Congestive Heart Failure

Congestive heart failure is a condition in which the heart is unable to pump blood efficiently enough to meet the body’s needs, leading to fluid build-up in the lungs and body. In Tanzania, it commonly results from long-standing hypertension, rheumatic heart disease, or cardiomyopathy.

• Shortness of breath, especially on exertion or when lying flat
• Swelling of the legs, ankles, or abdomen
• Fatigue and reduced exercise tolerance
• Waking at night breathless (paroxysmal nocturnal dyspnoea)
• Rapid or irregular heartbeat
• In severe or acute decompensation: severe breathlessness at rest and a rapid, laboured breathing pattern

• Long-standing, poorly controlled hypertension is a leading cause in this setting.
• Rheumatic heart disease, resulting from earlier untreated rheumatic fever, remains an important cause, particularly in younger patients.
• Cardiomyopathy (weakening of the heart muscle), coronary artery disease, and certain infections can also lead to heart failure.
• Anaemia, thyroid disease, and pregnancy-related heart conditions can worsen or unmask heart failure.

• Diagnosed clinically based on characteristic symptoms and examination findings, such as an elevated jugular venous pressure, lung crackles, and leg swelling.
• Chest X-ray may show an enlarged heart or fluid in the lungs.
• Echocardiography, where available, helps confirm the diagnosis, identify the underlying cause, and assess heart function.
• Blood tests help assess kidney function and identify contributing factors such as anaemia.

Acute decompensated heart failure with severe breathlessness is managed urgently at hospital level with oxygen, an intravenous diuretic (such as furosemide) to remove excess fluid, and treatment of any precipitating cause, such as infection or uncontrolled blood pressure.

Long-term management includes a diuretic to control fluid retention, alongside an ACE inhibitor (or angiotensin receptor blocker) and a beta-blocker, which help improve heart function and survival when introduced carefully and titrated over time.

Treating the underlying cause — such as controlling blood pressure, or referral for assessment of rheumatic or structural heart disease — is essential for long-term management.

Patients are advised on limiting salt and fluid intake and monitoring for early signs of worsening, such as increasing swelling or breathlessness, prompting early review.

• Control blood pressure through regular monitoring and consistent treatment.
• Seek prompt treatment for sore throat suggestive of streptococcal infection in children, to reduce the risk of rheumatic fever and later rheumatic heart disease.
• Limit salt intake and monitor for early signs of fluid build-up, such as increasing leg swelling.
• Take heart failure medicines consistently and attend regular follow-up appointments.