Congestive Heart Failure
The heart is responsible for pumping blood to all the organs of the body. A healthy heart pumps 50% of the blood it receives in one beat while a failing heart pumps 40% or less. When a heart is unable to pump enough blood to supply the body’s needs, blood gets backed up in the veins and begins to seep into surrounding tissues. Congestive heart failure (CHF) occurs when excess fluid starts to leak into the lungs, causing breathing difficulties, fatigue and weakness, and sleeping problems.
What Are The Signs?
Two of the signs of congestive heart failure are heart palpitations and sudden weight gain due to the accumulation of fluid (edema) in the feet, ankles, and legs. Also, people with CHF may feel excessive fatigue after doing normally routine things, such as walking up stairs or even eating. As CHF progresses, a person becomes completely disabled, unable to walk or move around.
As fluids accumulate in the upper body, a person with CHF may feel short of breath. If this happens during the night, a person may wake up with a choking feeling. Congestive heart failure patients often develop a persistent cough that may include mucus or blood. With the increase of fluid, there is an increase in the chances of having a heart attack or getting pneumonia.
What Are The Risk Factors?
High blood pressure is the number one risk factor for congestive heart failure (CHF). Other risk factors include:
- High cholesterol and low-density lipoprotein (LDL) in the blood
- Low level of high-density lipoprotein (HDL) in the blood
- Tobacco smoke
- Diabetes Mellitus
- Obesity
- Age
- Family history of heart disease
CHF can happen at any age but it is more common in people 65 years of age and older, African-Americans, and males. The causes of CHF can vary:
- Age. As we age, our heart gets weaker and the blood vessels get narrower.
- Abnormalities. These are most common in children suffering heart failure. Abnormal openings between the right and left side of the heart increase the amount of work the heart must do.
- Cardiomyopathy. This condition is a weakening of the heart caused by infection or inflammation.
- Coronary artery disease. CAD develops when fatty materials deposit in the coronary arteries. This causes the blood vessels narrow and restricts blood flow.
- Heart attacks. While heart failure can lead to heart attacks, the attacks themselves weaken the heart and may cause a section of it to stop functioning. With the heart pumping less, more heart failure occurs and a vicious cycle ensues.
- Heart valve disease. The blood may leak back through a defective valve, causing the heart to work harder and fluids to build up in the lungs. The first sign is chest pain, also known as angina. If an artery is fully blocked and blood supply to the heart is cut off, a heart attack occurs.
- Diabetes
- Cancer treatment, radiation, and some chemotherapy drugs
- Thyroid diseases, too much or too little thyroid hormones
- Alcohol abuse
- Cocaine or other illegal drug use
- HIV/AIDS
Diagnostic tests for CHF include:
- BNP (B-type Natriuretic Peptide) blood test - measures the level of BNP hormone in your blood; the higher the level the greater the chance of heart failure
- Cardiac catheterization
- Chest x-ray
- Coronary angiography
- Echocardiogram
- Electrocardiogram (ECG or EKG)
- Exercise stress test (cardiac stress test)
- Holter monitor
- Nuclear heart scan
- Pharmacologic stress test
- Thyroid function tests
- Angiotensin converting enzyme (ACE) inhibitors – works on the natural chemicals in the body that are involved in regulating blood pressure, resulting in lower blood pressure
- Beta blockers – blocks chemical called noradrenalin, which can widen the arteries and decrease the work of the heart
- Digitalis medicines – strengthen the heartbeat
- Diuretics – help remove excess fluid and salt from the body
- Nitrates – relax and widen the blood vessels in the body, allowing more blood and oxygen to flow to the heart
- Enhanced counterpulsation (ECP)
- Heart valve replacement surgery
- Intra-aortic balloon pump (IABP)iInsertion
- Ventricular assist device placement
- Valvulosplasty (Balloon or Surgical)
- Heart transplant (when all other treatments fail to control symptoms)
- Ventricular Assist Device (VAD)
- Balloon Valvuloplasty Catheter
- Enhanced Counterpulsation (ECP) Device
- Intra-aortic balloon pump (IABP)
- Prosthetic Heart Valve
- Exercise.
- Maintain a healthy weight.
- Eat a healthy diet.
- Control blood pressure.
- Control blood cholesterol.
- Prevent and manage diabetes mellitus.
- Quit or do not start smoking.
- Manage stress.
- Get enough sleep.
Reviewed by Francine Kaufman, MD. 4/08