Learning About Your Health

Congestive Heart Failure (CHF): What to Expect While You Are in the Hospital

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What is Congestive Heart Failure (CHF)?

Congestive Heart Failure (CHF) is a condition in which your heart is not pumping as well as it should. CHF can cause symptoms such as shortness of breath, generalized weakness, and swelling in the ankles, feet, and abdomen. Coronary artery disease, heart attack, high blood pressure, and heart valve disease are common causes of CHF.

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Causes of Heart Failure

Coronary Artery Disease
Coronary artery disease is caused by atherosclerosis (also called hardening of the arteries). This condition occurs when plaque (deposits of fat, cholesterol, and other materials) collects in the walls of the arteries. As plaque builds up, the arteries narrow and this reduces blood flow to the heart muscle. The muscle can weaken, and heart failure can develop.

Heart Attack
Congestive heart failure can be a complication of a heart attack. A heart attack occurs when a blood clot forms in a narrowed coronary artery, and blocks blood flow to a coronary artery. As a result, there is damage to the heart muscle. The damaged portion of the heart muscle loses its ability to pump well. Over time, the strained heart muscle weakens and heart failure can develop.

High Blood Pressure (Hypertension)
Blood pressure measures the force of the blood pumped by your heart through your body’s blood vessels. If arteries throughout your body are narrowed from a build-up of fatty deposits, your heart has to work harder than it should to circulate blood. The heart muscle may become weakened by the extra workload, and fail to effectively pump blood forward causing your blood pressure to increase.

Faulty Heart Valves
Valve disease occurs when the valves between the heart's chambers do not open or close properly. A damaged heart valve forces your heart to work harder to keep the blood flowing correctly. Over time, this extra work can weaken the heart and lead to heart failure.

Cardiomyopathy
Cardiomyopathy is a diseased heart muscle. The heart chambers enlarge and the heart muscle stretches and weakens. Causes of cardiomyopathy include infections, alcohol abuse, and the toxic effects of drugs such as cocaine and some drugs used for chemotherapy.

Other Related Health Problems
Certain health problems can strain and weaken the heart. Diabetes, severe anemia, hyperthyroidism, kidney or liver failure, and emphysema may precipitate heart failure. A rapid or irregular heartbeat may occur along with heart failure.

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What to Expect During Your Hospital Stay

  • You may stay in the hospital for 2-4 days.

  • You may wear a heart monitor that will record your heart rhythm at a central station in the nursing unit.

  • Your doctor may order one or more of the following tests to better understand your heart condition: blood tests, electrocardiogram (EKG), nuclear scan, echocardiogram (echo), chest x-ray, and cardiac catheterization.

  • You will have at least one intravenous line (IV) to give you fluids and medications. An IV is a small, thin plastic catheter (tube) that is placed in a vein in your arm.

  • You will receive oxygen through a mask that fits over your nose and mouth or through a small cannula (soft tube) that is placed under your nose.

  • Your care will include:
    • Taking diuretics that remove excess fluid from your body.
    • Taking medications to relax the blood vessels and help your heart pump more easily.
    • Close observation of your fluid intake and output, daily weights, potassium, and sodium blood levels.
    • Resting and paced activity.
    • Education about cardiac risk factors and a heart-healthy lifestyle.

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Tests to Evaluate Your Heart

Your doctor may order 1 or more of the following tests:

  • Electrocardiogram (EKG or ECG): A test that shows the pattern of your heartbeat and the size of your heart.

  • Echocardiogram (Echo): A non-invasive test to evaluate the structure and motion of heart function, heart valves, and blood flow through the heart. Echocardiogram uses ultrasound (high-frequency sound waves) to create an image of your heart on a television screen (monitor). This test identifies whether an area of your heart has been damaged by a heart attack.

  • Cardiac Catheterization & Coronary Angiogram: Cardiac catheterization is an invasive, non-surgical procedure. A coronary angiogram is a specialized x-ray procedure that is done as part of a cardiac catheterization. A cardiac catheterization and a coronary angiogram are done to study the structure of the arteries that bring blood to the heart muscle and to evaluate the function of the main pumping chamber of the heart. During a cardiac catheterization, the cardiologist inserts a small hollow tube (catheter) into an artery or vein and then advances it into the heart. The cardiologist injects contrast (x-ray dye) through the catheter to outline the arteries to show any blockages or narrowings that may exist within them.

  • Stress Testing: This test is performed to find out if your coronary arteries have any blockages. While you exercise on a treadmill, your doctor and a technician will watch your blood pressure, pulse, and electrocardiogram (EKG). During the test, you start walking and slowly the speed of the treadmill gets faster. Thallium treadmill and Persantine Thallium tests are different kinds of stress tests.
    • The Thallium treadmill test is a basic stress test, except that Thallium, a radioisotope, is put into your IV before you exercise.
    • The Persantine Thallium test is also a stress test, but you do not have to walk on a treadmill.
  • Transesophageal Echocardiogram (TEE): For this study, a doctor places a plastic tube, about the size of your finger, through your mouth into your esophagus. The tip of the scope makes and accepts sound waves. TEE takes better pictures of the heart’s movement than a regular EKG. Before the doctor places the tube in your throat, he or she will numb your throat and give you medication in your intravenous line (IV) to make you sleepy. You should experience little or no discomfort. The test will take about 30 minutes.

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Understanding Your Medications

Your doctor will order medications to help your heart work better and relieve some of your symptoms. Your medications may include:

  • ACE Inhibitors: This medication helps your heart pump more easily by relaxing the blood vessels. Some common ACE Inhibitors are Capoten (Captopril), Zestril, Prinivil (Lisinopril), and Vasotec (Enalopril). A dry cough or dizziness should be reported to your doctor.

