Congestive heart failure (CHF) develops when damage or disease impairs the heart's ability to pump blood. Because the heart's pumping action can't keep up to meet the body's needs, blood backs up in the blood vessels, creating congestion in the blood vessels, organs and tissues. Heart failure can be treated with medication, diet, and sometimes with surgery. For some peopl,e CHF remains mild, but most people with CHF decline over a long period as the heart's deterioration leads to severe complications. The end stages of CHF result from fluid overload of one or more organs.
Fatigue, Weakness, and Reduced Stamina
In CHF, fluid backs up in the blood vessels that empty from the lungs into the heart. Increased pressure in the vessels shifts fluid into the lung sacs where oxygen and carbon dioxide are exchanged. This excess fluid makes breathing difficult and impairs the absorption of oxygen. With too little oxygen available, people with CHF become tired easily, especially with exercise. As the disease progresses, they may become too weak and short of breath to walk.
Shortness of Breath
All people with CHF have some degree of shortness of breath, but toward the end, shortness of breath may be severe even without activity. Many people with advanced CHF feel breathless lying flat and need to sleep sitting up in a recliner or propped on pillows. Most at this stage require supplemental oxygen.
Swelling
As the heart weakens and fluid accumulates in the body, most people with CHF experience extreme swelling and puffiness, also called edema. Swelling typically begins in the feet and ankles, and in late-stage CHF many people have severe swelling up to or including their hips and abdomen. Abdominal pressure from retained fluid sometimes causes lack of appetite and nausea.
Pulmonary Edema
In advanced CHF, lungs become so congested with fluid that much less oxygen is exchanged. This condition, called pulmonary edema, drastically affects the patient's breathing. Patients may be gasping for breath even with supplemental oxygen. In mild CHF, pulmonary edema can be prevented or treated with medications called diuretics that trigger the kidneys to pull excess water out of the body. However, in end-stage CHF the weakened heart can't pump forcefully enough to flush blood through the kidneys, making diuretics ineffective. Furthermore, long-term CHF often causes such severe kidney damage that high doses of diuretics will lead to kidney failure. Symptoms of pulmonary edema include breathlessness, increased heart rate, restlessness, and anxiety. Coughing may be present and may produce pink-tinged sputum. Patients at this stage are often given supplemental oxygen and morphine to ease the work of breathing.
