Sun
19
Apr

Congestive Heart Failure

Congestive Heart Failure is a condition in which the heart is unable to pump the necessary amount of blood throughout the body. This causes blood to back up in the veins. Fluid pools in the liver and lungs. Swelling occurs first in the feet, ankles, and legs, and then throughout the body as the kidneys begin to retain fluid.

Causes

Causes include:
  • Problems with the heart's valves due to:
    • Rheumatic heart disease
    • Bacterial endocarditis
    • Congenital defects
    • Calcium deposits
  • High blood pressure
  • Heart muscle damage after a heart attack
  • Coronary artery disease
  • Cardiomyopathy (weakened, damaged heart muscle) due to:
    • Infection
    • Excess alcohol ingestion
    • Genetic defect
    • Certain medications
  • Arrhythmias
  • Complications from the use of beta-blocking or digitalis-containing medications
  • Diabetes
  • Emphysema
  • Hyperthyroidism (overactive thyroid)
  • Excess salt intake
  • Amyloidosis
  • Pneumonia
  • Kidney and/or liver failure
  • Anabolic steroid use
  • Thiamine (vitamin B1) deficiency

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Sex: Male
  • Race: Black
  • Advancing age
  • Pregnancy
  • Excess alcohol intake
  • Excess intake of salt and fat
  • High fever
  • Infection
  • Obesity
  • Chronic lung disease
  • Use of beta-blocking or digitalis-containing medications
  • Cancer chemotherapy
  • Arrhythmia
  • Heart valve disease
  • Heart muscle damage from heart attack, infection, medications
  • Overactive thyroid

Symptoms

Symptoms include:
  • Fatigue, weakness
  • Shortness of breath – at first only with activity, progressing to shortness of breath at rest
  • Wheezing
  • Cough – may be dry and hacking or wet sounding with a pink, frothy sputum
  • Need to sleep propped up
  • Swelling of feet, ankles, or legs
  • Frequent urination, especially at night
  • Unexplained weight gain
  • Abdominal pain and tenderness

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. In particular, the physical exam will include:
  • Listening to the lungs and heart with a stethoscope
  • Feeling the abdomen for tenderness and liver swelling
  • Checking the legs for swelling
Tests may include:

Blood tests – to look for certain markers in the blood that help the doctor determine what is happening with your heart

Urine tests – to look for certain markers in the urine that help the doctor determine what is happening with your heart

Electrocardiogram (ECG, EKG) – records the heart's activity by measuring electrical currents through the heart muscle

Echocardiogram – uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart

Exercise stress Test – records the heart's electrical activity during increased physical activity

Thallium Stress Test – thallium is used to scan the myocardium, the middle layer of the heart

Nuclear Scanning – radioactive material is injected into a vein and observed as it is absorbed by the heart muscle

Electron-beam CT Scan – a type of x-ray that uses a computer to make pictures of the inside of the heart

Coronary Angiography – x-rays taken after a dye is injected into the arteries; allows the doctor to look for abnormalities in the arteries.

Treatment

Treatments include:

Treat Underlying Conditions

If you have another condition that is causing CHF, appropriate treatment of that condition should improve or cure your CHF.

Lifestyle Changes
  • Avoid alcohol.
  • If you smoke, quit.
  • Lose weight if necessary.
  • Eat a healthful diet that is:
    • Low in fat and salt
    • High in fiber
  • Work with your doctor to develop an appropriate exercise program.
  • Weigh yourself every morning so you can detect fluid retention early.
Medications

Medications include:
  • Diuretics
  • Digitalis
  • Ace-inhibiting medications
  • Beta-blockers
  • Nitrates
  • Hydralazine
Left-Ventricular Assist Device (LVAD)
This is a mechanical pump that can be implanted in your chest. It temporarily assists the heart's pumping. This is used to maintain patients awaiting heart transplants.

Cardiomyoplasty
This is a surgical procedure in which a muscle from the back is removed and wrapped around the heart. A mechanical device stimulates the transplanted muscle to squeeze the heart, thus assisting the heart's pumping action.

Heart Transplant
This is reserved for the most severe cases of congestive heart failure.

Prevention

To prevent congestive heart failure or to prevent the condition from worsening:
  • If you smoke, quit.
  • Avoid alcohol.
  • Maintain a healthy weight.
  • Lose weight, if necessary.
  • Eat a healthful diet, one that is low in saturated fat and salt, and rich in whole grains, fruits, and vegetables.
  • Begin a safe exercise program with the advice of your doctor.