What is Congestive Heart Failure?
The heart is composed of two independent pumping chambers consisting of atrium and ventricles. One on the right side that pumps blood to the lungs and one on the left side that pumps blood to the rest of our body. Congestive Heart Failure is a condition that results from heart disease. The heart is unable to pump enough blood to our body systems to meet our needs. Also, the failing heart is unable to pump out all the blood that enters its ventricles. The normal pumping ability of our left ventricle is 50-75%, as measured by ECHO or MUGA exam.
You can have heart failure of the left side and/or the right side of the heart. Left-sided heart failure causes fluid to back up and accumulate in the lungs. This leads to the patient symptoms of shortness of breath, inability to sleep on only one pillow, waking up in the middle of the night gasping for breath, inability to exercise without shortness of breath, inability to catch your breath while at rest, and for severe cases coughing and gurgling with frothy sputum. Right-sided heart failure causes the blood entering the heart from the body to back up in the veins causing swelling of the legs, feet , and stomach. Usually, because the chambers of the heart are interconnected and work off a pressure system, congestive heart failure is a combination of left and right sided heart failure.
WHAT CAUSES CONGESTIVE HEART FAILURE?
Damage to the heart muscle itself or damage to the mechanisms that control the inflow and outflow of blood from the heart itself is the usual cause of Congestive Heart Failure. Some of the causes of heart failure include: coronary artery disease (CAD), damage after a heart attack which stems from coronary artery disease, high blood pressure, diabetes, heart valve disease, viruses, chemotherapy agents, chronic alcohol use and abuse, drug abuse, and amyloidosis.
WHAT ARE THE SYMPTOMS OF CONGESTIVE HEART FAILURE?
LEFT-SIDED HEART FAILURE
FATIGUE
SHORTNESS OF BREATH
WHEEZING
DRY HACKING COUGH OR WET FROTHY COUGH
SLEEP APNEA
DROWNING FEELING
SKIN IS CLAMMY AND PALE AND MAY TURN BLUE
RIGHT-SIDED HEART FAILURE
FATIGUE
SWELLING IN FEET, ANKLES, LEGS, AND STOMACH
DEPRESSED APPETITE
WEIGHT GAIN OF > 2 POUNDS IN ONE NIGHT
lOSS OF MUSCLE MASS
WHO GETS CONGESTIVE HEART FAILURE?
Some studies estimate that over 500,00 new cases of heart failure are diagnosed each year, and nearly five million Americans currently suffer from it. Congestive Heart Failure is the leading cause of hospitalization in the elderly. Men are at higher risk for developing congestive heart failure than women. African Americans are at higher risk than caucasians.
About 260,000 people die of heart failure each year and for people over the age of 65 it is the leading cause of death. However, the good news is people are living longer with heart failure and the new treatments available seem to be responsible for a steady decline in mortality rate over the past few years.
HOW IS CONGESTIVE HEART FAILURE DIAGNOSED?
A preliminary diagnosis of heart failure is often made with a medical history and careful physical examination by a physician. They check regularly for an enlarged heart, irregular heart sounds, abnormal sounds in the lungs, enlarged liver, signs of swelling in abdomen, and extremities, and enlarged neck veins.
There are routine tests that can be performed to confirm the diagnosis of congestive heart failure. Blood tests are used to check anemia, cholesterol, blood sugar kidney, liver, and thyroid function. Exercise stress tests are performed to measure heart rate, blood pressure, and oxygen use during exercise. This is a method for determining heart function impairment. an ECG will not diagnose heart failure, but it can identify underlying heart disease, coronary artery disease, or abnormal heart rhythms.
One of the best diagnostic tests for heart failure is the doppler echocardiogram (ECHO). ECHO uses ultrasound to take a picture of the heart while it is beating. ECHOs can reveal whether the right or left side of the heart or both is failing and determine if the heart valves are functioning properly. From the ECHO, the doctor determines the ejection fraction (EF) of your heart. The EF is the percent of blood pumped out of the ventricles with each heart beat. You have a right and left ventricular EF. Your doctor uses the left ventricular EF to determine how damaged your "pump" is. The normal pumping ability of our left ventricle is 50-75%, as measured by ECHO or MUGA exam.
The most definitive test used to diagnose congestive heart failure is the right heart catheterization (RHC). The test is invasive and is performed in your local hospital by the doctor. During this test, the doctor passes a catheter through you jugular vein in your right neck into the right side of your heart. While there, the catheter measures the pressures on the right side of your heart in your right atrium and right ventricle. Then the catheter is passed through the pulmonary artery and pressures are measured there. An estimation of the left-sided heart pressures is made by "wedging" the catheter into a small pulmonary artery. By studying this data, your doctor can determine how severe your heart failure is and if your lungs are injured as well. This is an invasive test, so there are risks of bleeding, stroke, kidney failure, and heart attack.
