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Congestive Heart Failure (CHF)

Congestive heart failure (CHF), also known as heart failure, is a condition in which the heart cannot pump enough blood to meet your body’s needs. Although the term sounds frightening, the definition of CHF does not mean your heart has stopped — it just indicates your heart might be weak and is not working effectively.

The UPMC Heart and Vascular Institute's Advanced Heart Failure Center is among the nation’s leading programs of its kind and the only full-service center in western Pennsylvania. We offer standard and minimally invasive procedures to treat CHF and other serious heart conditions.

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What Is Congestive Heart Failure?

According to the American Heart Association, more than 5 million people in the United States are currently living with heart failure. It's the most common reason for older adults to go to the hospital.

Causes of congestive heart failure

Congestive heart failure (CHF) is often the result of severe coronary artery disease, which decreases blood flow to the heart.

Pulmonary hypertension — a buildup of pressure in the blood traveling from the heart to the lungs — can also cause CHF.

Other causes of CHF often may include:

  • A previous heart attack, which weakens the muscle tissue in the heart
  • Prolonged high blood pressure
  • Cardiomyopathy
  • Abnormal heart valves
  • Congenital heart disease
  • Alcohol and drug abuse
  • Certain kinds of infections

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Congestive Heart Failure Symptoms and Diagnosis

Congestive heart failure (CHF) usually develops slowly, as the heart tries to compensate for its loss of function.

The heart’s weak pumping action causes a build-up of fluid, or congestion, in the lungs and other body tissues.

As CHF progresses, the heart becomes weaker and symptoms begin.

Congestive heart failure symptoms

Early CHF signs include:

  • Shortness of breath
  • Swelling (edema) of the ankles and feet
  • Fatigue and weakness
  • Irregular or rapid heart beat
  • Persistent cough or wheezing (possibly accompanied by white or blood-tinged phlegm)
  • Rapid weight gain
  • Increased or decreased urination

Diagnosing congestive heart failure

CHF diagnosis begins with a physical exam and review of your symptoms and medical history.

The doctor will use a stethoscope to listen for:

  • The crackling sounds of fluid in the lungs.
  • A heart murmur indicating faulty valves.
  • A quick heart beat.

A chest x-ray can show if your heart is enlarged and if you have fluid in and around your lungs.

Your doctor may order additional diagnostic tests, including:

  • An electrocardiogram (EKG)
  • An echocardiogram
  • Nuclear scanning
  • Coronary angiography
  • CT scans
  • MRI scans
  • An exercise stress test

Testing results

Your doctor or nurse will tell you when to expect your test results and will call you when they're available.

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Congestive Heart Failure Treatment

The Advanced Heart Failure Center at UPMC's Heart and Vascular Institute specializes in the treatment of people with congestive heart failure (CHF).

Depending on the severity of the disease and your general health, our group crafts a course of treatment to meet one of three goals:

  • Recovery
    • Lifestyle changes — such as quitting smoking, exercising, and managing your diet — can all help ease the workload of your heart.
    • Medical management — the mainstay of heart failure treatment — provides the recovery path leading to healing of the heart.
  • Repair
    • When medical management is not enough, our specialists may recommend a temporary or permanent device — like a defibrillator or a pacemaker — to repair a damaged heart.
    • Reparative heart surgery — In some cases, the heart valves or vessels themselves are so weak that you may need surgery. Our surgeons are experts at repairing (and replacing) damaged valves.
  • Replacement
    • Heart transplants — As one of the first medical centers to perform heart transplants, UPMC's experience and expertise are known the world over.
    • Ventricular assist devices (VADs) — In many cases, a VAD is the best treatment solution. They work mechanically to support the heart or augment the circulation of blood. They can act as a bridge to transplantation until a suitable donor organ becomes available, or until the heart muscle recovers on its own.
    • Destination VAD therapy — If you're not a candidate for a heart transplant, VADs may remain in place indefinitely. This growing treatment path is known as destination VAD therapy.

Each treatment path is intended to reduce the workload on your heart while restoring as much normal functioning to your life as possible.

Sometimes, treatment paths overlap. We often recommend combining certain treatment options to achieve the best results.

And, our researchers are continually working to develop new treatments that offer hope to more patients every day.

Medicines for congestive heart failure

In many cases, drugs can alleviate the consequences of CHF. Managing heart failure with medicine is a time-tested strategy that has helped people live better lives for years.

Every medicine has side effects and risks, but the risks are usually not as serious as leaving CHF untreated. Never stop taking medications without talking to your doctor.

