Congestive Heart Failure
Also known as: CHF
What is it?
Congestive heart failure occurs when the
heart is unable to pump blood effectively throughout the body. The term
congestive is used because lung congestion
causes some of the main symptoms of heart
failure. Heart failure does not mean
that your heart has stopped working completely. It means that the heart is not pumping as
strongly as it should. As a result, some of the blood that is normally pumped out of your
heart backs up into your lungs and other parts of your body. With congestive heart
failure, your body tissues and organs may not get as much blood as they need.
Who gets it?
Anyone can develop CHF. People who are most at
risk for developing CHF include those who have
been diagnosed with coronary artery disease,
heart attack, an enlarged heart (cardiomyopathy),
heart valve disease, longstanding or untreated
high blood pressure (hypertension), and those
with chronic kidney disease. Congestive
heart failure is more common in elderly people,
particularly those over the age of 70.
What causes it?
Congestive heart failure can be caused by a
number of conditions that damage the heart
muscle, including a heart attack or heart
infection; coronary artery disease; excessive
alcohol consumption; an over- or under-active
thyroid gland; and untreated high blood
pressure. Congestive heart failure can
also be caused by damage to or abnormalities in
the valves inside the heart, which regulate
blood flow out of the heart, and genetic
conditions, such as hypertrophic cardiomyopathy,
in which the heart muscle becomes thickened due
to enlarged heart muscle cells. Factors
such as high fever, anemia, lung infections,
pulmonary embolism, high salt or fluid intake,
overexertion, obesity, stress, and rapid
heartbeat can worsen or trigger congestive heart
failure in people with already weakened hearts.
What are the symptoms?
Symptoms of congestive heart failure depend
upon the side of the heart that is affected.
Left-side congestive heart failure causes
fatigue and shortness of breath during even mild
exertion. Other symptoms include a
wheezing or hacking cough and shortness of
breath during sleep, called orthopnea. One
particularly serious symptom is pulmonary edema,
a condition in which fluids accumulate in the
lungs. Right-side congestive heart failure
reduces the amount of blood returning to the
heart. The main symptom is swelling, usually of
the feet, ankles, legs, and abdomen, as the
veins and tissues throughout the body fill up
with the excess fluid. Patients with
right-heart failure often feel tired, have
little appetite, and experience weight gain
because they retain so much salt and water.
With treatment, patients may live with
right-heart failure for many years.
Because of the risk of pulmonary edema,
left-heart failure is more life threatening.
How is it diagnosed?
Doctors can usually make a diagnosis of
congestive heart failure based upon a physical
exam and the symptoms alone. During the physical
exam, the doctor will check for a weak or rapid
pulse rate, enlargement of the heart, swollen neck
veins, swelling of the liver, fluid retention,
sounds of fluid in the lungs, and abnormal heart
sounds. To confirm the diagnosis, he or she
may perform a number of tests, including chest
x-rays, blood tests, 12-lead
electrocardiograms (EKGs), urinalysis, and
exercise stress tests. Tests such as
electrocardiograms, echocardiograms, and
angiography create images of the heart's activity
and are also helpful in the diagnosis.
What is the treatment?
If there is a underlying cause of congestive
heart failure, it is corrected. For example,
infections can be treated with antibiotics,
surgery can correct malfunctioning heart valves
and remove blockages from coronary arteries, and
drugs can correct problems with the thyroid gland
and control high blood pressure and cholesterol
levels. There are also contributing factors
that can be corrected, including diet and
lifestyle changes such as reducing salt and fat
intake, controlling weight, eliminating cigarette
smoking, and reducing alcohol consumption.
Next, your doctor will try to improve the flow of
blood and oxygen through your body. There
are many drugs that are prescribed for this
purpose. For example, digitalis drugs slow the
heart rate and improve its pumping ability.
Vasodilators are drugs that dilate the blood
vessels. A class of vasodilators called ACE
inhibitors is used to treat high blood pressure.
