in your heart during exercise. It checks for blockage in the arteries of your heart. An EKG is done while you ride an exercise bike or walk on a treadmill. Caregivers will ask you how you are feeling during the test. They will want to know if you have chest pain or trouble breathing. Be sure to tell them how you feel.
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
• Echo: This test is also called echocardiography (ek-oh-kahr-dee-OG-rah-fee). Sound waves are used to show pictures of the size and shape of your heart. It also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen. This is a painless test done while lying down. It can tell if your heart is pumping well. An echo can also find heart problems, such as a heart attack or fluid around the heart. Problems with the valves of your heart may also be seen during an echo.
  
• Nuclear medicine testing: These tests show how well your heart is pumping. You will be given a small, safe amount of radioactive imaging agent (liquid). Caregivers will then take pictures of your heart. The pictures show if your heart is pumping the correct way.

Treatment options: You may have one or more of the following treatments.

Angioplasty: An angioplasty is a treatment that may be needed to open up an artery (blood vessel) blocked by plaque. Plaque is fatty material inside your arteries. A special tube with a balloon on the end is threaded into the blocked artery. Once the tube is in the artery, the balloon is filled up. As the balloon fills, it presses the plaque against the wall of the artery. Pressing the plaque against the artery wall opens the artery up so blood can easily flow through it.

Medicines: 

• Blood thinners: Blood thinners are medicines that help prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners may cause you to bleed or bruise more easily. If you are taking a blood thinner:
  
  
  • Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. Doing this can keep your skin and gums from bleeding. Tell your dentist and other caregivers that you take blood thinning medicine.
    
  • If you shave, use an electric shaver. Do not play contact sports since this medicine makes you bruise and bleed easily. Wear a bracelet or necklace that says you are taking blood thinning medicine.
    
• Diuretics: This medicine is often called water pills. Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
  
• Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.
  
• Morphine: This medicine helps decrease your pain. It may also help you breathe easier.
  
• Vasodilator medicine: This group of medicines relaxes the walls of arteries and veins so that blood can move through your body better.

Surgery: Your caregiver may suggest surgery if your CHF is very bad and no treatment has helped. These are some surgeries that may help people with CHF:

• Permanent pacemaker: This is a machine that helps your heart beat at a normal speed and in a regular rhythm.
  
• Valve repair or replacement: The valves in your heart are like doors between the chambers (rooms) of your heart. They keep the blood flowing in the right direction. With CHF, the valves may not work right. Caregivers may fix or replace them so that your heart works better.
  
• Bypass surgery: This is surgery to open blocked arteries on the heart.

How is CHF treated? CHF can usually be treated with the following:

• Medicine that helps your heart work better.
  
• Medicine that removes the extra fluid in your lungs and body.
  
• Oxygen to help you breathe easier.
  
• Tests and treatments in the hospital (blood tests, x-rays, or breathing treatments).

Medicines:

• Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
  
• Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.

Ask your caregiver when to return for a follow-up visit. Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.

Activity guidelines: 

• You may feel like resting more. Match your activity to the amount of energy you have. Nap a couple of times during the day. Going to bed early and getting up late may also help. Do not lift, push, or pull anything heavy, or work with your arms above your head until your caregiver says it is OK.
  
• Try to stay inside when it is hot or cold outside. Hot or cold temperatures cause your heart to work harder. Do activities during the cool part of the day in hot weather. Dress warmly in loose fitting clothes in cold weather. Cover your head and mouth to keep warm and to help you breathe.

Diet guidelines: 

• Always follow your caregiver's directions about how much liquid to drink.
  
  
  • You may need to limit the amount of liquid you drink each day to eight cups (64 ounces total) or less. Liquid intake does not only include water. It also includes ice, coffee, soda, milk, yogurt, pudding, ice cream, gelatin, or popsicles. Liquid intake also includes the water that you drink when you take your medicine. Check your cups, bowls, mugs, and glasses to see how much liquid they hold.
    
  • Write down and add up how much liquid you have each day. This will help you keep track of your liquid intake. If you use certain medicines that help your body get rid of fluid, you may often feel thirsty. If you feel thirsty, do not drink more than your caregiver tells you to. Instead, try sucking on small amounts of sugar-free candy to keep your mouth from getting too dry.
    
    
• Follow your caregiver's directions about the amount of salt to include in your diet. You may also be told to limit the amount of salt you eat. This means that you should not add salt to your food during meals or when you cook. You should also eat fewer high salt foods. Many vegetable juices and soups such as tomato soup, and packaged meats such as sausage contain a high amount of salt. Packaged foods such as seeds, nuts, potato chips and pretzels also may contain a high amount of salt. Read the labels on foods before buying or eating them. Ask your caregiver for more information about a low salt diet and how to read food labels. It can take time getting used to a new diet. Special cookbooks may help the cook in the family find new recipes.
  
  
• Eat a healthy diet as directed by your caregiver. Eat a variety of healthy foods including fruits, vegetables, breads, dairy products, meat and fish. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster. You may be told to eat foods that are low in fat. Ask your caregiver for more information about a low fat diet.

Monitor your weight: Weigh yourself every day before breakfast and write down the number. Being too heavy can make your heart work harder and can cause health problems. Weight gain can be a sign of worsening CHF. Call your caregiver if you have gained three or more pounds in one day, or five pounds in one week. You may need to talk to your caregiver about a weight loss plan.

CONTACT A CAREGIVER IF:

• You have a fever (increased body temperature).
  
• Your blood pressure is higher or lower than what your caregiver has told you it should be.
  
• Your pulse (heartbeat) is less than 50 beats each minute or over 100 beats each minute.
  
• You have swelling in your ankles, feet, hands, face, or neck.
  
• You have gained weight without trying.
  
• You are lightheaded or dizzy, sweaty, or feel sick after you take your medicine.
  
• You cough up yellow, green, or pink sputum.
  
• You have a dry cough that does not go away.
  
• You are wheezing (a high pitched noise when breathing in or out).
  
• You do not have an appetite and do not want to eat.
  
• You have any questions or concerns about your illness or medicine

SEEK CARE IMMEDIATELY IF:

• You have more trouble breathing than usual or cannot sleep or rest because of breathing problems.
  
• You are too dizzy to stand up.
  
• You have signs and symptoms of a heart attack. These may include the following:
  
  
  • Chest pain or discomfort that spreads to your arms, jaw, or back.
    
  • Nausea (sick to your stomach).
    
  • Trouble breathing.
    
  • Sweating.
    
  • This is an emergency. Call 911 or 0 (operator) for an ambulance to take you to the nearest hospital or clinic. Do not drive yourself!