Congestive Heart Failure

Related terms:

Cardiomyopathy, Pulmonary Edema, CHF, Localized edema, Left Sided Heart Failure, Right Sided Heart Failure, Systolic Heart Failure, Diastolic Heart Failure, Pleural Effusions, Acute Pulmonary Edema, Lymphedema, Lymph System, Lymphatics, Electrocardiogram, Echocardiogram, Multiple-gated Acquisition Scan, MUGA, Beta Naturetic Peptide, B-type

Discussion:

This is one of the most common diseases in the United States, affecting an estimated five million people, wih an estimate 500,000 new cases as year. While there is no "cure," there is treatment not only for the condition but for the complications associated with it. Heart failure is a condition in which the heart is no longer able to efficiently pump enough blood through the body. It is a gradually worsening condition that develops usually over a period of time.

It can develop in either side of, or the entire heart. In left sided heart falure, the heart is not able to pump enough blood through the entire body, whereas in right sided heart failure, the heart cannot pump blood efficient or effectively through the lungs. Left sided heart failure is the more common of the two.

Symptoms:

The most common symptoms of heart failure are shortness of breath or difficulty in breathing, feeling tired and unexplained swelling of the ankles, feet and legs. (edema).

Fluid build up in the lungs may also cause coughing and is generally worse at night when in bed. You may even experience episodes of waking up feeling as if your are drowning and unable to breath. This can lead to the life threatening condition known as acute pulmonary edema.

The swelling in the ankles, feet and leg is not to be confused with lymphedema.

The swelling from lymphedema is caused by malformations, destruction of or damage to the lymph system (lymphatics) and is not related to congestive heart failure. It is also not a recognized causative factor in congestive heart failure. Other indications of swelling will include weight gain and more frequent urination as the body attempts to cope with the fluid build up. Edema from congestive heart failure is a result of the heart inability to pump blood and fluids back through the cardiovascular system. As the fluid "wait" to be pumped back through the heart, it builds up in the leg and begins to "leak" out of the permeable structure of the veins.

Symptoms of chronic heart failure are broken down into four classes, depending on the lmitations the conditions places on your ability to engage in various activities. (1)

Class 1: No limitations on activities. Activities do not cause undue fatigue or shortness of breath.

Class 2: Slight or mild limits. You are comfortable at rest, but are beginning to experience more tiredness and shortness of breath when undertaking normal physical activity.

Class 3: Marked or noticeable limits--comfortable at rest, but less than ordinary physical activity causes tiredness or shortness of breath.

Class 4: Severe limits--unable to carry on any physical activity without discomfort. Symptoms are also present at rest. If any physical activity is undertaken, discomfort increases.

Complications:

Blood and fluid back up in the lungs (pulmonary edema or pleural effusions); buildup of fluids in the feet, ankles and legs (localized edema); tiredness and shortness of breath, mental confusion due to the lack of oxygen rich blood in the brain.

Risk Factors and Precipitating Causes:

There are many risk factors and precipitating causes leading to congestive heart failure.

The most common are life style choices we make and as such, we can reduce our risk by maintaining proper weight, developing a healthy diet, not smoking, limiting alcohol intake, getting enough exercise and limiting caffein consumption.

Medical conditions that contribute to congestive heart failure include anemia, infections, thyrotoxicosis, endocarditis, arrhythemia, rheumatic and other forms of myocarditis, hypertension, heart attacks, pulmonary embolisms, diabetes and congenital heart disease.

Physiological Cause:

Risk factors and precipitating causes will over time affect the hearts ability to function properly. The heart simply begins to "wear" out. The body attempts to compensate by causing the heart to work harder to performs its task. The result of this is that the heart enlarges and pumps faster and less efficiently. As the heart weakens and less blood flows through the blood vessels, they narrow and constrict causing further damage. Also, as less blood becomes available, the body will begin to divert the blood supply to organs it deems most important for "survival."

Other areas begin to be deprived of the needed blood flow and this can cause atrophy of muscles.

Eventually, neither the body nor the heart is able to maintain function and the entire system begins to breakdown, leading to failure and death.

Diagnosis:

While a physical exam and patient history can help diagnose congestive heart failure, there are a number of tests that will be administered for an accurate diagnosis.

These tests may include a chest x-ray (helpful in showing pleural edema), an electrocardiogram (shows the hearts electrical activity), echocardiogram which is an ultrasound type (shows the beating of the heart), and a multiple-gated acquisition scan, MUGA (dye test which shows problems with pumping an blood flow).

Blood tests will be done that will show blood counts, sodium and potassium levels, kidney function, and will reveal the presence of a substance called beta naturetic peptide (B-type). This is a substance that is produced by a failing heart.

Treatment:

There is no cure for congestive heart failure, but there is treatment for the conditions and for the complications associated with it. A treatment program will consist of three focal points.
First is lifestyle changes. This involves (again) weight control, smoking cessation, limiting of alcohol, low fat and low cholesterol diet, proper exercise and limiting caffeine and salt.
Second, is the appropriate use of medications. Commonly used medications includes diuretics for the edema. digoxin (digitalis) to improve the pumping ability of the heart, vasodilators which helps enlarge the smaller arteries for improvement in blood flow, beta-blockers which slow down the heart rate. Other medications may include Nesiritide which is used for congestive heart failure patients in the hospital to help stabalize their condition and anti-arrhythmics which can help control the rythm of the heart

Third is the possible use of surgical therapy. This may include coronary artery bypass to improve blood flow, angioplasty to clear blockages and may in the most severe cases of congestive heart failure lead to a heart transplant. If there is arrhythemia a pacemaker may be implanted.

(c) Pat O'Connor - Lymphedema People

See Also:

Edema and Congestive Heart Failure

For Further Information:

Congestive Heart Failure

American Heart Association

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Congestive Heart Failure

Cardiology Channel

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Congestive Heart Failure

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Congestive Heart Failure and Pulmonary Edema