What is Congestive Heart Failure?


The American Heart Association reports that one in five Americans over the age of 40 will develop congestive heart failure, and an estimated 5.8 million Americans are living with and managing the disease. Owing to a rapidly aging population and improved heart attack survival rates, we can expect to add as many as 660,000 new cases to that number each year.

multiple ecgs in an icu

Source // CC BY-SA 3.0

Dr. Howard Zahalsky, Chief Medical Officer for Activ Doctors Online, explains the causes, symptoms and treatment options available for patients with congestive heart failure during a webinar honoring the American Heart Associations American Heart month.

Dr. Zahalsky begins by briefly recapping the basic functions of the heart and circulatory system: “Your blood passes through the heart twice on each trip around the body. As it leaves each ventricle, it makes a quick ‘pit-stop’ at the lungs to pick up oxygen.”

The powerhouse of the heart is the left ventricle – it does most of the work. If the left ventricle does not function properly, there can be a “traffic jam” of blood that backs up into your lungs.

What Causes Congestive Heart Failure?

Congestive Heart Failure (CHF) is an umbrella term for any problem with the heart that causes the muscle to weaken. There are many causes, but the primary ones are heart disease and alcohol.

Heart Disease

The main cause of congestive heart failure is heart disease. Heart disease makes you prone to multiple or large heart attacks that can cause part of the heart to become damaged, interfering with the heart’s ability to pump blood effectively.

“Imagine your squeezing a stress ball,” suggests Dr. Zahalsky, “Now image you’re squeezing that stress ball without using your middle 2 fingers.” That’s what happens when a heart attack damages the walls of your heart. The heart is still able to pump blood (squeeze the stress ball), just not as effectively.


Now, a glass of red wine is supposed to be good for your heart, but alcohol in excess can be directly toxic to the heart. It can cause the heart muscle to thin out, become weak and can affect the rhythm of your heart. This is called an arrhythmia.

“Sticking with the stress ball analogy,” explains Dr. Zahalsky, “A weak heart is like someone with arthritis squeezing the stress ball – they’re just not able to get as good of a squeeze. An arrhythmia would be like squeezing the stress ball one finger at a time, so that the imaginary blood in the stress ball goes in all different directions, including backwards.”

squeezing a heart shaped stress ball

Source // CC BY-SA 3.0

Symptoms of Congestive Heart Failure

You probably already know if you are predisposed for CHF – maybe you’ve had a heart attack or have been warned by your doctors about the amount of alcohol you consume – but some of the early warning symptoms include:

  • Shortness of breath

    Fluid backing up in your lungs can make it very hard to breathe. Even mild exertions, like walking up the stairs, can be extremely draining.

  • Coughing

    Ever had a drink of water “go down the wrong pipe”? Your body’s immediate reaction to fluid in your lungs is to try and get it out, so you can develop a wet, mucus-y cough. The cough gets worse when you lie down and the fluid layers outs across a wider area of your lung.

  • Swollen ankles

    Sometimes you can get so much of a backup of fluid in your lungs that the “traffic jam” extends past the lungs. Then gravity takes over – all that fluid ends up in your ankles.

Treating CHF

There is no cure for congestive heart failure, but treatment can help manage the symptoms of the disease. Treatments can include eating less salt, limiting fluid intake, and taking prescription medications such as,

  • Beta blockers

    The primary medicines that have been proven to extend the life of patients, beta blockers slow down the heart, allowing it to beat more efficiently.

  • ACE Inhibitors

    ACE inhibitors loosen the blood vessels making it easier for the heart to pump blood, like opening another lane on the highway or stretching a balloon before blowing it up.

  • Diuretics

    Diuretics encourage the kidneys to pull excess fluid out of the blood. As a result, the amount of fluid in your lungs and ankles also decreases.

There are numerous examples of CHF patients living beyond the years normally expected for people with the disease, usually attributed to taking an active role in disease management.

How Can Activ Doctors Online Work for You?

CHF is a chronic condition where appropriate disease management is critical. Frequent communication between patients and their doctors and self-monitoring can help reduce hospitalizations and mortality rates.

Personal Health Records

Patients with CHF tend to be on a lot of medications. Maintaining a personal health records allows you keep all you doctors up to date on all the medications you are taking. It also allows you to carefully track your symptoms, set appointment reminders for your medication and doctors’ appointments and track fluctuations in your body including:

  • weight
  • blood pressure
  • A1C
  • cholesterol
  • and more!

Online Second Medical Opinions

When you receive a serious diagnosis, like CHF, it’s natural to have questions – or even fears (I mean, it says failure in the name!).

Do not hesitate for fear of offending your doctors – most physicians encourage second and even third opinions, especially when it involves a major operation such as heart valve replacement.

Activ Doctors has built a network of 6000+ physicians, some of whom are the best in their field. Because your personal health records are already in the system, they can often turn around your second medical opinion in as little as 48 hours.


If your doctor participates, you can conveniently talk to you doctors whenever you need to.

Studies show that this approach can achieve similar results to that of home health nurse, and offers the added benefit of reducing costs, without sacrificing the level of care.

Are you one of the millions of Americans living with congestive heart failure? What are some things you are doing to manage your symptoms? Do you have any tips for others in your community? Tell us in the comments!

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