Angiotensin converting enzyme (ACE) inhibitors

  • How does it work?
    • Block a hormone that increases blood pressure and worsens heart failure.
    • Regulate blood pressure to improve cardiac function.
  • Drug names
    • Captopril (Capoten®)
    • Enalapril (Vasotec®)
    • Lisinopril (Prinivil®)

Beta blockers

  • How does it work?
    • Keep stimulating hormones like epinephrine (adrenaline) and norepinephrine away from the heart's beta receptors.
    • Block the hormones to reduce the stress on the heart.
    • Often used in conjunction with ACE inhibitors.
  • Drug names
    • Carvedilol (Coreg®)
    • Metoprolol (Toprol-XL®)

Diuretics (water pills)

  • How does it work?
    • Increase urination to help the kidneys eliminate excess fluid from the body.
    • Often used together with a low sodium diet.
  • Drug names
    • Furosemide (Lasix®)
    • Ethacrynic acid (Edecrin®)
    • Bumetanide (Bumex®)
    • Hydrochlorothiazide (HydroDIURILl®)
    • Chlorothiazide (Diuril®)

Monitoring congestive heart failure

If you are living with congestive heart failure, your doctor will help you determine the best way to monitor your condition and reduce your chance of future hospitalizations.

Self-Management Skills
Doctors recommend that people with congestive heart failure develop good self-management skills to help manage their conditions. These self-management skills include:

  • Weighing yourself and recording your weight daily, reporting any gains of more than 2-3 pounds over two days or 4-5 pounds over one week to your doctor
  • Following a low-sodium diet
  • Taking all the medications your doctor prescribes

Your doctor can also provide recommendations for limiting your fluid intake, getting regular exercise, and quitting smoking, all of which can help manage your heart failure.

CardioMEMS™ HF System
Select patients may be eligible for the CardioMEMS™ HF System. Approved by the U.S. Food and Drug Administration in 2014, the system uses a small sensor implanted in your pulmonary artery and an external electronic system to transmit information directly to your doctor's office.

With the CardioMEMS™ HF System, you take daily readings of our pulmonary artery pressure from home. The readings are delivered securely to your doctor's office through an external electronic system, and can help your doctor determine if your condition is getting worse before you have symptoms. Your doctor can then adjust your medication or treatment plan and help you avoid hospitalization.

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Ventricular Assist Devices for Congestive Heart Failure

If your heart becomes too weak to respond to medical therapies, you may benefit from a ventricular assist device (VAD).

Also called artificial heart devices,VADs are small pumps that are implanted in the chest/upper abdomen and take over the pumping function for a failing heart.

They allow people to recover from their congestive heart failure (CHF), undergo rehabilitation, and be discharged from the hospital.

Overall survival, as well as functional capacity and quality of life also improve substantially after VAD implantation.

At the Advanced Heart Failure Center at UPMC, we offer several models of VADs to treat CHF.

Device selection depends on many criteria, such as:

  • Blood type
  • Medical history
  • Presence of a bleeding disorder
  • Body size

Devices provide left, right, or both left and right heart support.

Your doctors will know which one is right for you.

Who benefits from ventricular assist devices?

Your doctor may refer you for a VAD as:

Bridge to transplantation

Each year, more people with end-stage heart failure are evaluated and listed for transplantation. Unfortunately, there are not enough suitable donor organs for all of the patients waiting for a heart transplant.

People who are listed for heart transplantation and are too ill to wait any longer, or are expected to have prolonged wait times, are referred for a VAD as a bridge to transplantation. The VAD allows them to recover and wait at home for an organ to become available.

Bridge to recovery

In some cases of heart failure — particularly newly diagnosed CHF or heart failure after other cardiac surgery — the heart may recover after a period of support on a VAD. These patients are supported temporarily as a bridge to recovery.

After implantation, the VAD is turned down and the heart is reassessed to see if its function has improved enough to allow the VAD to be removed.

Typically, people recommended for VAD as a bridge to recovery have CHF as a result of:

  • Viral infection (myocarditis)
  • Childbirth (postpartum cardiomyopathy)
  • A heart attack
  • Another cause of heart disease that has not responded to medical therapy

Destination therapy

There is a growing population of people with end-stage heart failure who are not candidates for heart transplantation, usually due to age or other chronic medical problems. 

These patients may be referred for a VAD as an alternative to heart transplantation. This is known as destination therapy.

For end-stage heart failure patients who are not eligible for heart transplantation, destination VAD therapy:

  • Improves survival
  • Enhances functional status and quality of life
  • Allows for years of support

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