CONGESTIVE HEART FAILURE

CHF:

A common form of heart failure that results in a patient retaining excessive fluid, often leading to swelling of the legs and ankles and congestion in the lungs.

Overview

Congestive heart failure, or heart failure, is a condition in which the heart is unable to adequately pump blood throughout the body and/or unable to prevent blood from "backing up" into the lungs.

In most cases, heart failure is a process that occurs over time, when an underlying condition damages the heart or makes it work too hard, weakening the organ. Heart failure is characterized by shortness of breath (dyspnea) and abnormal fluid retention, which usually results in swelling (edema) in the feet and legs.

Heart failure can make you feel very tired and short of breath. Eating healthy foods can help improve those symptoms and get you back on the road to a full and enjoyable life. Salt, saturated fat and cholesterol in foods can make your symptoms worse, so avoid them.

Once you learn which foods help you to feel better, you can change your eating habits a little at a time. Ask your healthcare professional to help you get started. Everyone’s case is different, so be sure to consult your doctor about such things as how much liquid to drink each day and how much potassium your body needs. The main thing is to get back to a more enjoyable life. Eating right will help that happen more quickly.

If you or someone you love has been diagnosed with heart failure, it can be frightening. This is a serious condition that has no cure, but you can live a full and enjoyable life with the right treatment and active attention to your lifestyle.

The most important thing to remember is that you're not alone. Nearly 5 million Americans are living with heart failure, and 550,000 new cases are diagnosed each year. You can manage this condition, and we’re here to help. Regardless of your treatment, you need to follow all of your doctor’s recommendations and make the necessary changes in diet, exercise and lifestyle to give you the highest possible quality of life. 

 

Heart failure can involve the heart's left side, right side or both sides. However, it usually affects the left side first. Each side is made up of two chambers: the atrium, or upper chamber; and the ventricle, or lower chamber. The atrium receives blood into the heart, and the ventricle pumps it where it needs to go. Heart failure occurs when any of these chambers lose their ability to keep up with the amount of blood flow.

What is left-sided heart failure?

Left-sided or left ventricular (LV) heart failure involves the heart's left ventricle (lower chamber). Oxygen-rich blood travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the rest of the body. Because this chamber supplies most of the heart's pumping power, it's larger than the others and essential for normal function.

 

If the left ventricle loses its ability to contract normally (called systolic failure), the heart can't pump with enough force to push enough blood into circulation. If the ventricle loses its ability to relax normally (diastolic failure) because the muscle has become stiff, the heart can't properly fill with blood during the resting period between each beat. This is an important distinction because the drug treatments for each type of failure are different.

In either case, blood coming into the left chamber from the lungs may "back up," causing fluid to leak into the lungs. (The technical term for this is pulmonary edema.) Also, as the heart's ability to pump decreases, blood flow slows down, causing fluid to build up in tissues throughout the body (edema). This excess fluid or congestion explains the term congestive heart failure, which you've probably heard before.

What is right-sided heart failure?

The right atrium receives the "used" blood that returns to the heart through the veins; then the right ventricle pumps it into the lungs to be replenished with oxygen. Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, ultimately damaging the heart's right side. When the right side loses pumping power, blood backs up in the body's veins. This usually causes swelling in the legs and ankles.

How quickly does heart failure develop?

Heart failure is usually a chronic disease. That means it's a long-term condition that tends to gradually become worse. By the time someone is diagnosed, chances are that the heart has been losing pumping capacity little by little for quite a while. At first the heart tries to make up for this by:

  • Enlarging. When the heart chamber enlarges, it stretches more and can contract more strongly, so it pumps more blood.
  • Developing more muscle mass. The increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly, at least initially.
  • Pumping faster. This helps to increase the heart's output.

The body also tries to compensate in other ways. The blood vessels narrow to keep blood pressure up, trying to make up for the heart's loss of power. The body diverts blood away from less important tissues and organs to maintain flow to the most vital organs, the heart and brain. These temporary measures mask the problem of heart failure, but they don't solve it. This helps explain why some people may not become aware of their condition until years after their heart begins its decline. (It's also a good reason to have a regular checkup with your doctor.) Eventually the heart and body just can't keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a trip to the doctor.

The Normal Heart and How It Works

The normal heart is a pump made of muscle tissue.

 

 

It's about the size of your fist.

 

 

The heart has four chambers.

