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Congestive Heart Failure

Congestive heart failure (CHF) is a broadly applied term used to indicate congestion of the lungs with fluid because of poor heart function or build up of pressure in the heart's main pumping chambers (the left ventricle and/or left atrium). In its mildest form, it may manifest without symptoms, although a chest x-ray demonstrates congested (enlarged) blood vessels and/or small fluid collections on the outside of the lungs (pleural effusions).

As the disease progresses and the lungs become more congested, patients develop shortness of breath with activities (and eventually at rest), inability to lie flat (termed orthopnea), awakenings from sleep with breathlessness (nocturnal dyspnea), lower extremities swelling (edema), and low blood oxygen levels. In its severest form, termed pulmonary edema, accumulated fluid fills the air spaces of the lung causing marked shortness of breath and, on occasion, the need for placement on mechanical ventilation.

Underlying conditions that predispose to the development of CHF include coronary artery disease (blockage of the coronary arteries), hypertension, valvular heart disease (especially disease of the aortic and mitral valves), irregular heart rate such as atrial fibrillation, and occasionally primary disorder of the heart muscle itself.

The immediate treatment of CHF usually involves use of diuretics (such as furosemide), vasodilators (which lower the blood pressure and make it "easier" for the heart to pump), and inotropic agents (which helps the heart contract more forcefully).

Once stabilized, patients with newly diagnosed CHF usually undergo cardiac evaluation to determine the underlying cause of the CHF. Once the causes are identified, long-term management strategy tailored to the patient's specific underlying disease process can be instituted. Treatment options include medical therapy, cardiac surgery (including coronary artery bypass or valve replacement), or, on occasion, cardiac transplantation. The prognosis of CHF depends on both the severity and reversibly of the cardiac dysfunction.

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