These drugs reduce the force required to move
blood through the body by lowering blood pressure,
which reduces the heart's workload and prolongs
the patient's life. Patients who cannot tolerate
ACE inhibitors are prescribed angiotensin II
receptor blockers, which affect the blood vessels
in the same way as ACE inhibitors.
Patients
who experience swelling in the feet, ankles, legs,
and abdomen are given drugs called diuretics.
Diuretics stimulate the kidneys to increase urine
production and remove sodium and water from the
body. Reducing fluid retention also helps
relieve shortness of breath. However, patients
taking diuretics may also need to take a potassium
supplement because the body loses large amounts of
that mineral due to frequent urination. A diuretic
called spironolactone has been shown to have the
added benefit of preserving the body's potassium
levels. Patients with severe heart failure and
lowered kidney function may need to be
hospitalized and given diuretics intravenously
until their condition is stable. Patients
with pulmonary edema are hospitalized and given
high concentrations of oxygen through a face mask
or a tube inserted through the windpipe (trachea).
A number of medications, including diuretics and
vasodilators, can help remove fluids from the
lungs and improve heart function. Morphine may
also be given to help reduce the anxiety caused by
breathing difficulties associated with pulmonary
edema.
For long-term care, doctors recommend
alternating periods of rest with gentle exercise,
such as walking. Cardiac rehabilitation
programs can provide medically supervised exercise
programs for people with congestive heart failure.
Heart transplants are only considered for patients
with severe congestive heart failure. A
procedure called an intra-aortic balloon pump (IABP)
can be used as a short-term treatment for patients
who need a heart transplant. An IABP consists of a
balloon attached to the end of a long, thin tube
called a catheter. The catheter is inserted
is through an artery in the groin where it is
guided to the heart's aorta. A bedside pump,
attached to the catheter, inflates the balloon
immediately after the heart contracts. The
inflated balloon blocks the aorta and forces some
blood into the coronary arteries. Right before the
heart beats again, the balloon deflates.
This creates a vacuum in the arteries that makes
it easier for the heart to push oxygen-rich blood
out to the body. An IABP can be used for
only a few days, and the patient must remain in
the hospital, lying flat. Patients with
weakened left ventricles can be helped by a left
ventricular assist device (LVAD). This
device is a small pump that is implanted in the
upper part of the abdomen. A tube leading from the
left ventricle pulls blood into the pump, which
then forces the blood into the aorta. A
second tube protrudes outside of the body, through
the abdominal wall, and is attached a pump control
system. The LVAD takes over the work of the left
ventricle by letting blood flow bypass it
altogether. Like the IABP, the LVAD can
extend the life of patients with severe congestive
heart failure. The LVAD, however, shows
promise as a longer-term treatment device.
Recent advancements in surgical treatments
include cardiac transplantation, artificial
ventricular assist devices, and pacemakers. These
options for treatment would require an evaluation
from a heart failure specialist.
Recent
Advances in Surgical Treatment
Surgical
treatment now includes:
Physicians Who Treat Congestive Heart
Failure
Dwight Davis, M.D.
Eric Popjes, M.D.
Lawrence Sinoway, M.D.
Self-care tips
You can help prevent congestive heart failure
by following a low-salt, low-fat diet.
People who have congestive heart failure should
avoid processed foods and high-sodium foods such
as chips, chocolate, bacon, ham, and canned soups
and canned vegetables. While no one should consume
large amounts of alcohol, people taking diuretics
or with fluid retention problems may need to
restrict any type of fluid intake. It's also
important to monitor your weight gain by weighing
yourself at least every other day.
Substantial weight gain, such as more than 3
pounds in 1 week, may mean you are retaining too
much fluid and should be reported to your doctor.
Follow your doctor's recommendations for rest and
exercise, and try to lower known stresses in your
life. Make sure you take your medications at
the same time each day, and learn to take your
blood pressure or have it checked at your doctor's
office regularly.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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