Heart failure, in medical terms, doesn’t mean that
your heart has stopped beating. It means your heart
is failing to function properly. It isn’t pumping blood
out to the other organs and the rest of the body as
efficiently as it should.
Congestive heart failure
If you are in the hospital, but not for surgery or to have a baby, then you are probably over 65. And you are very likely in the hospital because of congestive heart failure.
That can lead to blood backing up into the lungs
and fluid seeping out of the bloodstream to cause
lung congestion. This is what is known as congestive
“When the lungs become wet, they have less
ability to exchange oxygen, and that translates to
shortness of breath, which is the main symptom
of congestive heart failure,” says Olujide Lawal,
M.D., a cardiologist with Sandhills Cardiology in
“I used to tell medical students that the heart does
just two things: It pumps and it relaxes. A failure to
do either one adequately can cause congestive heart
A common misconception is that only people
with weak hearts have congestive heart failure, says
Joseph Hakas, M.D., a cardiologist with Pinehurst
“It is actually fairly common to have a strong heart
that is inefficient,” he says. “Perhaps 40 percent
of people with congestive heart failure have hearts
that contract normally. It’s the relaxing they have
That is frequently the case in people with high
“When the heart muscle is having to work against
the blood pressure, it gets thicker, just like any
muscle would,” Dr. Hakas says. “It may squeeze
well, but it won’t relax properly.”
What causes heart failure?
Coronary artery disease is the number one cause
of heart failure. When one or more of the arteries
carrying blood to the heart is narrowed by the buildup
of plaque, the heart doesn’t get enough blood.
Over time, that weakens the heart to the point that
it begins to pump sluggishly.
If a section of the heart becomes so starved of
blood that some of the heart tissue starts to die, that
is a heart attack, which is another cause of congestive
The heart also can be weakened by viruses,
excessive alcohol use, thyroid disease and certain
inflammatory problems of the heart muscle.
Physicians can diagnose pre-symptomatic heart
failure with electrocardiograms (EKGs) and
congestive heart failure with blood tests.
|Olujide Lawal, M.D.
|Joseph Hakas, M.D.
If someone is diagnosed with heart failure but
doesn’t have symptoms, he or she often can be
treated effectively with medications without having
to be hospitalized. Congestive heart failure often
requires at least a few days of hospital care.
“The first thing we want to do is relieve their
shortness of breath,” Dr. Lawal says. “So, while they
are still in the Emergency Department, we give them
diuretics to reduce the volume of fluid the heart has
to pump and allow their wet lungs to dry.”
After that, physicians often give patients
medications to suppress the production of
adrenaline. Adrenaline causes the heart to beat
faster and the arteries to constrict, so blood
pressure goes up.
“If we block that effect, the blood pressure stays
low and the heart rate slows down, so it gives more
time for the heart to fill between beats,” Dr. Hakas
says. “This reduces mortality, too, partly because it
helps prevent heart rhythm problems. People with
weak hearts, in particular, are prone to dying from
If someone’s heart failure is caused by a viral
infection, thyroid disease or alcohol, the heart
can sometimes be restored to normal health by
eliminating the underlying problem. But in most
cases—that is, when heart failure is caused by
coronary artery disease or high blood pressure—the
damage can’t be reversed.
“In most patients, it isn’t curable, but we can often
manage it pretty well,” Dr. Hakas says. “If we keep
their blood pressure low, the heart can become
efficient again so, in a sense, their congestive heart
failure is fixed. But they remain on blood pressure
medication so that it doesn’t happen again.”
Excess weight and salt
Two of the greatest threats to people who are at
risk for heart failure are excess weight and excess
“The more obese you are, the higher your risk of
developing hypertension and diabetes, which can
lead to heart relaxation failure,” Dr. Lawal says.
Salt causes the body to retain fluid, which increases
the volume of blood and puts a greater burden on
“It’s very common for us to pinpoint salty food
as the trigger when people come into the hospital
with congestive heart failure,” Dr. Hakas says. “We
see a lot of that a few days after Thanksgiving and
Christmas. They have done really well with their
diet, but then they go to a relative’s house for the
holiday and have a big, salty meal.”
According to Dr. Hakas, the average American
diet contains too much salt and is much higher in
salt than someone with heart failure can tolerate.
“We can have you on the perfect combination of
medicines,” he says, “but if you’re eating the wrong
foods with too much salt, you’re going to get into
FirstHealth of the Carolinas offers a special program
for patients with congestive heart failure. For more
information, call (800) 213-3284.