Congestive Heart Failure: Causes, Diagnosis, and Nursing Care

Introduction to Congestive Heart Failure

Congestive heart failure is a serious problem for many individuals in the United States. It primarily affects older Americans, but younger individuals can also be affected by this condition. When individuals have congestive heart failure, the heart continues to work and does not actually "fail" in the literal sense; instead, it has difficulty pumping enough blood to keep the body adequately supplied. Individuals who suffer from congestive heart failure are able to perform many normal activities, but they cannot engage in anything strenuous or physically taxing because they will become overly tired and short of breath quite easily.

There are several conditions that can result in congestive heart failure. These include cardiomyopathy, congenital heart defects, an infection of the heart muscle or any of the heart valves, high blood pressure, a previous heart attack, diseases of the heart valves, and coronary artery disease — that is, a narrowing of the arteries.

Disease Condition and Risk Factors

In congestive heart failure, the blood flow that normally comes from the heart is slowed down, and therefore the blood returning to the heart through the veins often backs up. This can cause swelling of various tissues. In general, the swelling is usually seen in the legs and feet, but any part of the body can swell due to the congestion and fluid buildup in the tissues (Congestive, 2005). One of the main places that fluid can back up and cause a serious problem is in the lungs (Congestive, 2005). When this happens, the affected individual usually experiences difficulty breathing, especially when lying down (Congestive, 2005). In addition to this backing up of blood and swelling of tissues, congestive heart failure also affects the kidneys. They are not able to dispose of water and sodium as efficiently as they would under normal circumstances, and the resulting fluid retention further increases the swelling (Congestive, 2005).

In addition to the causes listed above, there are other risk factors for congestive heart failure involving both lifestyle choices and underlying medical conditions. If an individual has a risk factor for congestive heart failure, the likelihood of developing the disease is increased. However, it is possible to develop congestive heart failure even without any risk factors, and conversely, some people who do have risk factors will never develop the condition. The likelihood of developing congestive heart failure increases with the number of risk factors an individual has, making them important to identify and address.

From a medical standpoint, risk factors for developing congestive heart failure include coronary artery disease, a previous history of heart disease, obesity, high blood pressure, diabetes, severe emphysema, and hyperthyroidism (Badash, 2003). Lifestyle factors that increase an individual's risk include smoking, excessive consumption of alcohol, and long-term use of anabolic steroids (Badash, 2003). Men have a slightly higher risk of developing congestive heart failure than women, and the condition is most common in individuals aged 65 or older (Badash, 2003). This does not mean that younger women cannot develop congestive heart failure — only that it is less common in that demographic.

Diagnosing congestive heart failure is something that a physician must do. Swollen ankles and legs and/or difficulty breathing are possible signs or symptoms of congestive heart failure, but these problems can also be caused by other conditions (Congestive, 2005). Another symptom to watch for is unexplained weight gain as fluid accumulates in the body (Congestive, 2005).

Diagnosis

Many different instruments and medical approaches are used to diagnose congestive heart failure. Obtaining a complete and thorough clinical history for the patient is the first step toward this diagnosis (Shamsham & Mitchell, 2000). Once this has been completed, the patient is typically classified based on the severity of the suspected congestive heart failure and what they can and cannot do on a normal basis (Shamsham & Mitchell, 2000). A complete physical examination is also performed (Shamsham & Mitchell, 2000). Diagnosing congestive heart failure in elderly patients can sometimes be difficult because atypical presentations — such as anorexia and anxiety — are more commonly observed in this age group rather than the classic symptoms (Shamsham & Mitchell, 2000).

Diagnostic testing for congestive heart failure includes an electrocardiogram, chest radiography, an angiogram, an echocardiogram, and other techniques such as magnetic resonance imaging (Shamsham & Mitchell, 2000). Evaluating the differences between the systolic and diastolic function of the patient's heart can also be indicative of congestive heart failure (Shamsham & Mitchell, 2000). All of these tests help the physician assess the functioning of the patient's heart, and when considered alongside signs and symptoms, they can support a definitive diagnosis.

Conclusion

Congestive heart failure is a condition that primarily affects the elderly and is slightly more common in men than in women. However, this does not mean that younger people or women are not also at risk. There are many risk factors for congestive heart failure, and not all of them can be controlled. It is important, however, to manage the modifiable risk factors — such as quitting smoking, controlling blood pressure and diabetes, losing weight, and maintaining a healthy diet. Family history and certain underlying medical conditions are non-modifiable risk factors, and individuals with these factors must be especially diligent about managing the risk factors they can control, in order to protect their longevity and overall health.