The left heart catheterization (angiogram) is performed to determine if you have coronary artery disease. A catheter is inserted in your right groin and guided while using fluoroscopy up to your heart. A dye is injected into the heart and at the openings of the coronary arteries. X-rays are taken during this time and blockages in the coronary arteries are shown on x-ray. This is an invasive test and uses dye, so there are risks of allergic reaction to dye, bleeding, stroke, kidney failure, and heart attack.
HOW IS HEART FAILURE TREATED?
Early diagnosis and treatment offers the best chance of living a longer and fuller life with heart failure. Any underlying conditions that may be causing the heart failure need to be treated first and controlled such as; diabetes, thyroid dysfunction, coronary artery disease, high blood pressure, anemia, valve dysfunction, and irregular heart rhythms. Congestive heart failure can be treated medically and surgically. There is no real "cure" for congestive heart failure. However, it can be managed either medically or surgically.
Medically there are four general classes of medications that can be used to manage the symptoms of congestive heart failure; diuretics, vasodilators, inotropics, and beta blockers.
Diuretics are drugs that reduce fluid. Some examples are: furesomide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin), torsemide (Demadex), amiloride (Midamor), spironolactone (Aldactone), chorthiazide (Diuril), metolazone (Zaroxylyn). Diuretics are usually always given inconjunctionwith other medications. The dosage is adjusted to increase urine output and lose weight. Side effects include: low blood pressure, dehydration, decreased potassium, and increase in creatinine and blood urea nitrogen from kidney dysfunction.
Ace Inhibitors are Angiotension-Converting Enzyme (ACE) inhibitors and are one of the most important agents in fighting heart failure. These drugs block the formation of a powerful enzyme (angiotension II). This enzyme raises blood pressure, constricts blood vessels, and causes salt retention.By blocking or inhibiting this enzyme, these actions do not occur, thereby reducing the signs and symptoms of CHF. Common ace inhibitors are: captopril (Capoten), enalopril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace). In the SOLVD trial, ACE inhibitors were found to reduce mortality rates by 40%, reduce heart size and reduce the need for diuretics. Also, the drugs are improving outcomes in patients with no symptoms of heart failure but have left ventricular dysfunction. Side effects include: persistent, dry cough, low blood pressure, kidney failure, and increase in potassium.
Beta Blockers are drugs that prevent adrenaline from binding to heart cells. Adrenaline increases heart rate. An overabundance of adrenaline can overstimulate the failing heart, which increases heart failure. In the past, beta blockers have not been used in heart failure because they reduce the pumping action of the heart. However, studies are now showing that certain beta blockers, carvedilol (Coreg) may improve heart function. Combination of this beta blocker with other heart failure medications can improve heart function and size and reduce mortality rates in some patients. These drugs should be administered only by specialists in heart failure. Side effects include: slow heart rate, low blood pressure, asthma,
Inotropes are drugs that increase the strength of the heart's contractions, reduce heart size, and reduce certain irregular heart beats. Digoxin is the only oral inotrope available. It has been used to treat heart failure since the 1700's. However, modern science recommends the treatment of heart failure should now begin with the prescribing of ACE inhibitors or carvedilol before digoxin is prescribed. Digoxin does not reduce mortality rates, but it improves symptoms and seems to decrease hospitalizations. Side effects include: toxicity: nausea and vomiting, irregular heart beats, stomach pain, greenish-yellow vision, halos around lights. Blood Levels of this drug can be measured by a blood test. Milrinone is an IV inotrope. It is administered either continuosly or intermittently through a vein. It is a last resort drug. If a patient is being maintained by IV medication such as milrinone and/or dobutaimine and/or dopamine, then they should have been referred for transplant evaluation months before.
Other medications such as angiotensin II recptor antagonists, vasodilators, clacium channel blockers, and amiodarone.
IT CAN NOT BE STRESSED ENOUGH, THE MODERN MANAGEMENT OF HEART FAILURE REQUIRES SPECIALISTS KNOWLEDGABLE IN THE CURRENT ADVANCEMENTS AND TREATMENTS OF HEART FAILURE.
ASK YOUR FAMILY DOCTOR FOR A REFERRAL TO A HEART FAILURE SPECIALIST TODAY!!!!
WHAT ARE THE SURGICAL TREATMENTS FOR CHF?
When all medical treaments have failed, then surgery is the only option left. Heart transplantation is the option of choice. Each transplant center has its own center-specific selection criteria, but generally transplant is indicated in patients with severe heart failure who have failed medical treament and who are less than 65 with underlying good health and the ability to understand and comply with the strict medical follow-up and medication regimen. There are other surgical interventions available as alternatives to transplant, such as ventricular remodeling and dynamic cardiomyoplasty; however, these are not offered at MUSC. Ventricular assist devices (VADs) have been approved as a bridge to transplant and inplantable cardioverter-defibrillators (ICDs) may be used for patients with life-threatening arrythmias.