The two upper ones are the atria, and the lower two are the ventricles. (See diagram.)

Four heart valves open and close to keep the blood flowing in one direction as it's pumped through the heart.

The four heart valves are:

  1. the tricuspid valve, located between the right atrium and the right ventricle
  2. the pulmonary (pulmonic) valve, between the right ventricle and the pulmonary artery
  3. the mitral valve, between the left atria and the left ventricle
  4. the aortic valve, between the left ventricle and the aorta

Each valve has a set of "flaps" (also called leaflets or cusps). The mitral valve normally has two flaps; the others have three.

Dark bluish (oxygen-poor) blood returns to the heart after circulating through the body. It flows to the heart through veins and enters the right atrium. This chamber empties blood through the tricuspid valve into the right ventricle. The right ventricle pumps blood under low pressure through the pulmonary valve into the pulmonary artery. From there the blood goes to the lungs, where it gets fresh oxygen. Oxygen-rich blood is bright red. Now the blood returns to the left atrium. From there it passes through the mitral valve and enters the left ventricle.

The left ventricle pumps the red, oxygen-rich blood through the aortic valve and into a large artery called the aorta. The aorta takes blood from the heart to the rest of the body. The blood pressure in the left ventricle is the same as in the arm. While passing through the body, oxygen in the blood is distributed to the tissues. The cycle repeats as the blood flows back to the right atrium.

Heart Attack, Stroke & Cardiac Arrest Warning Signs

 

Act in Time
The American Heart Association and the National Heart, Lung, and Blood Institute have launched a new "Act in Time" campaign to increase people's awareness of heart attack and the importance of calling 9-1-1 immediately at the onset of heart attack symptoms.

7648-inter-phot.jpg
 

Dial 9-1-1 Fast
Heart attack and stroke are life-and-death emergencies -- every second counts. If you see or have any of the listed symptoms, immediately call 9-1-1. Not all these signs occur in every heart attack or stroke. Sometimes they go away and return. If some occur, get help fast! Today heart attack and stroke victims can benefit from new medications and treatments unavailable to patients in years past. For example, clot-busting drugs can stop some heart attacks and strokes in progress, reducing disability and saving lives. But to be effective, these drugs must be given relatively quickly after heart attack or stroke symptoms first appear. So again, don't delay -- get help right away!

 

Statistics 
Coronary heart disease is America's No. 1 killer. Stroke is No. 3 and a leading cause of serious disability. That's why it's so important to reduce your risk factors, know the warning signs, and know how to respond quickly and properly if warning signs occur.

Heart attack warning signs
 

Heart Attack Warning Signs
Some heart attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

If you or someone you're with has chest discomfort, especially with one or more of the other signs, don't wait longer than a few minutes (no more than 5) before calling for help. Call 9-1-1... Get to a hospital right away.

Calling 9-1-1 is almost always the fastest way to get lifesaving treatment. Emergency medical services staff can begin treatment when they arrive -- up to an hour sooner than if someone gets to the hospital by car. The staff are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too.

If you can't access the emergency medical services (EMS), have someone drive you to the hospital right away. If you're the one having symptoms, don't drive yourself, unless you have absolutely no other option.

 

warning signs
 

Stroke Warning Signs


The American Stroke Association says these are the warning signs of stroke:

If you or someone with you has one or more of these signs, don't delay! Immediately call 9-1-1 or the emergency medical services (EMS) number so an ambulance (ideally with advanced life support) can be sent for you. Also, check the time so you'll know when the first symptoms appeared. It's very important to take immediate action. If given within three hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.

 

Cardiac arrest strikes immediately and without warning.

Here are the signs:

If cardiac arrest occurs, call 9-1-1 and begin CPR immediately.

If an automated external defibrillator (AED) is available and someone trained to use it is nearby, involve them.

 

The Importance of Potassium

Some people with heart failure need to eat foods high in potassium. Potassium helps maintain the normal function of the heart and nervous system. Many people with heart failure take a diuretic (water pill) to help their kidneys make more urine and get rid of excess fluid. This can cause potassium loss.

Doctors sometimes prescribe a potassium supplement and recommend eating more potassium-rich foods.

Every situation is different, so ask your healthcare team what's needed. People who have kidney problems or take certain medications may risk having potassium build up in their systems. And too much potassium can be just as harmful as too little.
 

