CHF stands for congestive heart failure. CHF is not a kind of heart disease. Heart disease is called cardiomyopathy and it's cardiomyopathy that causes heart failure. Heart failure is the set of symptoms that hit you when your heart can't pump enough blood to meet your body's needs. It's called congestive because fluid settles in your lungs, "congesting" you. Honestly, I usually think of CHF as meaning Chronic Heart Failure.
So now you have a weak heart, probably enlarged. You may have "episodes" of heart failure, meaning sometimes you have the symptoms and sometimes you don't. Or you may have symptoms all the time. Either way, you "have" CHF. However, you are only "in" CHF if you are having symptoms right now. The symptoms include shortness of breath, fatigue, lightheadedness, swelling, insomnia, and the other fun stuff described in the section called Expect These Symptoms .
If you don't usually have symptoms, you are called "well compensated." This means meds and life style changes are compensating for your weak heart function. If you are in CHF, meaning that you have all or some of those symptoms, you are called "decompensated." With good treatment your CHF (symptoms) may go away, but that doesn't mean you're cured. You should be kept on certain drugs even if all your symptoms go away - to keep them away.
What's happening to my heart?
Your lungs take the oxygen you breathe in and put it into your blood. Your heart pumps that oxygen-rich blood out of your lungs into the rest of your body. Your other organs and tissues get a good drink of oxygen-rich blood and then it goes back through your lungs, picking up oxygen again. The heart pumps it out again and again and again - we hope.
A weakened heart can't pump hard enough to keep up with this cycle. It receives more blood from the lungs than it can pump out into the body with each heart beat. The blood it can't handle backs up, spilling over into the lungs and other tissues. Cells get waterlogged. This causes swelling called edema .
This swelling often happens in the ankles and legs first. That's because gravity pulls the backed-up, "loose" fluid straight down. The fluid also backs up into your lungs, which makes it hard to breathe. When you're lying down, gravity isn't pulling the fluid out of your lungs down into your feet, so it is even harder to breathe. Your heart can fail in two basic ways:
Systolic dysfunction is when the heart can't pump out enough blood. Most CHFers have this problem
Diastolic dysfunction is when enough blood cannot get into the heart because the heart muscle refuses to properly relax. Because the heart doesn't relax, there isn't enough room inside it for all the blood. With diastolic dysfunction, your heart may be normal size and you may have a normal ejection fraction
Do I really have heart failure?
Your heart does not just stop if you go into heart failure. Usually you get heart failure over a period of time - maybe even years - before it is diagnosed. Heart failure causes shortness of breath, swelling of legs, feet and maybe your stomach. You can get a feeling of fullness in your stomach that makes it hard to breathe. Sleeping can be difficult. Wheezing and extreme fatigue are common.
Heart failure is often misdiagnosed as respiratory infection, bronchitis, asthma or gallstones. Certain tests can identify heart failure in different ways. A chest x-ray can show if your heart is enlarged. An echocardiogram can measure how well your heart is pumping. A new 20-minute blood test called the Triage BNP test can confirm a CHF diagnosis. Some common causes of congestive heart failure are listed here .
Am I going to die tomorrow?
With proper treatment, you may live a long time with heart failure. Of course, some adjustments have to be made. That's why you should read the rest of this page. It will tell you in plain English what to expect, what to do, and what not to do. If you doubt anything you read here, please discuss it with your doctor, whom I hope is a CHF specialist .
It is said that up to 40% of people with heart failure will die from SCD (sudden cardiac death) but I would personally guess 15% or less. This is more likely in people with arrhythmia - an unstable heart rhythm. The longer or more often you are in heart failure, the more likely you are to develop an unstable heart rhythm. That's because as your heart enlarges, the electrical pathways in the heart get stretched out and no longer work quite right. The subtances in your body that control "electricity" also get out of whack. In end-stage CHF, your lungs may fill with fluid, drowning you. I don't want to depress you, but my pages are honest and accurate. I won't
yank your chain. Inotropes can relieve a lot of symptoms in people with end-stage heart failure.
