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Congestive Heart Failure

Congestive Heart Failure or CHF is a condition where there is weakening in the pumping action of the heart due to fluid buildup in the body. The term 'congestive' is indicative of the blood backing up into the liver, abdomen, lungs or lower extremities. This medical condition develops over a period of time and leads to enlargement of the heart. Due to the inability to pump enough blood, the heart compensates by becoming larger. This leads to enlarged heart chambers and thicker heart wall muscles. Persons suffering from coronary disease or arrhythmia are more at risk for CHF.


Persons suffering from hypertension and heart valve disease are more susceptible to congestive heart failure. If you have suffered a heart attack or congenital heart defect, you are more likely to be prone to CHF. Congestive heart failure is characterized by backing up of the blood from both one or both the lower chambers of the heart.


Symptoms of Congestive heart failure include shortness of breath and weakness. A person suffering from CHF may notice weight gain on account of body fluid accumulation. This shows up as water retention and edema in the ankles, feet and legs. The fluid buildup leads to frequent urination, especially at night. Chest pain, irregular pulse and restlessness are other symptoms of CHF. Decreased alertness and inability to pursue exercise are signs of congestive heart failure. There is weakness and extreme fatigue due to reduced blood flow to the major organs. Dizziness and confusion is noticed due to inadequate oxygen supply to the brain. Persistent cough and wheezing can also be noticed.


Diagnostic tests such as chest x-rays and ECG can aid in detecting any stress on the heart. During a physical examination, a doctor can detect fluid buildup in the chest. Imaging tests such as angiography and nuclear ventriculorgraphy help in clear diagnosis of the heart's pumping condition. EKG and echocardiogram aids in detecting any possible heart enlargement and fluid buildup. Blood tests can indicate any kidney or thyroid malfunction that may affect heart's functioning. BNP test or B-type natriuetic peptide Test is conducted to assess heart failure.


Medications for congestive heart failure include ACE inhibitors that keep the blood vessels open and inotropics to strengthen the heart's pumping capacity. Diuretics may be prescribed to get rid of excess body fluids. Vasodilators and Calcium channel blockers open up narrowed blood vessels. Angioplasty is done to open up narrowed arteries. This is resorted to in cases where there is fatty plaque buildup. Surgery to repair existing defects such as heart valve repair and coronary artery surgery are sometimes resorted to. Lifestyle changes can go a long way in keeping CHF at bay. CHF is a progressive condition; it cannot be cured but lifestyle changes can go a long way in slowing the progress of the disease. These include quitting smoking and controlling diabetes, cholesterol and high blood pressure. Control alcohol consumption and embark on a fitness regimen that includes aerobic exercise.

ESR blood test

ESR (erythrocyte sedimentation rate) blood test is used to measure the distance that RBCs settle in unclotted blood. Blood sample is monitored for an hour in a specially-marked test tube. The levels of ESR indicate any inflammatory or malignant disease. This test is often used to diagnose rheumatologic ailments, tuberculosis or tissue necrosis. Elevated levels of blood ESR may be indicative of rheumatoid arthritis, thyroid disease, kidney disease, syphilis or tuberculosis. Pregnancy, infection and old age can bring about elevated levels of blood ESR. Extremely low levels of ESR may suggest sickle cell anemia, Hypofibrinogenemia (Fibrinogen deficiency), CHF or hyperviscosity. ESR is a non-specific inflammation marker and may need to be supported with other diagnostic tests for medical decisions. ESR blood test is often suggested along with CRP blood test to check for arthritis since they both check for proteins associated with inflammation. However, a normal value of ESR does not rule out disease.


ESR is also known as Acute Phase Reactant Test as it reacts to severe conditions - infections or trauma. The Erythrocyte Sedimentation rate increases, some times directly in relation to a rise in body temperature and increase in white blood cell count. ESR reaches a peak after many days and usually it lasts longer than high temperature or increased white blood cell count.

Many diseases induce the body to make abnormal proteins that cause the red blood cells to clump together and stack up which results in a column called as Rouleaux. In such a situation as the red cells are heavier, they fall faster and settle further resulting in higher ESR.

ESR Results - Normal values (Westergren method):

  • Newborn : 0-2 mm/hr
  • Women < 50 years: 0-25 mm/hr
  • Men < 50 years old: 0-15 mm/hr
  •  Women 50 years and above: 0-30 mm/hr
  •  Men 50 years and above: 0-20 mm/hr

The highest ESR levels are usually seen in a cancer involving white blood cells - Multiple Myeloma and Rheumatoid disease. Other diseases which elevate the ESR : infections, anemia, kidney disease, inflammatory conditions, white blood cell disorders, cancer and autoimmune diseases.

Any disease or condition which affects the shape and size of RBC decreases the ESR. Diseases that cause the body to make less protein or extra red blood cells will also decrease the ESR. Some medicines such as anticonvulsant, and oral contraceptives may increase the ESR while drugs like Cortisone and Quinine may decrease the ESR.



BNP blood test

The brain natriuretic peptide or BNP blood test measures the level of B-Natriuretic Peptide in your blood. This protein hormone is produced in excess when the heart's ventricles are not functioning properly. When there is heart failure, the ventricles secrete BNP and N-terminal-pro-BNP (NT-pro-BNP). Natriuretic peptides promote better blood circulation, urine excretion and heart functioning. Both BNP and NT—Pro BNP are markers of atrial and ventricular distension caused due to raised intra-cardiac pressure.


Typically, the BNP test helps determine if a person is suffering heart failure, when there are symptoms that can be indicative of other conditions too. Blood BNP levels are also indicative of the exercise tolerance and risk of death in a person suffering from CHF (congestive heart failure).


You may need to fast for about 10 hours prior to a BNP blood test. BNP blood test is usually measured by the Triage test and the test usually takes about 15 minutes. The elevated BNP values indicate the severity of the heart condition. While BNP levels below 100 pg/mL indicate no heart failure, BNP levels above 600 pg/mL indicate moderate heart failure. The diagnostic gray area of levels between I00 and 500 pg/mL shows inconclusive result. If BNP levels are above 900 pg/mL, it is indicative of severe heart failure. Medication affects the levels of BNP. BNP values tend to be elevated with increasing age and noticed to be higher in women than men. Conditions such as chronic obstructive pulmonary disease (COPD), kidney disease or kidney dialysis can alter the BNP blood readings.


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Collection of Pages - Last revised Date: September 15, 2019