 

Lifestyle and Exercise

 

In heart failure, the heart isn’t working properly, so many people think that exercise will hurt them. Actually, moderate physical activity can help the heart get stronger. With daily exercise, most people will find that they don’t feel as tired, they have less stress and their energy level increases. Other advantages include weight control or weight loss, better circulation, and lower blood pressure and cholesterol levels. That’s a lot of benefits for a little physical effort.

It’s important to plan your physical activity with your healthcare professionals. How much exercise you can do will depend on your specific condition. But even a small amount can improve the way you feel and help you have a more positive attitude. If you can enjoy some recreation, family outings or other leisure activities, you’ll get more pleasure out of life.

 

The Importance of Rest

If you have heart failure, you need to schedule time every day for rest and relaxation, much like you'd schedule a doctor's appointment or lunch with friends. Rest times are essential because they give the heart a chance to pump more easily. You might try napping after lunch, putting your feet up for a few minutes every couple of hours, or sitting down while doing certain household tasks, such as preparing food or ironing.

Why is daytime rest important?

Daytime rest can help keep you from "overdoing it," which can make you feel much worse for a day or two. It also makes it easier to cope with feelings of tiredness caused by nighttime sleep interruptions. People with heart failure sometimes find themselves awakened by symptoms such as shortness of breath and coughing. Their sleep may also be interrupted because they need to urinate more often. This is a result of the diuretics (water pills) that may have been prescribed to help rid the body of extra fluid. If getting a good night's sleep is hard, then resting during the day is even more essential.

Is there any way to get a better night's sleep?

To improve nighttime sleep, use pillows to prop up your head, and avoid naps and big meals right before bedtime. Sometimes diuretics can be timed so they're less likely to cause you to urinate at night. This usually means taking them in the morning. Your doctor can give you more information about this.

The Importance of Potassium

Some people with heart failure need to eat foods high in potassium. Potassium helps maintain the normal function of the heart and nervous system. Many people with heart failure take a diuretic (water pill) to help their kidneys make more urine and get rid of excess fluid. This can cause potassium loss.

Doctors sometimes prescribe a potassium supplement and recommend eating more potassium-rich foods.

Every situation is different, so ask your healthcare team what's needed. People who have kidney problems or take certain medications may risk having potassium build up in their systems. And too much potassium can be just as harmful as too little.
 

Treatment

Treatment for heart failure varies and involves reducing symptoms, treating the underlying cause of the condition when possible (e.g., antibiotics to treat pneumonia, restoring normal heart rhythm in patients with atrial fibrillation), and using medications to prevent further deterioration of heart function.

In mild cases, lifestyle modifications can help reduce symptoms such as fatigue, shortness of breath, and swelling (edema). These modifications may include dietary changes (e.g., restricted salt intake), abstaining from alcohol, and exercising regularly (only under the supervision of a physician).

Medications used to treat heart failure include the following:

Angiotensin-converting enzyme (ACE) inhibitors help open (dilate) the arteries, making it easier for the heart to pump blood throughout the body. They usually are the treatment of choice for heart failure. Studies have shown that these drugs, which are often used to treat high blood pressure, can improve symptoms and reduce the risk for sudden death from heart failure.

ACE inhibitors usually are well tolerated and may be taken once a day, or 2 or 3 times daily. They are not used in patients with low blood pressure (hypotension) and may affect kidney function and potassium levels.

Side effects include the following:

  • Chronic, nonproductive cough (occurs in about 10% of patients)
  • Dizziness or weakness (caused by low blood pressure)
  • Increased potassium levels
  • Skin rashes
  • Sudden swelling of the lips, face, and cheeks (if this occurs, the patient must seek medical attention immediately)

    Angiotensin II receptor blockers (ARBs) may be used in patients who are unable to tolerate ACE inhibitors due to chronic cough, low blood pressure, or edema. These drugs, which help open (dilate) the arteries, are similar to ACE inhibitors, make it easier for the heart to pump blood, and may improve heart failure symptoms. Ongoing studies are investigating the use of ACE inhibitors with the use of ARBs in some patients with heart failure.

    Angiotensin II receptor blockers generally are taken once a day, and they usually do not cause significant side effects. Rarely, they can impede kidney function.

    Heart failure often causes the heart to pump harder to compensate for its weakened pumping ability. Beta-blockers help to relax the heart, reduce the vigor of its contractions, and reduce additional strain on the heart. These drugs often are used in combination with other drugs (e.g., ACE inhibitors, diuretics) to treat mild to moderate heart failure.