  • Angiotensin Receptor Blockers: This medication is sometimes used instead of an ACE inhibitor. It has many of the beneficial effects of ACE inhibitors. Some common ARB’s are Cozaar (Losartan) and Diovan (Valsartan).

  • Beta-Blockers: This medication helps strengthen your heart. A beta-blocker is usually started at a low dose and gradually increased over time. Common beta-blockers are Coreg (Carvedilol), Inderal (Propranolol), Lopressor, Toprol XL (Metroprolol), and Tenormin (Atenolol). If you experience fatigue and dizziness please report these symptoms to your doctor.

  • Digitalis - Lanoxin (Digoxin): This medication helps your heart to pump with more strength. Digoxin can also help regulate your heartbeat.

  • Diuretics (also called "water pills"): Diuretics are medications that get rid of the extra water in your body. Excess water can cause swelling in your ankles, feet, or abdomen. Diuretics also increase the amount of urine the body makes and the dose may be linked to your daily weight. Common diuretics are Furosemide (Lasix) and Hydrochlorothiazide.

  • Diuretic (Potassium Sparing) Aldactone (Spironolactone): This medication is a diuretic that spares potassium and helps the heart muscle.

  • Potassium: An electrolyte that is important for muscle function and maintaining a regular heartbeat. Regular use of a diuretic causes the body to lose potassium. Your doctor may order a potassium replacement.
Note: Make sure to tell your doctor about any non-prescription drugs you may be taking, such as cold remedies, sleep aids, or herbal medications.

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Managing Your Pain

CHF does not usually cause pain. However, you may experience some discomfort, or you may have pain from another existing condition. If you are having pain, it is important to take action to control your pain as soon as the pain starts. Managing pain early and adequately is key in effective pain control. Please let your doctor or nurse know if you are having pain.

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Your Activity in the Hospital

  • You may get out of bed to sit in a chair or go to the bathroom, if you are not short of breath. You will need to ask for help the first few times you get out of bed.

  • Once you are feeling better, you may take a walk in the hall 2 or 3 times a day.

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About Your Diet

  • Salt makes the body hold onto water that can make Congestive Heart Failure worse. Most doctors allow you to have no more than 2-3 grams (2000-3000 milligrams) of sodium (salt) each day.

  • You will be asked to follow a low-salt diet. A heart-healthy diet low in fat may also be necessary for you to follow. After you leave the hospital, you may need to continue these diet restrictions. If you have questions about your diet, please ask to speak to a dietitian.

  • You may drink a moderate amount of liquids (4 cups a day is a moderate amount). Juice, water, milk, decaffeinated coffee or teas are recommended.

  • Avoid drinking large amounts of liquids. Drinking more than 6 cups of liquid in a day is considered a large amount.

  • You may not feel like eating because you are tired or find it hard to breathe. Eating is very important. If you would like smaller meals more often or lighter food, please ask your nurse or dietitian to arrange this for you.

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Getting Support from the Medical Team

  • Doctors and nurses are available to listen to your concerns and feelings, as well as RN case managers, social workers, and chaplains.

  • RN case managers are available to assist you with getting ready to go home. However, your doctor may decide that you need more time in the hospital for treatment or rehabilitation before going home. A "Post-Acute Unit" is a licensed, skilled nursing facility that provides short-term care for people who do not need to be in the "acute" hospital.

  • Social workers are available to help with matters related to finance, and your home situation.

  • Financial counselors are available to answer questions or concerns about your health insurance.

  • Chaplains are available at all times. Please let your doctor or nurse know if you would like us to arrange for a visit.

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Arranging Your Transportation Home

If you need help getting home, ask to speak with an RN case manager who can help you make arrangements. Most insurance will not pay for transportation home. Otherwise, you may leave the hospital in a car with a family member or friend.

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Setting Up Help at Home

If you need extra help or equipment at home, an RN case manager will meet with you. The RN Case Manager will help you find out what services your insurance plan pays for and, if needed, will help arrange them.

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More Ways to Learn

  • Watch the Patient Video Education Channel in your hospital room. Anyone can use the video channel by following these instructions:
    • Tune to channel 60 on the television set, and follow the on-screen directions.
    • Pacific Campus patients dial extension 78888; California Campus patients dial extension 21000; and Davies Campus patients dial extension 33600.
    • Order videotape for viewing according to category or title by listening to information given over the telephone.
      Please watch videotapes #28 "Congestive Heart Failure" and #49 "How to Beat Cigarettes."
  • Ask about our Cardiac Rehabilitation Program at California Pacific Medical Center. This is a comprehensive program for cardiac patients and their families. A multidisciplinary team of health care professionals create a supportive environment, motivating participants to achieve a healthy lifestyle. The program includes supervised exercise three times per week, group education, and risk factor counseling. For more information call (415) 600-3361.

  • Call 1-800-NO-BUTTS for more information about smoking cessation.

  • Visit Our Community Health Resource Center at 2100 Webster Street, San Francisco (415) 923-3155. Services include classes and written information on a wide variety of health topics.

  • Visit these Web sites:


Produced by the Center for Patient and Community Education in association with Department of Outcomes Management at California Pacific Medical Center. Last updated: 8/05.

© 2002 – 2008 California Pacific Medical Center.

Funded by: A generous donation from the Mr.and Mrs. Arthur A. Ciocca Foundation.

Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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