• 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.
  
• defects in the heart present at birth congenital heart disease.
  
• infection of the heart valves and/or heart muscle itself — endocarditis and/or myocarditis.
  

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 commonly in the legs and ankles, but possibly in other parts of the body as well. 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 ability of the kidneys 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 diagnose and treat congestive heart failure. The most common signs of congestive heart failure are swollen legs or ankles or difficulty breathing. Another symptom is weight gain because of the build-up of fluid.

Congestive heart failure usually requires a treatment program of:

• rest
  
• proper diet
  
• modified daily activities
  
• drugs such as
  - digitalis
  - diuretics
  - vasodilators
  - A.C.E. or angiotensin converting enzyme inhibitors
  

When a specific cause of congestive heart failure is discovered, it should be treated or, if possible, corrected. For example, in some cases congestive heart failure can be treated by treating high blood pressure. Some are treated with surgery to replace abnormal heart valves.

Still, when the heart becomes so damaged that it can’t be repaired, a more drastic approach such as a heart transplant should be considered.