Congestive Heart Failure

Congestive heart failure (CHF) is a serious, progressive condition that affects millions of people worldwide, yet it is often misunderstood. Contrary to its name, heart failure does not mean the heart has stopped working—it means the heart is struggling to pump blood efficiently, leading to a buildup of fluid in the lungs and other parts of the body.

Here, Raaid Museitif, MD, Cardiologist at Fort HealthCare, discusses the causes, risk factors, symptoms, and treatment options for CHF, empowering individuals with the knowledge to recognize, prevent, and manage this common yet serious heart condition.

When the Heart’s “Plumbing” System Breaks Down

Per Dr. Museitif, heart failure is much like a plumbing issue in a house. When the system is working properly, fluid (blood) moves efficiently through arteries, which deliver oxygen-rich blood—like clean water from a main pipe—and veins, which drain deoxygenated blood, like a home’s wastewater system.

However, when there is a malfunction—whether due to heart issues, kidney problems, malnutrition, or liver disease—fluid can leak from blood vessels into surrounding tissues, causing swelling, shortness of breath, and other complications. Just as a failed sump pump can lead to basement flooding, a failing heart or circulatory system can result in fluid buildup throughout the body, leading to congestive heart failure.

How Is Congestive Heart Failure Diagnosed?

Congestive heart failure is a clinical diagnosis, meaning it is identified based on a patient’s history, physical exam, and specific tests rather than a single definitive marker. A person may have heart, kidney, or protein issues without necessarily being in heart failure.

Healthcare providers diagnose CHF by listening for extra heart sounds or crackling in the lungs, checking for swelling in the legs, and observing the jugular vein in the neck for signs of fluid overload. To confirm the diagnosis, they use a BNP blood test (brain natriuretic peptide), which detects a hormone released by the heart when it is stretched due to excess fluid. Additional tests, such as chest X-rays, kidney and protein blood tests, and an echocardiogram—which is an ultrasound of the heart—help assess the severity and underlying cause of CHF.

“Our heart and our body are so amazing. The heart can actually sense if it’s being stretched with too much fluid. It would leak out that hormone, which is actually a signal. It’s almost like a walkie talkie smoke signal. The BNP goes to your kidneys and tells them, ‘Hey, we have too much fluid,’ and it will try to make your kidneys urinate out more fluid,” explains Dr. Museitif. “That’ll compensate for a while. Then, eventually it fails.”

The Age Factor with CHF

With age, several physiological changes make people more susceptible to CHF. Blood vessels become stiffer, reducing their ability to expand and contract, which impacts blood pressure regulation. Kidneys become less efficient at removing excess fluid, while the liver and nutrition deficiencies—especially low protein levels—further contribute to fluid imbalances. Additionally, the heart itself stiffens, leading to diastolic dysfunction, where the heart struggles to relax and fill properly.

Another key factor is the development of arrhythmias, particularly atrial fibrillation (AFib), which disrupts the heart’s normal rhythm and can contribute to CHF. Given the complex, multi-organ involvement, treating heart failure in elderly patients requires a team-based approach, involving cardiologists, nephrologists, pulmonologists, nutritionists, and internal medicine specialists. Managing CHF often requires balancing medications that remove excess fluid while ensuring they don’t harm the kidneys or other organs, making a collaborative, specialized care plan essential for older adults.

“As we get older, just a normal part of aging, all those causes of heart failure start to add up. A lot of times, those old cliches we’ve heard since childhood come true. There’s a reason why they stick around for hundreds and thousands of years, these sayings, but the combination of factors becomes the straw that broke the camel’s back. So, as we age, people can go into heart failure one day. Why weren’t they in heart failure yesterday? Well, it’s the straw that broke the camel’s back.”

Treating Congestive Heart Failure

Treating CHF starts with identifying the underlying cause, just like diagnosing the source of a flooded house before making repairs. If CHF is due to kidney failure, treatments may include medication or dialysis to remove excess fluid. If it stems from malnutrition or liver disease, those conditions must be addressed. If it’s a venous issue, treatment focuses on improving circulation.

When CHF is caused by the heart itself, treatment depends on the specific problem. If there is fluid around the heart, it can be drained. If a heart valve is damaged, it may need repair. If the heart isn’t pumping effectively, doctors determine whether the issue is due to blocked coronary arteries (ischemic cardiomyopathy), which may require procedures to restore blood flow, or if it is a non-ischemic cardiomyopathy, where the heart is weak despite open arteries, possibly due to infections or other conditions.

“We have guideline directed medical therapy for heart failure and have multiple classes of medications that are designed to get your heart pumping back again,” notes Dr. Museitif. “So, we first make a diagnosis. After making a diagnosis, we tailor the treatment specifically to the cause of the heart failure.”