Congestive Heart Failure (CHF) Overview: Causes and Symptoms

That old schoolyard ditty, “Sticks and stones can break my bones…” got it all wrong. Names can hurt you, especially if they cause undue anxiety about a medical condition. Take the term “heart failure.” To many people, it implies that your heart is on the verge of calling it quits, a vision that can be very scary. Actually, in medical lingo, “failure” really means “fatigue.” The vast majority of the 5 million Americans who have congestive heart failure (CHF) are not in imminent danger of dying.

On the other hand, CHF can be fatal. It kills some 43,000 Americans each year, according to the American Heart Association. In general, the longer you have it, the more serious it becomes. After five years, the death rate from CHF is around 50 percent. About two-thirds of those who die from CHF are women.

CHF is rare before age 45. But it rises steadily after that, with people over 75 at greatest risk.

Symptoms of Congestive Heart Failure (CHF)

Shortness of breath and swollen ankles are the classic symptoms of congestive heart failure, one of the nation’s most common—but underpublicized—serious medical conditions.

CHF develops when, after many years of being overworked, your heart begins to poop out. It keeps pumping, but not as well as it should. As CHF develops, your blood flow slows. Your tissues don’t get the oxygen they need. Your body tries to compensate by increasing your rate of breathing, which is one reason why shortness of breath is a common CHF symptom. The other effect of slowed blood flow is that blood doesn’t return to your heart as well as it should. It backs up in your veins, and collects in your tissues, causing swelling (edema) and congestion, hence “congestive” heart failure. Fluid is most likely to collect in areas farthest from your heart, notably in your ankles and feet, which is why swollen ankles are a common CHF symptom. Fluid may also collect in your lungs, which aggravates shortness of breath.

Heart failure also affects your kidneys, which are very sensitive to changes in blood flow. As your circulation becomes sluggish, your kidneys can’t eliminate excess fluid like they should. Retained fluid just adds to tissue swelling and congestion.

CHF can also lead to electrical problems in your heart that make it beat irregularly (arrythmias). Arrythmias, in turn, can lead to a potentially fatal condition similar to heart attack called sudden cardiac death.

Finally, CHF may cause a persistent cough because of fluid accumulation in your lungs.

Causes and Risk Factors for Congestive Heart Failure (CHF)

The most common cause of CHF is the narrowing of your arteries (atherosclerosis) by cholesterol-rich deposits (plaques), the same process that causes heart disease and most strokes.

As your arteries narrow, your heart must work harder to pump blood through them, and over time, it becomes fatigued. Atherosclerosis also raises blood pressure. High blood pressure is another key CHF risk factor. About three-quarters of those who develop CHF have high blood pressure, and a recent analysis of 14 years of data from the Framingham Heart Study, the nation’s oldest ongoing investigation of risk factors for heart disease, showed that of all the risk factors for atherosclerosis—high blood pressure, high cholesterol, high-fat diet, obesity, diabetes, lack of exercise, and hard-driving Type-A behavior—high blood pressure is the most important.

Other risk factors for CHF include: high salt intake, high temperature, kidney or liver disease, obesity, certain nutrient deficiencies, and emotional stress.

Some 225 years ago, congestive heart failure played a pivotal role in demonstrating to mainstream doctors that folk herbalists had more up their sleeves than just “old wives’ tales.” Back then, CHF was called “dropsy,” and doctors were powerless to treat the shortness of breath and swelling it caused.

Then in 1775, the fiancée of an English physician, William Withering, mentioned that she knew a “wise woman” out in the countryside who could treat dropsy. The couple visited a Shropshire herbalist, who showed Withering the tea she used. Its main ingredient was foxglove (Digitalis purpurea).

Withering tested the plant on patients with dropsy, found it effective, and wrote of his success in a medical journal. His report introduced this herb into medicine. Until fairly recently, drugs derived from foxglove, notably digoxin, were first-line treatments for CHF. Recently, that has changed (see Pharmaceutical Drugs to Treat CHF), but foxglove-derived drugs continue to be prescribed to treat this condition.

See Congestive Heart Failure Treatments and Remedies for more information.