Congestive Heart Failure

Overview

A weak pump

Despite the confusing terminology, congestive heart failure (CHF) is not the same as cardiac arrest. In other words, congestive heart failure doesn't mean the heart has stopped pumping, but it does mean that the heart isn't able to pump enough blood to supply the body's oxygen needs.

Although the condition usually worsens over time, people with heart failure can live for years with proper treatment, including drug therapy and lifestyle modifications.

Detailed Description

People with congestive heart failure often have shortness of breath and feel tired and weak because their muscles aren't getting enough blood. The heart keeps working but doesn't work as efficiently as it should. As blood flows more slowly out of the heart, the blood returning to the heart through the veins backs up in the tissues. This plumbing problem often causes swelling — most commonly in the legs and ankles. Heart failure also affects the ability of the kidneys to dispose of sodium and water. The extra water increases blood volume and therefore the swelling.

Congestive heart failure can cause a buildup of fluid in the lungs, called pulmonary edema, that results in extreme shortness of breath and can be life-threatening. Many people experience this shortness of breath while lying down because the fluid moves into the lungs. People with congestive heart failure may have to sleep sitting up to allow the fluid to drain from the lungs and make breathing easier.

How Common Is Congestive Heart Failure?

According to the American Heart Association, about 4,600,000 Americans (2,200,000 males and 2,300,000 females) have CHF and are alive today. About 400,000 new cases of CHF occur each year, and the incidence of CHF approaches 10 per 1,000 people after age 65.

Conventional Treatment

Goals of Treatment

Treatment options depend on the underlying cause. In many cases, lifestyle changes to help lower blood pressure, lose weight, and improve overall cardiovascular function are sufficient. Medication is available to strengthen the heart's pumping action. Surgery is also used to treat rarer cases of congenital (from birth) heart defects or a diseased heart valve. Treatment for congestive heart failure has four goals:

• Improve the heart's ability to pump
• Reduce the heart's workload
• Remove excess salts and fluids
• Relieve symptoms such as shortness of breath, fatigue, and weakness

The only way to cure congestive heart failure is to treat its cause, but for most patients, no cure exists, and the best approach is to improve the quality of life, prolong life, and make physical activity more comfortable. Depending on the severity of the underlying cause, congestive heart failure can be managed effectively for some time.

Treatment Overview

There are three main approaches to treating congestive heart failure:

• Treat the underlying cause, such as heart valve problems or coronary artery disease: surgery can correct narrowed or leaking heart valves, abnormal connections between heart chambers, or coronary artery blockage. Antibiotics can cure infection. Drugs, surgery, or radiation therapy can correct an overactive thyroid gland. Drugs can reduce and control high blood pressure. Lifestyle modifications such as dietary restrictions and gradual exercise programs treat the underlying causes such as high blood pressure and coronary artery disease.
• Remove contributing factors, such as smoking and obesity: doctors may recommend smoking and/or alcohol cessation programs and dietary counseling.
• Treat the heart failure itself with medication and sometimes surgery: Medications include diuretics, digoxin, vasodilators, and beta-blockers. In extreme causes of CHF, heart transplantation may be recommended.

Drug Therapy

Accupril
Aldactone
Altace
Cardizem
Coreg
Coumadin
Diovan
Imdur
Lasix http://www.nmihi.com/f/furosemide.html
Lotensin
Norvasc
Lopressor
Vasotec

Procedures

Treatment for CHF includes:

• If CHF is caused by severe coronary artery disease:
  • Angioplasty: A catheter with a balloon tip is inserted into a narrowed artery and then inflated, widening the artery by cracking plaques. In one newer variation, a rotating blade shaves the plaque into tiny particles, and in another, a laser beam vaporizes the plaque.
  • Coronary bypass surgery: A section of vein or artery is removed from elsewhere in the body and reconnected to detour blood around the diseased vessel.
  • Transmyocardial revascularization: A laser cuts a series of channels in the heart muscle to increase blood flow. A surgeon makes an incision on the left side of the chest and inserts a laser into the chest cavity. With the laser, the surgeon shoots from 15 to 30 holes, each a millimeter in diameter, through the heart's left ventricle, in between heartbeats. (The laser is fired when the chamber is full of blood so the blood can protect the inside of the heart.) Then the surgeon seals the outer openings but lets the inner channels stay open, allowing oxygen-rich blood to flow through the heart muscle. This is a new procedure and is still considered experimental.
• Cardiomyoplasty: A procedure in which a large muscle from the back is wrapped around the heart and stimulated by an artificial pacemaker to contract rhythmically.
• Myocardial wall resection: Flabby, nonfunctioning heart muscle is simply cut out.
• Heart transplant