Where can I learn about all this stuff?
Doctors often pass off cardiomyopathy and CHF as the same thing but as you've seen, they're not. Cardiomyopathy causes heart failure. See my Site Index for links to plain English pages about heart failure. ACE inhibitors. beta-blockers. drug trials. IV drugs. medical studies. CHF tests. implanted devices. low sodium diet and links to lots more. The Beat Goes On. the Me Too pages let you talk to other people living with heart failure. Jon's Place also offers support. If you prefer reading a book, the one I highly recommend is Success With Heart Failure by Dr. Marc Silver. It's worth reading cover to cover.
Can I be cured?
You may live well for a long time if you do it right. Both support and information that you need to improve your life are offered here. It's time to accept the fact that you are sick - but don't dwell on it.
The two questions I hear most are, "How long do I have?" and "Can I be cured?" No one knows how long you have - not the doctors, not me, not anyone. Other health problems, the cause of your heart failure, your life style, genetics, and many other factors figure into it. Concentrate on living - not on dying. A positive outlook literally increases your chances of living longer.
Your cardiomyopathy may get cured, but your heart usually sustains some permanent damage before the underlying problem is fixed. This is one reason it's a question with no answer. It depends completely on your individual circumstances. Focus on getting back near-normal heart function instead of thinking "cure."
In studies, the highest number of CHFers to get back to truly normal was 27%. If you haven't gotten your heart function and energy back in the first year after diagnosis, you may not ever get it all back. You may get a whole lot better - just not fully "normal." Get with the program and know what to do and why - and then do it - and I believe most CHFers can indeed get much better. It was several years after my diagnosis that I really improved.
How long do I have to take all these pills?
If you do get normal heart function back, your doc would be wise to keep you on an ACE inhibitor and a beta-blocker for life, since CHF can come back. Time and time again, I see CHFers come to my heart forum, regain heart function, go off their meds, and they're back in a year - back in serious heart failure! This is even stated in the official heart failure treatment guidelines .
For the other common question, "Can my enlarged heart shrink back to normal size?" I do have an answer. Yes, an enlarged heart can return to normal size. ACE inhibitors and beta-blockers are the best bet to reverse this heart remodeling. Now, let's explain those mysterious heart classes the docs always talk about - Class one, Class 3, whatever! Jon.
No limitation; Ordinary physical activity does not cause excess fatigue, shortness of breath or palpitations.
Slight limitation of physical activity; Patients are comfortable at rest but ordinary physical activity results in fatigue, shortness of breath, palpitations, or angina.
Marked limitation of physical activity; Although patients are comfortable at rest, less than ordinary activity will lead to symptoms.
Inability to carry on any physical activity without discomfort; Symptoms of congestive heart failure are present even at rest. With any physical activity, increased discomfort is experienced.
As of November 8, 2001, the American College of Cardiology and the American Heart Association have released a new class system for heart failure patients. This new system is meant to be used along with the functional class system described above. The new system classifies heart failure in "stages" A through D. Only stage C and D patients actually have CHF. The new guidelines can be found at www.acc.org and www.americanheart.org .
patient is at high risk for developing CHF but has no structural disorder of the heart. Examples: patients at high risk for developing CHF because of high blood pressure, CAD. diabetes, history of drug or alcohol abuse, history of rheumatic fever, family history of cardiomyopathy, etc.
patient has a structural disorder of the heart but has never developed CHF symptoms. Examples: patients with structural heart disease like left heart enlargement, heart fibrosis, valve disease, previous heart attack.
patient with past or current CHF symptoms and underlying structural heart disease.
patient with end-stage disease who is frequently hospitalized for CHF or who requires special treatments such as LVAD. artificial heart. inotropic infusions. heart transplant or hospice care.