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If you've been diagnosed with congestive heart failure, the feeling of your chest constricting can be scary. With congestive heart failure, the heart’s capacity to pump blood cannot keep up with the body’s need. As the heart weakens, blood begins to back up and force liquid through the capillary walls. The term “congestive” refers to the resulting buildup of fluid in the ankles and feet, arms, lungs, and/or other organs.

Almost 6 million Americans have congestive heart failure. However, with the correct treatment, patients can recover to good health. 

What causes congestive heart failure?

The most common cause of congestive heart failure is coronary artery disease. Risk factors for coronary artery disease include:

  • high levels of cholesterol and/or triglyceride in the blood
  • high blood pressure
  • poor diet
  • a sedentary lifestyle
  • diabetes
  • smoking
  • being overweight or obese
  • stress

In addition to coronary artery disease, several other conditions can damage the heart muscles, including inherited and genetic factors, some infections and autoimmune diseases and some treatments such as chemotherapy.

What are the symptoms of congestive heart failure?

Daniel Louis Jacoby, MD, director of Yale Medicine’s General Heart Failure Program and the Cardiomyopathy Inherited Cardiovascular Disease Program, says that symptoms may be mild or severe and may not always be noticeable.

“Most commonly, though, a patient may experience shortness of breath, fatigue, problems with the heart’s rhythm called arrhythmias, and edema—or fluid buildup—in the legs,” he says.

How is congestive heart failure diagnosed?

Patients are generally referred to Dr. Jacoby and his team by another cardiologist, or from a patient’s primary care physician.

“Initially, the patient will have an intake visit with a heart specialist and nurse or physician’s assistant,” he says. “During this visit, a review of the patient’s prior records and his or her current health status is incorporated to establish a picture of where the patient is along the spectrum, and then a plan is established for prognosis and treatment. There will later be a discussion with the family, tailored to their needs and desires."

The process often takes more than one meeting and involves both the patient’s local cardiologist or referring physician.

“We see thousands of heart patients a year,” Dr. Jacoby says. “Yale provides the facilities to best evaluate what is treatable, and we offer cutting-edge treatments once a patient has been diagnosed. We employ advanced cardiac imaging, exercise testing and hemodynamic assessment.”

How is congestive heart failure treated?

“We assess the current health status of the patient to establish a baseline and develop a long-term health plan with the goal of improving the patient’s health,” says Dr. Jacoby. “This may involve the optimization of medicines and therapies, adding new medication or maybe enrollment in one of the clinical trials going on here.”

There’s no quick fix, he says. Stabilizing and/or reversing a patient’s condition often involves long-term collaborative follow-up with a referring cardiologist or physician,” Dr. Jacoby says.

“In worst-case scenarios, we may offer advanced therapies, which include mechanical solutions, a heart transplant or hospice,” Dr. Jacoby says. “But first, we work very closely with our partners in cardiology and Interventional Cardiology Program at Yale to see if the patient would benefit from any interventional strategies.

"Yale has the best program in the area for heart transplants and artificial parts, but we want to exhaust all other options to avoid either if we can.”

What is the outlook for heart failure patients?

“Very good, particularly now compared to prior generations,” says Dr. Jacoby. “We have medicines and treatments that reverse many cases of heart failure, and in most cases, the outlook is generally very good.”

In cases where reversal of damage to the heart and affected areas is not possible, Dr. Jacoby says that the Yale Medicine team follows the patient closely and works to optimize quality of life while treating him or her.

What makes Yale Medicine’s approach to treating congestive heart failure unique?

“We have a very patient-focused team at Yale Medicine,” says Dr. Jacoby. “Every person seen here, we treat as an individual, rather than offering a simple cookie-cutter treatment plan.”

Yale Medicine’s multidisciplinary team comprises of heart failure cardiologists and cardiac surgeons, dedicated advanced-practice, registered nurses and nurse coordinators, dietitians, exercise physiologists, financial counselors, immunologists specializing in transplants, psychologists, and specialists in palliative care.

“In our multidisciplinary approach, we include the patient’s desires as well as input from the family,” Dr. Jacoby says. “We develop a plan for social work support and take into account all of their financial and emotional stresses in addition to their physical treatment needs.”