Congestive Heart Failure

Risk factors include: Sex: maleRace: BlackAdvancing agePregnancyExcess alcohol intakeExcess intake of salt and fatHigh feverInfectionObesityChronic lung diseaseUse of beta-blocking or digitalis-containing medications in certain settings Cancer chemotherapyArrhythmiaHeart valve diseaseHeart muscle damage from heart attack, infection, or medicationsOveractive thyroid Symptoms Symptoms include: Fatigue, weaknessShortness of breathat first only with activity, progressing to shortness of breath at restWheezingCoughmay be dry and hacking or wet sounding with a pink, frothy sputumNeed to sleep propped upSwelling of feet, ankles, or legsFrequent urination, especially at nightUnexplained weight gainAbdominal 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 stethoscopeFeeling the abdomen for tenderness and liver swellingChecking the legs for swelling Tests may include: Blood teststo look for certain markers in the blood that help the doctor determine what is happening with your heartUrine teststo look for certain markers in the urine that help the doctor determine what is happening with your heartElectrocardiogram (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 scanningradioactive 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 TreatmentTreatments include:

Treatment of Underlying ConditionsIf you have another condition that is causing CHF, appropriate treatment of that condition should improve or cure your CHF. Lifestyle ChangesAvoid alcohol.If you smoke, quit.Lose weight if necessary. Eat a healthful diet that is: Low in fat and saltHigh in fiberWork with your doctor to develop an appropriate exercise program.Weigh yourself every morning so you can detect fluid retention early. Medications Medications include: DiureticsDigitalisACE-inhibiting medicationsBeta-blockersNitratesHydralazine 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. CardiomyoplastyThis 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) PlacementPatients 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 TherapySome 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 TransplantThis 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 Physicianshttp://www.aafp.org American College of Cardiologyhttp://www.acc.org American Heart Associationhttp://www.americanheart.org CANADIAN RESOURCES: Canadian Cardiovascular Societyhttp://www.ccs.ca/home/index_e.aspx Canadian Family Physicianhttp://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. Last reviewed December 2007 by J. Peter Oettgen, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.