Congestive heart failure

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Overview

Congestive heart failure (CHF) or cardiac failure (CCF) occurs when the heart can no longer pump blood quickly enough. This causes fluid to build up particularly in the liver, lungs, hands and feet. The legs may develop swelling that gets worse when the person stands and improves when they lie down. If the lungs are involved, it can cause shortness of breath and coughing, especially during exercise such as walking up stairs or when lying down flat in bed. CHF may occur in those who have had a previous heart attack or who have high blood pressure, narrowed arteries to the heart, infections, or congenital heart disease.

A combination of tests may be used to diagnose the condition, including physical examination, an echocardiogram and chest x-ray. Laboratory tests are used to a lesser extent, but may include urinalysis to determine if there is kidney failure and blood sampling to check for electrolyte balance or kidney failure, since symptoms of kidney disease are similar to those of CHF.

A new test, BNP or NT-proBNP (B-type natriuretic peptide), can be used to help diagnose CHF. However in Australia a Medicare rebate is only available if the test is ordered on a patient presenting to a hospital emergency department with symptoms of CHF. This is a substance produced by the left ventricle (the main pumping chamber of the heart). Levels of BNP are raised in CHF, and it is possible to use this to decide which patients should have further investigations.

CHF is usually a progressive disease. Treatment is aimed at stabilising the condition and treating the symptoms. This usually includes controlling salt intake, water retention and eliminating smoking and alcohol. Regulating these external problems will also help control blood pressure – a primary concern in heart diseases.

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