Congestive heart failure occurs when a dilated heart cannot pump blood into the circulation, a condition that is not compatible with life. As such, congestive heart failure is the endpoint of many types of heart disease, lung disease, and hypertension.

Disease and Congestion

The term "heart disease" most commonly refers to ischemic heart disease, a situation in which not enough blood is supplied to the heart muscle. When the heart becomes diseased, it is eventually no longer able to eject blood through the aorta. This lack of pumping causes the heart to fill with blood, resulting in dilatation of the chambers and congestion of the venous system, which provides the term "congestive" to describe the heart failure.

Heart Failure

If the heart tissue is damaged, as often occurs with ischemia and other diseases, the heart can no longer contract efficiently. Contraction is necessary for the heart to pump blood through the lungs and out to the body. An inability to eject the blood out of the heart is called forward failure. This initial event compromises circulation, resulting in kidney and liver problems. The blood remaining in the heart initially backs up into the blood vessels of the lungs, leading to pulmonary edema, an accumulation of fluid in the lungs. The congestion continues to affect upstream vessels, resulting in backward failure.

Compensated vs. Decompensated Heart Failure

Compensated heart failure is the maintenance of output despite the dilatation, which can be likened to a balloon filling with air as the heart fills with blood and works against the extra load. The heart may meet the output demand by increasing the heart rate or increasing the contraction force of the ventricles. Eventually, the heart can no longer meet the demand, even by compensating, and decompensated heart failure ensues, resulting in death.

Left-side vs. Right-side Heart Failure

The first side of the heart to fail is the left. This is easily remembered by knowing that pulmonary edema is one sign of congestive heart failure. The pulmonary vessels connect the right side to the left, which ejects blood through the aorta. Left-sided failure is most often caused by hypertension, ischemic heart disease (often caused by heart attacks), mitral or aortic valve disease, and primary myocardial diseases. Right-side failure is most often a result of left-side heart failure, though it can also occur as a result of cor pulmonale, which is most often caused by chronic obstructive pulmonary disease (COPD), a disorder associated with long-term cigarette smoking.

Treating Congestive Heart Failure

There are medications available to treat congestive heart failure and maintain cardiac output. These compounds remove excess water and salt to limit the pressure in the compromised circulation, such as furosemide (lasix) and anti-hypertensive drugs, in particular angiotensin receptor blockers (ARBs) and ACE inhibitors. Digitalis and dobutamine are also used because they strengthen the heart muscle and heart function over weeks and months. There are also surgical remedies, depending on the particular case, that can be discussed with your physician.

Learn more about this author, Alicia M Prater PhD.
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