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
(406) 329-5615

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 heart failure.

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!