    Beta-blockers are started at low doses that are gradually increased over a period of several months. During the first several weeks of treatment, some patients experience worsening symptoms due to a decrease in oxygen circulation in the body. Other side effects include low blood pressure, difficulty breathing, and nausea and weakness with exertion.

    Heart failure increases the risk for stroke caused by blood clot (thrombus) formation and blood thinners (e.g., warfarin [Coumadin®]) often are prescribed to help reduce this risk. Blood thinners may cause nosebleeds and excessive bleeding and bruising.

    In most cases, diuretics, commonly called "water pills," are prescribed to reduce fluid buildup in the body. These drugs cause the kidneys to excrete excess amounts of sodium and water into the urine, often reducing symptoms of heart failure (e.g., shortness of breath and swelling of the legs, ankles, and feet).

    The correct diuretic dosage is based on the patient’s weight. If not enough fluid is removed, heart failure symptoms do not improve and if too much fluid is removed, fatigue, low blood pressure, and impaired kidney function may occur. Diuretics usually are taken once (in the morning) or twice a day. In some cases, two diuretics are used to increase salt and fluid excretion.

    Side effects include frequent urination and low potassium blood levels. Because of this, blood tests are performed periodically, and a potassium supplement is prescribed if blood levels are low.

    Inotropic agents such as digoxin (Lanoxin®) and dopamine may be used in heart failure patients when ACE inhibitors and diuretics are ineffective. These drugs can help the heart pump more vigorously and can modestly increase the ejection fraction (percentage of blood pumped out of the left ventricle with each contraction), reducing heart failure symptoms.

    Patients who are taking inotropic agents must undergo regular blood tests to monitor levels of the drug. They usually are well tolerated and side effects are rare when correct blood levels are maintained. Side effects include the following:

    • Blurred vision
    • Cardiac conditions (e.g., arrhythmias, heart block)
    • Diarrhea
    • Headaches
    • Loss of appetite
    • Low blood pressure (hypotension)
    • Nausea and vomiting

    Other vasodilators (e.g., hydralazine, isosorbide dinitrate, nitroglycerin) may be used in patients who are unable to tolerate ACE inhibitor therapy. Side effects include fainting or dizziness upon standing, headaches, and flushing.

    Other Treatments


    In some cases, heart failure persists or worsens in spite of lifestyle modifications and medications. Other treatments, which often depend on the cause of heart failure, include the following:

    Heart failure caused by reduced blood flow in the heart as a result of blockages (plaques) in one or more coronary arteries may be treated using coronary angioplasty. In this procedure, a hollow tube (catheter) is inserted through an artery (usually the femoral artery in the groin), into the coronary artery, and to the blockage. A small balloon is then inserted through the catheter and is inflated to open the blocked artery.

    There is a slight risk for damage to the artery during angioplasty, but heart failure symptoms usually improve following the procedure.

    Coronary artery bypass surgery reroutes the blood supply around a blocked coronary artery. In this procedure, the surgeon removes a healthy section of an artery from another part of the body and attaches it to the coronary artery so blood can flow around the blocked section.

    An implantable cardiac defibrillator (ICD) may be used to treat severe heart failure. An ICD is a small electronic device that is surgically implanted under the skin in the chest to monitor heart rhythm. When an abnormal rhythm is detected, the defibrillator delivers an electrical "shock" to the heart to restore normal heart rhythm.

    An intra-aortic balloon pump (IABP) is a device that is inserted through an artery in the groin (femoral artery) and then placed within the main artery (aorta). An IABP is an inflatable balloon that expands and deflates in coordination with each heartbeat. It can be left in place for days to weeks, and decreases the strain on the heart, and increases blood flow throughout the body.

    Patients with heart failure caused by an abnormal heart valve may require valve repair or valve replacement surgery. These are open-heart procedures in which an abnormal valve is repaired or replaced with a porcine valve (from pig tissue), a mechanical valve (made of synthetic material), or a homograft valve (from a human donor). Complications include bleeding, blood clots, infection, kidney failure, stroke, heart attack, and death.

    A left ventricular assist device (LVAD) is a mechanical pump that is surgically implanted in the upper abdomen to bypass the left ventricle and pump blood throughout the body. This device may be used in patients with end-stage heart failure who are awaiting heart transplantation. Long-term use of the device in patients with severe heart failure is being explored and defined.