Heart Failure - The Basic

By understanding some basics about congestive heart failure (CHF) and its symptoms, you will be better prepared to care for your loved one and talk to his or her physicians. This section provides general information about how the heart works and how CHF affects the heart and other organs.

What is Congestive Heart Failure?

Although the disease is called "heart failure," the heart is not actually failing. It is losing its ability to pump blood effectively which has a negative effect on most bodily functions. Because a weakened heart moves less blood with each pump, fluid backs up in the lungs. As a result, the body does not receive enough oxygen. The kidneys cannot work properly in removing excess fluid from the body and fluid accumulates in parts of the body, particularly the feet and lower legs. The body becomes "congested" with fluid - hence the phrase, "congestive" heart failure. CHF is a progressive and eventually fatal illness.

What Causes CHF?

More than five million Americans have CHF. The most common cause is blockage of the coronary arteries, either with or without a previous heart attack. Other causes include:

  • Coronary heart disease, a narrowing of the heart's blood vessels, which constricts blood flow to the heart's muscle tissue

  • Residual damage after heart attack
  • High blood pressure (hypertension)
  • Infections that affect the heart
  • Severe lung disease
  • Obesity
  • Diabetes
  • Problems with heart valves
How Does CHF Progress?

Congestive heart failure is a progressive, chronic disease. This means that that it is a long-term condition that worsens over time and although the symptoms can be treated, the disease cannot be cured.

In the early stages of CHF, the heart tries to compensate by:

  • Enlarging: The heart enlarges so that it can contract more strongly and pump more blood.
  • Increasing its muscle mass: More heart muscle fibers enable the heart to pump more strongly.

  • Pumping faster: To increase the output of blood flow from the heart into circulation.

Because the heart can compensate, people can live with heart failure for quite some time before it is diagnosed. Eventually, the heart cannot keep up, and a person loses energy, gets short of breath, or experiences other problems that lead to a doctor's visit.

How is Heart Failure Diagnosed?

Several tests can be done to determine whether or not a person has CHF. These tests determine whether the heart is working as well as it should be, and if it is not, where the problem lies. Common tests include chest x-rays, echocardiography, cardiac catheterization, stress and blood tests, and MUGA scans.

Chronic Obstructive Pulmonary Disease - The Basics

By understanding some basics about chronic obstructive pulmonary disease (COPD) and its symptoms, you will be better prepared to care for your loved one and talk to his or her physicians. This section provides general information about how the lungs work - and how COPD affects the lungs and other organs.

What is Chronic Obstructive Pulmonary Disease?

COPD is a condition in which the airways are damaged, leading to shortness of breath and increased coughing. COPD is progressive and irreversable. Emphysema and chronic bronchitis are forms of COPD.

With emphysema, the lungs' air sacs lose their elasticity, making it very difficult for the exchange of oxygen to occur. The air sacs are often damaged, leaving fewer of them to do the work. This combination of factors contributes to shortness of breath. When the air sacs cannot work, more stale air remains in the lungs. This air has a high amount of carbon dioxide and limits the ability to inhale fresh air. Because all human activity requires oxygen, people with emphysema are often very tired and short of breath because of their lack of oxygen.

With chronic bronchitis, the small airways within the lungs become inflamed and harden over time. The cilia, small protective hairs that clear mucus, are also damaged and become less effective and mucus glands enlarge. The narrowed airways and increased mucus cause congestion and coughing and make it more difficult to breathe.

What Causes COPD? What are Common Symptoms?

Prolonged exposure to irritants, such as cigarette smoke, is a primary cause of COPD, although other factors can lead to it. COPD is a progressive, chronic disease. COPD is a chronic illness because it gradually worsens over time and although the symptoms can be treated, the disease cannot be cured. By the time someone is diagnosed with COPD, it is likely that the lungs have been losing their ability to function for some time.

The most common signs and symptoms of COPD include:

  • Shortness of breath
  • Cough
  • Wheezing
  • Frequent lung infections
  • Reduced appetite (which may eventually lead to weight loss)
  • Restlessness or confusion
  • Reduced ability to perform daily activities
  • Fatigue

Someone with lung disease may experience these symptoms for ten years or more before they become so bad that activities of daily living become difficult. Most people with lung disease find their difficulty breathing to be the most troublesome symptom. As the disease becomes severe, walking even short distances may be impossible, and breathing may become difficult when resting or lying flat. While there is no cure for the underlying disease, there are various methods available to treat shortness of breath.

How Is COPD Diagnosed?

The doctor will order tests to determine whether the heart and lungs are working as well as they should be, and if it is not, where the problem lies. The most common tests are described in the following table. During the course of the illness, some of these will be repeated.

Medical History Questions about the patient's lifestyle: work history; smoking history; exposure to dust, pollutants or other irritants; family history for lung disease; and a review of symptoms.
Physical Examination
Doctor listens to patient's lungs, gets a baseline or update of general health status.
Pulse Oximetry
Measures the level of oxygen in the blood at rest and after exercise.
Blood Tests (including ABG)
Measures the amount of oxygen and carbon dioxide in the blood.
Exercise Treadmill
Determines how well the heart and lungs work under physical stress.
Measures how much air patient can exhale: how hard and how fast.
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