Understanding Heart Failure

Definition

Congestive heart failure (CHF) 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.

	Pulmonary Edema
	© 2008 Nucleus Medical Art, Inc.

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
• Hyperthyroid ism (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.

Risk factors include:

• 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 in certain settings
• Cancer chemotherapy
• Arrhythmia
• Heart valve disease
• Heart muscle damage from heart attack, infection, or 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, function, and motion of the heart
• Exercise stress test —records the heart's electrical activity during increased physical activity; may be coupled with echocardiogram. Patients who cannot exercise may be given a medication intravenously that simulates the effects of physical exertion. The test is done usually days or weeks after the heart attack.
• Nuclear scanning—radioactive material (such as thallium) is injected into a vein and observed as it is absorbed by the heart muscle. Areas with diminished flow, and therefore uptake of the radioactive material, show up as dark spots on the scan.
• Electron-beam CT scan (coronary calcium scan, heart scan, CT angiography )—a type of x-ray that uses a computer to make detailed pictures of the heart, coronary arteries, and surrounding structures. This type of CT scan measures the amount of calcium deposits in the coronary arteries and, based on that and other health information, attempts to determine the risk of heart disease, including heart attacks.
  • The American Heart Association (AHA) published guidelines in 2006 indicating that heart scans are not for everyone and those most likely to benefit from the procedure are patients at intermediate risk of coronary artery disease.
• Coronary angiography —x-rays taken after a dye is injected into the arteries; allows the doctor to look for abnormalities (narrowing, blockage) in the arteries and evaluate the function of the heart

Treatment

Treatments include:

Treatment of 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. The pump may take over the function of either or both ventricles. Initially it has been used only for patients awaiting heart transplant, but in recent years it has emerged as possible long-term treatment for some patients.

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.

Implantable Cardioverter Defibrillator (ICD) Placement

Patients with heart failure are more prone to certain heart arrhythmias that put them at risk for sudden cardiac death. ICDs are implanted in those patients to prevent such arrhythmias from occurring.

Cardiac Resynchronization Therapy

Some patients with heart failure benefit from a specific type of electrical stimulation to the ventricles that allow the ventricles to contract in a synchronized matter and therefore improve patients’ symptoms.

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.

RESOURCES:

American Academy of Family Physicians
http://www.aafp.org

American College of Cardiology
http://www.acc.org

American Heart Association
http://www.americanheart.org

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca/home/index_e.aspx

Canadian Family Physician
http://www.cfpc.ca/cfp/

References:

American College of Cardiology website. Available at: http://www.acc.org/ . Accessed October 7, 2005.

Congestive heart failure. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4585 . Accessed October 7, 2005.

Dambro MR. Griffith's 5-Minute Clinical Consult. 2001 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.

Heart pumps. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/heart-failure/HB00076 . Accessed on November 15, 2006.

Hunt, SA, Abraham, WT, Chin, MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation . 2005; 112:e154.

Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult. American College of Cardiology Foundation (ACCF) . 2001 Sep; 56.

What is heart failure? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Hf/HF_WhatIs.html . Accessed October 7, 2005.

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