Appropriate Healthcare Setting

The appropriate health care is outpatient, unless the condition requires surgery, or otherwise becomes severe enough to warrant hospitalization.

Healthcare Professionals Who May Be Involved in Treatment

Health professionals who participate in managing this disorder:

• Family practitioners
• Internists
• Geriatricians
• Cardiologists
• Pulmonologists
• Pediatricians
• Radiologists
• Cardiac surgeons
• Thoracic surgeons
• Transplant surgeons

Activity & Diet Recommendations

During severe stages of congestive heart failure, bed rest is recommended. You should sit up in bed to prevent fluid buildup in the lungs. Avoid unnecessary exertion, such as climbing stairs, until the condition is under control. Talk to your doctor about gradually increasing your activity to improve overall cardiovascular strength.

Low salt intake reduces fluid accumulation, which in turn decreases the heart's workload. Research suggests that a low-fat, high-fiber diet rich in fruit and vegetables benefits patients with coronary artery disease in addition to helping with weight control. Here are some general guidelines:

• Avoid foods high in saturated fats, such as meats, eggs, cheeses, and other dairy products
• Eat plenty of whole grains, breads, and cereals instead of white and refined grains
• Eat lots of fresh fruits and vegetables with meals and as snacks
• Eat legumes such as beans, peas, and lentils in soups and salads

Because some diuretic medications increase potassium excretion, eating foods high in potassium is advised if you're taking these drugs. Potassium-rich fruits include oranges, orange and grapefruit juice, bananas, melons, nectarines, prunes, peaches, pears, and avocados. Vegetables high in potassium include collard greens, cucumbers, potatoes, sweet potatoes, cabbage, beans, peas, winter squash, and tomatoes.

Possible Complications

A sudden accumulation of fluid in the lungs is called acute pulmonary edema. It causes the person with CHF to gasp for breath and is a life-threatening condition requiring immediate hospitalization.

Other possible complications of CHF include the following:

• Electrolyte imbalances
• Digitalis intoxication characterized by cardiac arrhythmias, gastrointestinal upset, and central nervous system effects such as visual disturbances, weakness, dizziness, and headache
• Heart arrhythmias
• Protein intestinal disease

Quality of Life

Depending on the severity and stage of congestive heart failure, available treatments range from lifestyle adjustments and drug therapy to major surgery. Which treatment is right for you depends on your individual situation. Congestive heart failure can lead to difficulties with basic daily living activities, causing frustration and anxiety. Try relaxation techniques to help reduce anxiety and improve your mood.

Considerations for Women

Pregnancy

Certain medications prescribed for congestive heart failure (such as ACE inhibitors) cannot be taken during pregnancy.

Nursing mothers

Likewise, ACE inhibitors can be excreted into breast milk, so you should either avoid these medications or refrain from nursing.

Considerations for Older People

Older people are more likely to have congestive heart failure, because they're at higher risk for its underlying causes. In general, older people have less efficient heart functions. With age, the heart muscle becomes thicker, but not stronger. While congestive heart failure reduces life expectancy, some cases are well-controlled with medication.

Instead of shortness of breath, some older people with congestive heart disease will first experience insomnia, fatigue, weakness, agitation, or confusion. Also, older people are more likely to experience the toxic effects of the medication digoxin, which can include dizziness, confusion, weakness, and depression. Any symptoms should be reported promptly. Also, older people are especially sensitive to blood-pressure-lowering medications, so start with small doses.

Considerations for Children and Adolescents

Some cases of congestive heart failure are caused by a congenital (from birth) heart defect.