Congestive Heart Failure (CHF)

Sometimes the heart becomes larger and fails as a pump. There can be several reasons for this. Some of them are:

a) Generalized slow development of coronary artery disease. This can develop slower and more diffusely so that no overt heart attack will develop. Instead there is a diffuse slow death of many of the heart muscle fibers.

b) Leaky heart valves. This leads to a backwards flow and accumulation of fluid in the heart eventually widening and enlarging the heart (heart enlargement).

c) Myocarditis from toxins such as alcohol abuse or from viral infection, which both leads to diffuse damage of the heart muscle and CHF (congestive heart failure).

The cardiologist needs to sort out what the cause is of CHF. Often it remains unknown of there is a combination of factors. Before the ACE inhibitors CHF was as deadly as cancer with a 5 year survival of about 50%. Now on an ACE inhibitor the average survival is about 10 years or more. In the case of heart valve problems porcine and other valve replacements by a cardiovascular surgeon have improved survival even more. Viral and alcoholic myocarditis have the worst prognosis and may require a heart transplant to replace the failing pump with a "new" pump.

More on treatment from the Mayo Clinic.

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapters 197, 202, 205 and 207.

2. Braunwald: Heart Disease: A Textbook of Cardiovascular Medicine, 6th ed., 2001, W. B. Saunders Co.

3. D C Bauer: Audio-Digest Family Practice Vol. 49, Iss. 09, March 2, 2001.

Last Modified: Dec. 17, 2006