One of my closest friends, Tillie, is approaching her 90th birthday. When one of her many ailments rears its ugly head, she confidently tells me not to be concerned since "this is the price we have to pay for living longer".

And so it is with heart failure - for every 10 years of living, the prevalence of heart failure is estimated to double. As we live longer, the occurrence of heart failure rises and it has become an increasingly common problem for people with heart disease.

As the expression implies, 'heart failure' is a condition in which the heart does not do something which it is expected to do. In this case, the heart does not efficiently pump oxygen-rich blood around the body. This usually happens because the heart muscle has become stiffened or weakened by culprits such as heart attacks, angina, heart valve disorders, chronic lung disease or infections of the heart muscle.

Congestive heart failure (CHF) is the most common type of chronic heart failure and is a combination of failure of the left and right sides of the heart. Congestive heart failure is so called because the body becomes congested with excess fluid. There is ankle-swelling and gradual build-up of fluid in the lungs and other body tissues.

Treatment of CHF must begin immediately after diagnosis to prevent its worsening. In many cases however, the underlying cause of heart failure cannot be treated effectively, and the condition becomes progressively worse.

Lifestyle changes

Salty foods should be avoided since the sodium in table salt encourages the body to retain fluid. An intake of less than two grams of sodium per day is advised. By the same token, patients with CHF are advised to drink less fluid, limited to less than two litres per day.

Exercise for patients with CHF is a delicate activity since patient response differs. Exercise used to be discouraged in cases of CHF but has now been shown to be helpful in maintaining the heart's ability to function. It may improve the quality of the patient's life and even survival. Regular gentle exercise, like walking, may help in mild and moderate CHF. Avoidance of drinking and smoking can significantly improve muscle weakness of the heart.

Medications

Diuretics like furosemide and hydro-chlorothiazide help to remove excess fluid and salt from the body through increased urine production. Spironolactone is another diuretic which works differently to benefit patients with CHF.

When CHF is caused by chronic, uncontrolled high blood pressure, aggressive blood pressure control will often improve the condition. A class of drugs called ACE inhibitors (including captopril, enalapril, lisinopril and ramipril) has been used in treatment; they widen blood vessels, and reduce the workload on the heart. Unwanted effects of ACE inhibitors include a nagging dry cough, dizziness, low blood pressure and retention of potassium.

A similar class of drugs called ARBs (angiotensin receptor blockers), which includes losartan, candesartan, valsartan and irbesartan, may be used; they are just as effective as ACE inhibitors with the same side effects but the nagging dry cough is much less common.

Beta-blockers, including carvedilol and metoprolol, are effective in treating CHF, but they provoke breathing difficulties in persons with asthma and emphysema. Digoxin, which stimulates the heart to contract more forcefully, has been used for many years in CHF treatment.

Surgery

Surgery including heart transplant, coronary artery surgery, catheter procedures, and valve surgery are considered by the medical doctor, if the patient with CHF is in otherwise good health and other measures have failed.