Congestive Heart Failure

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By Dr. Tim Moser, Denver House Calls in Denver
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Jerry was having a hard time breathing. It was the middle of the night, and it was impossible to be flat on his back due to the feeling of not getting enough air. His wife could hear a faint wheeze as he exhaled. Occasionally Jerry would have a coughing fit, where he would bring up a foamy material from his lungs.

Relatives had been in town for the past several days. Jerry and his wife entertained by taking them out to eat several times. He noticed his ankles had become more swollen than usual, but he attributed this to the higher than average temperatures this warm spring.

Since Jerry seemed to be getting worse, his wife took him to the Emergency Room for an evaluation. His oxygen level was low, so tubing was placed under his nose to deliver additional oxygen. A chest X-ray showed his lungs were filling with excess fluid. Jerry was admitted to the hospital for several days of intense medical care before being sent home with several new prescription drugs.

Congestive Heart Failure (often abbreviated CHF) is a common heart condition that usually affects people older than 40 years of age. It is caused by a decreased ability of the heart to pump blood effectively. Symptoms of CHF may include leg swelling, fluid collection in the lungs, and shortness of breath. If left untreated, CHF can be fatal.

My heart is a pumpin’

It is well known that the heart pumps blood. It is easy to take the heart for granted, toiling away day and night from weeks after conception in the womb until death. The heart pumps enough blood in an average person’s lifetime to fill 3 supertankers, or around 3 million barrels. Now that’s a lot of blood!

The human heart contains four separate chambers. The upper chambers, known as the atria of the heart direct blood down to the lower chambers. The lower chambers, or ventricles, force blood to the lungs ( the right ventricle), or out to the body (the left ventricle). This arrangement works so well we never really think about our hearts toiling away anonymously, until something goes wrong.

Pump failure

If the heart muscle does not squeeze properly, blood is not moved well. This can cause blood to ‘back up’ into the veins, waiting patiently in line to reach the pump, so it can be sent along its way to the lungs or body. Depending on how poorly the heart is working, the volume of blood waiting to reach the heart can increase dramatically. As this blood pools, mischief can begin to happen.

Blood trying to reach the right ventricle of the heart collects in the legs, and to a lesser extent, in the arms. Fluid starts to seep out of the blood vessels, causing swelling and weight gain (doctors refer to this excess fluid as edema). This condition could be referred to as right sided heart failure, since the right heart is affected.

In a like manner, if blood is unable to be pumped out of the left side of the heart due to a problem with the left ventricle, the pooling blood may seep into the tissues of the lung. This left sided heart failure can lead to a condition known as pulmonary edema. Since it is the left side of the heart that sends blood to the kidneys, the excess fluid collecting may not be removed efficiently, making the problem worse.

In many cases, both the left and right ventricles are affected in heart failure.

The symptoms of a failing heart

Some symptoms of heart failure are quite obvious to the naked eye. Weight gain and edema of the legs is a common problem that is sometimes caused by pump failure. As the lungs fill with fluid, oxygen is taken up by the body less efficiently. The result is shortness of breath, and cough often productive of a foamy sputum. As the lungs collect more fluid, breathing becomes faster and more shallow in an attempt to compensate.

As the heart function continues to decline, other organs are affected. The kidneys respond to decreased blood flow by producing less urine. Lack of adequate blood flow to the brain may cause confusion and lethargy. Temperature regulation may also be affected, leaving the person feeling cold. In extreme cases, congestive heart failure can progress to organ failure and death.

Treatment

The goal of treatment in congestive heart failure is to help the heart muscle contract better, allowing the blood to circulate normally. The keystone treatment for heart failure is remove the excess fluid that collects in the body. “Water Pills’, or diuretics are used to help the kidneys eliminate this extra fluid.

Some medications act directly on the heart muscle itself, promoting a stronger contraction and better pumping. Digitalis (also known as Digoxin) has been around for centuries, and is very good for this purpose.

A class of drugs called beta blockers help the heart heal, and increase the survival of patients with congestive heart failure.

Finally, most patients with heart failure are also treated with ACE Inhibitors, which have also been shown to increase the survival of patients with CHF.

Diet and exercise also plays an important role in treatment. Avoidance of sodium in the diet helps to avoid fluid overload, which can make heart failure worse. Regular exercise can also keep the heart muscle strong, and functioning properly.

Need more information about congestive heart failure?

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001211/

http://www.mayoclinic.com/health/heart-failure/DS00061