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What is heart failure?
Heart failure, also called congestive heart failure,
is a condition in which the heart cannot pump enough
oxygenated blood to meet the needs of the body's other
organs. The heart keeps pumping, but not as efficiently
as a healthy heart. Usually, the loss in the heart's
pumping action is a symptom of an underlying heart problem.
Heart failure affects nearly 5 million US adults. It
is on the rise with an estimated 400,000 to 700,000
new cases each year.
What causes heart failure?
Heart failure may result from any/all of the following:
• heart valve disease - caused by past rheumatic
fever or other infections
• high blood pressure (hypertension)
• infections of the heart valves and/or heart
muscle (i.e., endocarditis)
• previous heart attack(s) (myocardial infarction)
- scar tissue from previous attacks may interfere
with the heart muscle's ability to work normally
• coronary artery disease - narrowed arteries
that supply blood to the heart muscle
• cardiomyopathy - or another primary disease
of the heart muscle
• congenital heart disease/defects (present
at birth)
• cardiac arrhythmias (irregular heartbeats)
• chronic lung disease and pulmonary embolism
• drug-induced heart failure
• excessive sodium intake
• hemorrhage and anemia
• diabetes
How does heart failure affect the body?
Heart failure interferes with the kidney's normal function
of eliminating excess sodium and waste from the body.
In congestive heart failure, the body retains more fluid
- resulting in swelling of the ankles and legs. Fluid
also collects in the lungs - resulting in shortness
of breath.
What are the symptoms of heart failure?
Heart failure usually does not occur suddenly. If undiagnosed,
it will gradually worsen over time. Uncontrolled and
untreated hypertension is usually the most significant
risk factor associated with heart failure. The following
are the most common symptoms of heart failure. However,
each individual may experience symptoms differently.
Not everyone in heart failure will develop swelling
of the ankles and legs. Many patients who have heart
failure come in with shortness of breath but they don’t
necessarily have weight gain and swelling. Shortness
of breath, fatigue and weakness are the most common
symptoms of heart failure.
Symptoms may include:
• shortness of breath during rest, exercise,
or lying flat
• weight gain
• visible swelling of the legs and ankles (due
to a build-up of fluid), and, occasionally, the abdomen
• fatigue and weakness
• loss of appetite and nausea
• persistent cough - often produces mucus or
blood-tinged sputum
• reduced urination
The severity of the condition and symptoms depends
on how much of the heart's pumping capacity has been
lost.
The symptoms of heart failure may resemble other conditions
or medical problems. Always consult your physician for
a diagnosis.
How is heart failure diagnosed?
In addition to a complete medical history and physical
examination, diagnostic procedures for heart failure
may include any, or a combination of, the following:
• chest x-ray - a diagnostic
test which uses invisible electromagnetic energy beams
to produce images of internal tissues, bones, and
organs onto film.
• echocardiogram (also called echo)
- a noninvasive test that uses sound waves to produce
a study of the motion of the heart's chambers and
valves. The echo sound waves create an image on the
monitor as an ultrasound transducer is passed over
the heart.
• electrocardiogram (ECG or EKG)
- a test that records the electrical activity of the
heart, shows abnormal rhythms (arrhythmias or dysrhythmias),
and detects heart muscle damage.
• BNP testing - B-type natriuretic
peptide (BNP) is a hormone released from the ventricles
in response to increased wall tension (stress) that
occurs with heart failure. BNP levels rise as wall
stress increases. BNP levels are useful in the rapid
evaluation of heart failure.
Treatment for heart failure:
Specific treatment for heart failure will be determined
by your physician based on:
• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures,
or therapies
• expectations for the course of the disease
• your opinion or preference
The cause of the heart failure will dictate the treatment
protocol established. If the heart failure is caused
by a valve disorder, then surgery is usually performed.
If the heart failure is caused by a disease, such as
anemia, then the disease is treated. And, although there
is no cure for heart failure due to a damaged heart
muscle, many forms of treatment have proven to be successful.
The goal of treatment is to improve a person's quality
of life by making the appropriate lifestyle changes
and implementing drug therapy.
Treatment of heart failure may include:
• controlling risk factors
» losing weight (if overweight)
» restricting salt and fat from the diet
» stop smoking
» abstaining from alcohol
» proper rest
» controlling blood sugar if diabetic
• medication, such as:
» angiotensin converting enzyme
(ACE) inhibitors - to decrease the pressure
inside the blood vessels, or angiotensin II receptor
blockers if ACE inhibitors are not tolerated
» diuretics - to reduce the
amount of fluid in the body
» vasodilators - to dilate
the blood vessels and reduce workload on the heart
» digitalis - to increase
heart strength and control rhythm problems
» inotropes - to increase
the pumping action of the heart
» antiarrhythmia medications
- keep the rhythm regular and prevent sudden cardiac
death
» beta-blockers - reduce
the heart's tendency to beat faster by blocking
specific receptors on the cells that make up the
heart
» aldosterone blockers -
block the effects of aldosterone which causes sodium
and water retention
• biventricular pacing/cardiac resynchronization
therapy - a new type of pacemaker that paces both
sides of the heart simultaneously to coordinate contractions
and improve pumping ability. Heart failure patients
are potential candidates for this therapy.
• implantable cardioverter defibrillator - a
device similar to a pacemaker that senses when the
heart is beating too fast and delivers an electrical
shock to convert the fast rhythm to a normal rhythm
• heart transplantation
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