Congestive Heart Failure; Living Better, Longer
Bradley D. Berry, M.D.
Director Heart Failure Clinic
International Heart Institute of Montana
Providence St. Patrick Hospital
500 West Broadway Street, Suite 320
Missoula, MT 59802
Congestive Heart Failure; Living Better, Longer
Congestive heart failure (CHF) is a clinical syndrome in which the body
inappropriately retains sodium and consequently water. This condition
is generally due to a weakening of the heart muscle. It is estimated that
450,000 new cases are diagnosed annually in this country alone. 4.6 million
Americans currently are diagnosed and live with this disease. It is the
single largest volume diagnosis in the Medicare age population in this
country. In addition, it is the most likely diagnosis that leads to readmission
to the hospital after initial treatment. Despite the ominous sound to
the name of this condition it should not imply that people typically die
suddenly or that their hearts suddenly stop working. As the heart muscle
weakens, the heart has to work harder to adequately meet the demands of
their body. The heart generally weakens in response to injury such as
a heart attack, long-standing high blood pressure, or abnormal heart values
for example. As the heart muscle weakens, it often cannot handle the fluid
with which it is presented and the accumulating fluid can leak into the
lungs, abdomen, feet, and legs. This fluid accumulation, in conjunction
with the weakening heart muscle, leads to the development of symptoms.
The most prominent symptoms are shortness of breath with exertion, while
lying down, or even simple daily activities. People may awaken at night
suddenly breathless or require pillows to prop themselves up to avoid
symptoms at night. In addition patients can experience fatigue, cough
with or without exertion, and feet or leg swelling. It is important to
keep in mind that all symptoms of heart failure are not specific to this
disease and may or may not be due to heart failure. The most important
first step is to discuss any new or concerning symptoms with your health
care provider to assess and evaluate the cause.
Common risk factors for developing congestive heart failure include coronary
artery disease, previous heart attack, high blood pressure, history of
heart murmurs or heart valve disease, enlarged heart, obesity, and diabetes.
The first step in diagnosing this condition is to see your provider for
a careful history and physical examination. Physicians have a number of
tests that they may order to diagnose this condition. The most common
are laboratory blood testing, electrocardiogram (EKG), chest X-Ray, stress
test, and most importantly an echocardiogram. An echocardiogram is a noninvasive
ultrasound study that allows the physician to assess heart function, size
of the heart, as well as the condition of the heart valves. Depending
on findings there may be further tests, such as a heart catheterization
or coronary angiogram to look at the blood vessels supplying the heart.
Once the diagnosis is made, your physician will be able to assess the
cause of the condition as well as initiate therapies to treat this disease.
Early diagnosis and initiation of treatment is very important. Dramatic
strides have been made over the last three decades in the treatment of
congestive heart failure. It was once thought that once the heart had
been damaged that damage could not be reversed. We now know that this
is clearly not true. There are at least five distinct classes of medications
that have clearly been shown to decrease symptoms of heart failure, improve
the pumping function (ejection fraction) of the heart, as well as increase
survival of those suffering from heart failure. In addition, appropriate
action can be taken to correct heart valve disease or blocked arteries
that may be the cause of the weakened heart muscle. If inadequate blood
flow to the heart from blocked arteries is the cause, reestablishing adequate
blood flow is important to improving the function of the heart muscle.
Certain pacemakers can be advantageous in improving heart function and
implantable defibrillators can treat potentially dangerous heart rhythms
that can accompany weakened heart muscle and congestive heart failure.
Treatment of congestive heart failure may be the best example in medicine
where optimal outcomes are achieved by the patient and physician working
together. There are many things patients can do to not only feel better
but to improve the quality of their care and improve their outcome. The
patient's role in this partnership is critical to achieve in the best
results. The most critical thing a patient can do is avoiding salt (sodium)
in their diet. Sodium consumption directly relates to fluid retention
and makes it difficult to keep the weakened heart compensated from a fluid
retention standpoint. In addition it is important for the patient to weigh
themselves daily to monitor their fluid status to be aware of fluctuations
in fluid and weight gain early. Participation in cardiac rehabilitation
early with subsequent independent activity is very beneficial. Exercise
has clearly been shown to decrease symptoms, optimize physical conditioning
around an imperfect heart, and prolong life in the setting of congestive
heart failure. Losing weight, maintaining an optimal weight, as well as
maintaining a healthy diet and lifestyle are critically important to long-term
symptom relief and survival. Taking medications as directed, and going
in for regular checkups are just one part to the treatment of congestive
There are many disease conditions that can masquerade as congestive heart
failure. All that swells is not heart failure. In addition to conventional
forms of heart failure there are also similar conditions caused by stiff
heart muscle and secondary heart issues from chronic lung conditions.
Most of these can be appropriately diagnosed and treated through history,
physical examination, and routinely available diagnostic tests. Fortunately,
we now know the importance of early diagnosis and initiation of appropriate
treatment. In the past, treatment of heart failure was limited only to
the alleviation of the symptoms caused by heart failure. Through the early
recognition of heart failure and initiation of treatment, we now can not
only treat the symptoms, but slow progression or reverse the disease process.
For patients, there is a bright side to congestive heart failure that
was not there in decades past. This is manifested not only in living longer
but living better. Living a fulfilling, symptom-free life is achievable.
Questions and or comments regarding this week's health column please
contact Marcus Daly Cardiology Services in collaboration with the International
Heart Institute of Montana at 1200 Westwood Drive, Hamilton, MT 59840.
Working together to build a healthier community!