Congestive heart failure results in hypoperfusion of oxygenated blood to the tissues and the inability to effectively carry away the flood pools of waste-filled, spent blood.
Perhaps the number one effect of CHF is the feeling of shortness of breath or difficulty breathing (i.e., dyspnea). This occurs as blood and fluid back up in the left and right pulmonary veins due to the failure of the left side of the heart. This backpressure causes fluid to leak into the lungs resulting in an unpleasant feeling of breathlessness during activity (most commonly), at rest, or while sleeping. This breathless feeling may come on suddenly and be intense enough to wake a person from sleep gasping for air. Those with CHF often have difficulty breathing while lying flat and may need to prop the upper body and head up on two or more pillows. They commonly complain of waking up tired or feeling anxious and restless, a complaint that should clue a healthcare provider that CHF may be lurking.
A companion symptom of lung congestion is the presence of persistent coughing or wheezing not related to another disease process such as the flu or a cold. This occurs as the fluid builds up in the lung tissues due to the congestion of the pulmonary vasculature. Generally, any long, ongoing bouts of coughing that consistently produce white or pink blood-tinged phlegm should be suggestive of CHF.
The buildup of excess fluid in body tissues, i.e., edema, is a sign of a definite circulatory problem and possibly CHF. This edema comes about as blood flow out of the heart slows, causing blood returning to the right side of the heart through the veins to back up. This back up is much more serious than a spoiled commute drive, however, as it is causing fluid to build up in the body tissues, areas not designed for excess fluid storage. The kidneys, for example, are less able to dispose of sodium and water when bogged down and the necessary brisk flow of blood is unavailable. This, in turn, causes additional fluid retention in the tissues, marked by swelling in the feet, ankles, legs or abdomen along with fluid weight gain. So, if your shoes are suddenly feeling a bit tight, there might be more going on than too much salt on last night's popcorn!
Forceful pump pressures falter leaving fluid further from the heart to puddle along
All this thinking about CHF making you tired? Maybe it is because your heart cannot pump enough blood to meet the needs of your body tissues. With CHF, unexplained fatigue is a major symptom of trouble ahead. The body starts diverting blood away from less vital organs, particularly muscles in the limbs, in order to send it to the heart and brain. When a person starts feeling tired all the time and has difficulty with everyday activities such as shopping, climbing stairs, carrying groceries, or walking, it is time to go visit the local healthcare professional. A body should not need to be performing daily activities dependent on emergency systems. The resulting wear and tear trashes vital organs in a most unappealing manner.
Directly related to this robbing of the blood supply are the symptoms of lack of appetite and/or nausea. When blood flow is being diverted to the brain and lungs, the digestive system receives less oxygen rich blood and problems with digestion compound. One such feeling that occurs is that of being both full and simultaneously nauseous.
Cyanosis, or observable discoloration in the extremities due to the lack of oxygenated blood flow, may occur with any form of CHF. The cause of CHF can be considered central and may reflect hypoxemia. A quick way to tell if the cause is central or peripheral is when improved color of the nail bed can be regained with vigorous massage. This is strongly suggestive of peripheral cyanosis. A cyanosis of central origin, in contrast, cannot be altered by increasing the local blood flow with massage, warming, or by any other peripheral means.12
The brain is the organ that is receiving the most attention during CHF. Confusion and impaired thinking are common companions of CHF. Changing levels of certain substances in the blood, such as sodium, can contribute to confusion, memory loss, and feelings of disorientation. Remember those poor bogged down kidneys? All organ systems interlock. No injury to one occurs without a cascade of effects influencing all the rest. An interesting side note to the confusion and sluggish thought processes that result with CHF is that family or friends are the ones that often seek help for the patient. Perhaps the very progressive nature of the disease condition itself makes it harder for an individual to know that they are in need of medical assistance.
Of the actual physical changes occurring to the heart in its attempt to compensate for decreased pumping ability, the only one likely to get noticed by the individual is an increased heart rate. This increase in rate is directly connected to an attempt to make up for the loss of pumping capacity. In order to increase capacity, the heart beats faster. This may be reflected in cardiac palpitations, which feel like the heart is racing or throbbing.
Diagram of dynamic circulatory flow patterns
Acute pulmonary edema is a life-threatening manifestation of left-sided heart failure, most often secondary to the sudden onset of pulmonary venous hypertension. A sudden rise in left ventricular filling pressure results in rapid movement of plasma fluid through the pulmonary capillaries and into the interstitial spaces and alveoli. This symptom of CHF is, in reality, a medical disaster in its own right and presents with extreme dyspnea, deep cyanosis, tachypnea, hyperpnea, restlessness and anxiety, accompanied by a sense of suffocation. Pallor and diaphoresis in this medical emergency are common. The pulse may be thready and a blood pressure difficult to obtain. Respirations are labored, and rales are widely dispersed over both lung fields anteriorly and posteriorly. Some individuals manifest with marked bronchospasm or wheezing (cardiac asthma). Noisy respiratory efforts often render cardiac auscultation difficult, but a summation gallop, merger of S3 and S4 sounds may often be heard. Hypoxemia is severe. CO2 retention in this emergency state is a late, ominous manifestation of secondary hypoventilation and requires immediate attention.12