Congestive heart failure
Almost as many as 6 million Americans are affected by heart failure or congestive heart failure. One in nine deaths are associated with heart failure, and the five-year survival rate of those diagnosed with heart failure is 50 percent. When heart failure occurs and the body is congested with fluid, the term used to define the condition is "'congestive heart failure"'
Definition & Facts
Heart failure does not mean that a person's heart has stopped beating or working. When a person has heart failure, the blood moves through his or her heart and body at a slower rate than normal as pressure within the heart grows stronger. The heart then is not able to pump sufficient nutrients and oxygen to meet a person's needs.
The response of the heart's chambers is to stretch in order to hold a larger amount of blood and to pump the blood through the person's body. The heart's chambers may also become thickened and stiff as they work harder to pump blood.
However, the problem is the cardiac muscle of the heart may eventually become weak and unable to efficiently pump. This results in fluid building up (edema) in the ankles, legs, feet, arms, lungs (pulmonary edema) or other organs of the body.
Symptoms & Complaints
- Retention of water and fluid: When an insufficient amount of blood reaches the kidneys, water and fluid is retained and the result is swollen legs, ankles, abdomen and weight gain. One will have an increased nighttime need to urinate (nocturnal enuresis). Loss of appetite or nausea due to abdominal bloating may occur.
- Lung congestion: Due to a backup of fluid in the lungs, one will experience being short of breath when exercising or may have difficulty breathing when laying flat in bed or resting. The congestion in the lungs can cause wheezing or a hacking cough. They may also cough up pink and foamy mucus.
- Weakness, fatigue, and dizziness: When a person's muscles and major organs don't receive sufficient blood, they will feel weak and tired. Not enough blood (hypoxia) getting to the brain will cause the person to be dizzy and confused. They may also have difficulty concentrating or experience a decrease in the alertness.
- Irregular heartbeat (cardiac arrhythmia) or rapid heartbeat (tachycardia): The heart must beat faster in order to get enough blood to travel throughout the body. This will result in causing an irregular or rapid heartbeat.
- Chest pain: When heart failure is the result of a heart attack, the individual will likely feel chest pain.
Possible causes of heart failure include the following:
- High blood pressure known as hypertension -- Blood is pumped through one's arteries by the heart. The force the blood is pumped is blood pressure. In order to circulate blood through the entire body, the heart has to work harder than it should when the blood pressure is high.
- Due to the extra work needed to pump the blood throughout the body for some time, the muscle of the heart may become either too weak or too stiff to be effective in pumping blood.
- Coronary artery disease- The most common cause of heart failure is coronary artery disease. The arteries supplying blood to the muscle of the heart narrow due to fatty deposits (arterial plaque) building up within them (a condition called atherosclerosis). Eventually, this narrowing of the arteries causes the blood flow to the heart to be reduced.
- Heart attack -- If the plaques that are formed by the fatty deposits in the arteries should rupture, a heart attack can occur. A blood clot is then formed as a result causing the blood flow to an area of the heart muscle to weaken its ability to pump and leave permanent damage. Significant damage can then lead to the heart muscle being weakened.
- Valvular heart disease -- It is the job of the heart valves to keep the blood flowing in the right direction through the heart. A congenital heart defect, an infection like endocarditis or pericarditis or coronary artery disease often are responsible for damage to one or more of the heart valves. This damage makes it necessary for the heart to work harder in order to keep the blood flowing as it should. In time, the extra work may weaken the heart. However, if the problem is found quickly enough, the valves can be replaced or fixed.
- Heart muscle damage or cardiomyopathy -- The muscle of the heart can be damaged in several ways such as by infections, several diseases, abuse of alcohol, or the toxic effects of drugs' including cocaine or chemotherapy.
- Congenital disorders of the heart -- Congenital heart defects are defects of the heart that a person is born with. The defects involve malformations of the heart, its chambers, or its valves. This results in the healthy heart part having to work harder to pump the blood through the heart. In time, the result may be heart failure.
- Heart rate and or rhythm problems called cardiac arrhythmias -- If the heart beats too fast or too slow (bradycardia), the result can be heart failure. This is because when the heart beats faster than it should, extra work is created for the heart. If the heart beats too slowly, the heart may not get enough blood to circulate through the body.
- Diabetes mellitus, hypothyroidism, hyperthyroidism, HIV, and other chronic diseases may also contribute to heart failure.
Diagnosis & Tests
The first steps in diagnosing heart failure done by a doctor is to take a medical history and family history, review the patient's symptoms and perform a complete physical examination. He or she will check whether any risk factors are present. These would include coronary artery disease, high blood pressure or diabetes.
Through the use of a stethoscope, the doctor will then listen for congestion in the lungs and abnormal heart sounds. Checking for fluid buildup in the legs or abdomen will be part of the physical exam which will involve palpation. The following tests would be ordered:
- Chest X-rays
- Blood tests
- Magnetic resonance imaging (MRI) or cardiac computerized tomography (CT) scan.
- Cardiac stress test
- Myocardial biopsy which involves cardiac catheterization.
- Coronary angiogram
Treatment & Therapy
Chronic heart failure is a disease that need lifelong management. Proper treatment can give the person relief of the symptoms and the heart may actually become stronger. Above all, treatment may give the person longer life and reduce the danger of dying suddenly.
Heart failure can sometimes be corrected by treating the cause. For instance, by repairing a heart valve heart failure can be reversed. Most people can be treated for heart failure with the right medications or through the use of devices. One or more of the following medications are prescribed by doctors depending on the symptoms:
- Angiotensin-converting enzyme inhibitors
- Beta blockers
- Angiotensin II receptor antagonists
- Aldosterone antagonists
At times, doctors recommend surgery to correct the problem leading to heart failure. Some treatments such as the following surgeries and medical devices are used:
- Heart valve replacement or repair
- Coronary bypass surgery
- Biventricular pacemaker or cardiac resynchronization therapy
- Implantable cardioverter-defibrillators
- Heart transplant
Prevention & Prophylaxis