• narrowed arteries that supply blood to the heart muscle — coronary artery disease.
• past heart attack, or myocardial infarction, with scar tissue that interferes with the heart muscle's normal work.
• high blood pressure.
• heart valve disease due to past rheumatic fever or other causes.
• primary disease of the heart muscle itself, called cardiomyopathy.
• heart defects present at birth — congenital heart defects.
• infection of the heart valves and/or heart muscle itself — endocarditis and/or myocarditis.

The "failing" heart keeps working but not as efficiently as it should. People with heart failure can't exert themselves because they become short of breath and tired.

As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down.

Heart failure also affects the kidneys' ability to dispose of sodium and water. The retained water increases the edema.

How do you diagnose and treat congestive heart failure?

Your doctor is the best person to make the diagnosis. The most common signs of congestive heart failure are swollen legs or ankles or difficulty breathing. Another symptom is weight gain when fluid builds up.

CHF usually requires a treatment program of

• rest
• proper diet
• modified daily activities
• drugs such as
  
  • ACE (angiotensin-converting enzyme) inhibitors
  • beta blockers
  • digitalis
  • diuretics
  • vasodilators

Various drugs are used to treat congestive heart failure. They perform different functions. ACE inhibitors and vasodilators expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart's work easier or more efficient. Beta blockers can improve how well the heart's left lower chamber (left ventricle) pumps. Digitalis increases the pumping action of the heart, while diuretics help the body eliminate excess salt and water.

When a specific cause of congestive heart failure is discovered, it should be treated or, if possible, corrected. For example, some cases congestive heart failure can be treated by treating high blood pressure. If the heart failure is caused by an abnormal heart valve, the valve can be surgically replaced.

If the heart becomes so damaged that it can't be repaired, a more drastic approach should be considered. A heart transplant could be an option.

Most people with mild and moderate congestive heart failure can be treated. Proper medical supervision can prevent them from becoming invalids.