Thursday, July 23, 2009

Health Care and Congestive Heart Failure

Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enough blood to meet your body's needs, according to the Mayo Clinic. Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently. You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life. The best way to prevent heart failure is to control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity. According to, each year, nearly 300,000 Americans die from heart failure.

According to the American Heart Association (AHA), CHF can result from:
--narrowed arteries that supply blood to the heart muscle — coronary artery disease
--past heart attack, or myocardial infarction, with scar tissue that interferes with the heart muscle's normal work.
--high blood pressure.
--heart valve disease due to past rheumatic fever or other causes.
--primary disease of the heart muscle itself, called cardiomyopathy.
--heart defects present at birth — congenital heart defects.
--infection of the heart valves and/or heart muscle itself — endocarditis and/or myocarditis.

The "failing" heart keeps working but not as efficiently as it should, according to the AHA. People with heart failure can't exert themselves because they become short of breath and tired. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down. Heart failure also affects the kidneys' ability to dispose of sodium and water. The retained water increases the edema.

According to the AHA, your doctor is the best person to make the diagnosis. The most common signs of congestive heart failure are swollen legs or ankles or difficulty breathing. Another symptom is weight gain when fluid builds up. CHF usually requires a treatment program of:
--proper diet
--modified daily activities
--drugs such as ACE (angiotensin-converting enzyme) inhibitors: beta blockers, digitalis, diuretics, vasodilators.

Various drugs are used to treat congestive heart failure, according to the AHA. They perform different functions. ACE inhibitors and vasodilators expand blood vessels and decrease resistance. This allows blood to flow more easily and makes the heart's work easier or more efficient. Beta blockers can improve how well the heart's left lower chamber (left ventricle) pumps. Digitalis increases the pumping action of the heart, while diuretics help the body eliminate excess salt and water. When a specific cause of congestive heart failure is discovered, it should be treated or, if possible, corrected. For example, some cases of congestive heart failure can be treated by treating high blood pressure. If the heart failure is caused by an abnormal heart valve, the valve can be surgically replaced. If the heart becomes so damaged that it can't be repaired, a more drastic approach should be considered. A heart transplant could be an option. Most people with mild and moderate congestive heart failure can be treated. Proper medical supervision can prevent them from becoming invalids.

The symptoms of congestive heart failure vary among individuals according to the particular organ systems involved and depending on the degree to which the rest of the body has "compensated" for the heart muscle weakness, according to An early symptom of congestive heart failure is fatigue. While fatigue is a sensitive indicator of possible underlying congestive heart failure, it is obviously a nonspecific symptom that may be caused by many other conditions. The person's ability to exercise may also diminish. Patients may not even sense this decrease and they may subconsciously reduce their activities to accommodate this limitation. As the body becomes overloaded with fluid from congestive heart failure, swelling (edema) of the ankles and legs or abdomen may be noticed. In addition, fluid may accumulate in the lungs, thereby causing shortness of breath, particularly during exercise and when lying flat. In some instances, patients are awakened at night, gasping for air. Some may be unable to sleep unless sitting upright. The extra fluid in the body may cause increased urination, particularly at night. Accumulation of fluid in the liver and intestines may cause nausea, abdominal pain, and decreased appetite.

According to, after congestive heart failure is diagnosed, treatment should be started immediately. Perhaps the most important and yet most neglected aspect of treatment involves lifestyle modifications. Sodium causes an increase in fluid accumulation in the body's tissues. Because the body is often congested with excess fluid, patients become very sensitive to the levels of intake of sodium and water. Restricting salt and fluid intake is often recommended because of the tendency of fluid to accumulate in the lungs and surrounding tissues. An American "no added salt" diet can still contain 4 to 6 grams (4000 to 6000 milligrams) of sodium per day. In patients with congestive heart failure, an intake of no more than 2 grams (2000 milligrams) of sodium per day is generally advised. Reading food labels and paying close attention to total sodium intake is very important. Likewise, the total amount of fluid consumed must be regulated. Although many patients with congestive heart failure take diuretics to aid in the elimination of excess fluid, the action of these medications can be overwhelmed by an excess intake of water and other fluids. The maxim that "drinking eight glasses of water a day is healthy" certainly does not apply to patients with congestive heart failure. In fact, patients with more advanced cases of congestive heart failure are often advised to limit their total daily fluid intake from all sources to 2 quarts. The above guidelines for sodium and fluid intake may vary depending on the severity of congestive heart failure in any given patient and should be discussed with the patient's physician.

An important tool for monitoring an appropriate fluid balance is the frequent measurement of body weight, according to An early sign of fluid accumulation is an increase in body weight. This may occur even before shortness of breath or swelling in the legs and other body tissues is detected. A weight gain of two to three pounds over two to three days should prompt a call to the physician, who may order an increase in the dose of diuretics or other methods designed to stop the early stages of fluid accumulation before it becomes more severe. Aerobic exercise, once discouraged for congestive heart failure patients, has been shown to be beneficial in maintaining overall functional capacity, quality of life, and perhaps even improving survival. Each patient's body has its own unique ability to compensate for the failing heart. Given the same degree of heart muscle weakness, patients may display widely varying degrees of limitation of function. Regular exercise, when tailored to the patient's tolerance level, appears to provide significant benefits and should be used only when the patient is compensated and stable.

According to, congestive heart failure is generally a progressive disease with periods of stability punctuated by episodic clinical exacerbations. The course of the disease in any given patient, however, is extremely variable. Factors involved in determining the long term outlook (prognosis) for a given patient include:
--the nature of the underlying heart disease,
--the response to medications,
--the degree to which other organ systems are involved and the severity of other accompanying conditions,
--the patient's symptoms and degree of impairment, and
--other factors that remain poorly understood.

In cases where the patient is eventually at the end of CHF, death can be imminent with the last stages incredibly painful. The last months, weeks, and days are extremely difficult, and the patient has no quality of life. Congestive heart failure makes the patient totally dependent on caregivers, and hospice is usually recommended for patients who have no alternative options. Medical providers then resort to pain management until the patient dies from the disease. CHF is a terrible way to die; and unless another medical option is reasonable, eventually the patient will succumb to it. Various medications and other health care procedures can attempt to prolong life, but the end result is not favorable for the patient. If you have CHF, or know someone who does, look to your doctor to help assist you in a course of treatment that can help deal with the disease as long as possible.

Until next time. Let me know what you think.

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