Congestive Heart Failure
What is congestive heart failure?
Congestive heart failure occurs when the heart becomes weakened and cannot pump enough oxygenated blood. to meet the needs of the body's other organs, the heart keeps pumping, but not as efficiently as a healthy heart. Congestive heart failure occurs. Usually, the loss in the heart's pumping action is a symptom of an underlying heart problem.
In congestive heart failure, not enough blood reaches the vital organs. This, for example, interferes with the kidney's normal function of eliminating excess sodium and waste from the body. In congestive heart failure, the body retains more fluid - resulting in swelling of the ankles and legs.
#1: Fluid may also collect in the lungs, resulting in shortness of breath.
What are the symptoms of congestive heart failure?
The following are the most common symptoms of congestive heart failure. However, each individual may experience symptoms differently. The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been lost. Symptoms may include:
- Visible Swelling of the legs and ankles (due to a build-up of fluid), and, occasionally, the abdomen
- Weight gain
- Shortness of breath during rest or exercise
- Fatigue
- Loss of appetite and nausea
- Persistent cough - often produces mucus or blood-tinged sputum
The symptoms of congestive heart failure may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
Key Points:
Common symptoms of congestive heart failure:
– Swelling of legs and ankles
– Shortness of breath
– Fatigue
– Persistent cough
What are the causes and risk factors for congestive heart failure?
Congestive heart failure may be a consequence from any/all of the following: Causes and risk factors include:
- Coronary artery disease - narrowed arteries that supply blood to the heart muscle
- Previous heart attack(s) (myocardial infarction) - scar tissue from previous attacks may interfere with the heart muscle's ability to work normally
- Heart valve disease - caused by past rheumatic fever or other degeneration of the valves
- High blood pressure (hypertension)
- Infections of the heart valves and/or heart muscle (i.e., endocar-ditis)
- Congenital heart disease/defects (present at birth)
- Cardiac arrhythmias (rapid heartbeats)
- Chronic lung disease and pulmonary embolism
- Drug-induced heart failure
- Excessive sodium in the diet intake
- Hemorrhage and anemia
- Cardiomyopathy (a disease of the heart muscle)or another primary disease of the heart muscle
- Obesity
- Smoking
- Excessive alcohol intake
Key points:
– Many conditions that affect the heart can lead to congestive heart failure
– The most common are previous heart attack, valve disease, and high blood pressure. Smoking is an important risk factor
How is congestive heart failure diagnosed?
In addition to a thorough medical history and physical examination, diagnostic procedures for congestive heart failure may include any, or a combination of, the following:
- Laboratory tests
- Chest x-ray - a diagnostic test which uses invisible energy beams to produce images of internal tissues, bones, and organs onto film.
- Electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
- Echocardiogram (also known as a 2D echo) - a noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.
- Nuclear test (MUGA or RNCA) - a test involving a radio-isotope which is injected into a vein. A camera records the amount of isotope in the blood pool of the heart to provide a measurement of how efficiently the heart is pumping.
Key Points:
Diagnosis of congestive heart failure includes:
– An examination and history of symptoms
– Laboratory tests and chest x-rays
– Electrocardiogram to measure electrical activity of the heart
– Echocardiogram to study the movement of the heart
– Nuclear tests to measure how well the heart is pumping
Treatment for congestive heart failure:
The goals of treatment are (1) to improve a person's quality of life by making the appropriate lifestyle changes and implementing drug therapy and (2) to prolong life. Treatment of congestive heart failure may include:
- Controlling risk factors
Lose weight (if overweight)Restrict dietary salt and fat from the diet
Stop smoking
Abstain from alcohol Proper rest
- Medications:, such as:
Digitalis- to increase heart contraction strength
Angiotensin converting enzyme (ACE) inhibitors - to decrease the pressure inside the blood vessels and to prevent heart remodeling
Diuretics- to reduce the amount of fluid in the body
Vasodilators- to dilate the blood vessels
Beta-blockers- to reduce the effects of adrenaline on the heart
- Cardiac resynchronization
- Implantable cardiac defibrillator (ICD) - a key consideration in treating patients with heart failure is a measure called the "ejection fraction". This refers to the amount of blood pumped by the heart with each heartbeat. ICDs are indicated for patients with moderate to severe heart failure and ejection fractions less than or equal to 35%.
- Heart transplantation, in the most severe cases
Specific Treatment for congestive heart failure will be determined by your physician based on your:
- age, overall health, and medical history
- extent of disease
- tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- opinion or preference
The cause of the congestive heart failure will dictate the treatment protocol established. If the heart failure is caused by blockages in the coronary arteries, a procedure or surgery to relieve these blockages may be recommended. If the heart failure is caused by a valve disorder, then surgery may be recommended. If the heart failure is caused by a disease, such as anemia, then the disease is treated. And, although there is no cure for heart failure due to a damaged heart muscle, many forms of treatment have proven to be successful.
Key Points:
– Your doctor will decide which treatment is right for you.
– Medications include digitalis, ACE inhibitors, diuretics, vasodiators and beta blockers
– Procedures and devices can help make the heart beat more efficiently; in severe cases, a heart transplant may be considered
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Fast facts:
– Congestive heart failure results when the heart muscle becomes weakened and cannot pump blood efficiently
– Many conditions that affect the heart can lead to congestive heart failure, including coronary artery disease, previous heart attacks, hypertension, infections, and chronic lung disease
– Diagnosis of congestive heart failure includes an examination and history of symptoms, chest x-rays, and tests to measure heart function
– Depending on how severe the disease is, congestive heart failure can be treated with medications to help the heart pump more efficiently, implanted defibrillators, certain procedures, or a heart transplant
– When possible, conditions causing heart failure will also be treated and corrected
– Lifestyle changes to control risk factors are important, including weight loss, cessation of smoking, decreased alcohol intake, and proper rest
For more information about congestive heart failure, visit http://www.americanheart.org/presenter.jhtml?identifier=4585
References:
1. Ho, KK, Pinsky, JL, Kannel, WB, Levy, D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 1993; 22:6A.
2. Hunt, SA, Abraham, WT, Chin, MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005; 112:e154.
3. He, J, Ogden, LG, Bazzano, LA, et al. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 2001; 161:996.
4. Felker, CM, Thompson, RE, Hare, JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000; 342:1077.
5. Gheorghiade, M, van Veldhuisen, DJ, Colucci, WS. Contemporary use of digoxin in the management of cardiovascular disorders. Circulation 2006; 113:2556.
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