congestive heart failure

Congestive heart failure is the everyday name for heart failure when the dominant problem is fluid backing up and pooling — congestion. Think of traffic jamming up behind a bottleneck: cars (here, blood and fluid) accumulate in the lungs and the veins of the body, producing the wet, swollen, breathless picture most people associate with heart failure.

Mechanically, when a ventricle cannot empty adequately, the pressure behind it rises and is transmitted to the upstream circulation. Left-sided congestion floods the lungs and causes breathlessness; right-sided congestion swells the legs, liver, and abdomen. The kidneys, sensing what they read as low circulating volume, retain salt and water, which adds still more fluid to a system that is already overloaded.

The term ‘congestive heart failure’ is somewhat dated and is being replaced in formal classification by descriptions based on ejection fraction. It remains useful and widely understood, but congestion is a feature, not a separate disease — many patients have heart failure without overt congestion when their fluid balance is well controlled by treatment.