Heart Failure
Heart failure is a condition that develops when the heart’s
work as a pump delivering oxygen-enriched blood to the body is
compromised. As the heart pumps blood volume less effectively,
the resulting residual fluid congestion builds up in the lungs
and the peripheral tissues.
To compensate for its failing pumping action, the heart has to
work harder in an attempt to move blood through the heart out to
the body. As a result, the heart enlarges and the pulse rate increases
as the heart pumps faster to move the fluid overload. Heart failure
is a progressive condition and often is not identified with symptoms
until it has become significantly advanced.
Because people in the United States are living longer and the
percentage of those with heart disease continues to increase, more
and more cases of congestive heart failure are diagnosed each year.
In working to prevent heart disease, we will also be preventing
the development of congestive heart failure.
Risk Factors for Heart Failure
Risk factors for heart failure are those conditions where compromise
of the heart’s ability to act as an effective and efficient
pump occurs. A history of coronary artery disease or past heart
attacks can predispose a patient to the development of heart failure.
Other causes include high blood pressure (hypertension), significant
valve disease, or irregular heartbeat (arrhythmia).
Cardiomyopathy is a condition in which the heart muscle itself
is diseased, thus adversely affecting its tone and subsequently
its pumping ability. Often occurring in younger people without
identifiable reason, cardiomyopathy is a leading cause of heart
failure. Other predisposing conditions include a history
of alcohol and drug abuse, obesity, and diabetes.
Types of Heart Failure
Heart failure may involve the left side of the heart, the right
side of the heart, or both sides. When the left side of the heart
is not functioning effectively, blood and fluids will back up into
the lungs. In this case, shortness of breath, weakness and fatigue,
coughing and sputum production that is either pink or tinged with
blood are very common symptoms. This fluid build-up in the lungs
is called pulmonary edema.
Right-sided heart failure results when there is a backflow of
blood and fluids into the venous system of the body. It frequently
occurs as a result of left-sided or left ventricular failure. The
fluid congestion of the venous system results in swelling of the
peripheral tissue of the legs, feet, and ankles. Sometimes the
congestion, or edema as it is called, can involve the liver and
abdomen.
Symptoms of Heart Failure
Symptoms of congestive heart failure will depend on which side
or sides of the heart are compromised in its pumping ability, but
generally the following problems occur as a result of failure:
- Shortness of breath
- Weight gain from fluid accumulation
- Weakness and fatigue
- Edema of the lower extremities
- Insomnia
- Loss of appetite
- Restlessness, listless behavior, and confusion
- Chest pain
- Cold, clammy skin
Diagnosis of Heart Failure
The diagnosis of congestive heart failure will be determined by
a combination of physical examination and diagnostic testing. Echocardiogram
utilizing ultrasound waves will provide critical information to
the physician regarding valve function, size of the heart and its
chambers, and the ejection fraction. Ejection fraction is a critical
measurement of the heart’s pumping abilities. Some degree
of heart failure exists when the ejection fraction is less than
50 percent. A chest x-ray may reveal an enlarged heart with fluid
present in the lungs.
Cardiac catheterization and coronary angiography may be performed
to determine the cause and severity of heart failure. In this procedure,
the physician introduces a catheter
from a major vessel in the arm or leg and injects dye which travels
throughout the circulation. A precise ejection fraction can also
be determined at this time.
Treatment of Heart Failure
Management of heart failure and its symptoms will focus on reducing
the workload of the
heart and supporting its ability to pump more effectively. Medication
therapy, interventional procedures such as angioplasty and stent
placement, or perhaps coronary artery bypass grafting may be undertaken
to address this condition. Lifestyle changes will be an important
part of successful management and symptom relief.
With regard to lifestyle choices, all those factors that contribute
to congestive heart failure and its symptoms will need to be considered.
Dietary restrictions may involve a reduced sodium and fluid intake.
Weight loss may contribute to alleviation of symptoms. A physician-directed
exercise or activity plan can actually help to strengthen the heart
muscle. Smoking should be stopped.
Controlling high blood pressure as well as management of diabetes
and elevated cholesterol levels will be important. Watching your
weight and fluid consumption on a daily basis aids in management
of the fluid retention. Alcohol use should be curtailed or eliminated.
Medication therapy is of primary importance for treatment of congestive
heart failure. It is individualized for symptom relief and management
of the heart’s pumping ability. Diuretics or “water
pills” help to decrease fluid retention. Inotropic drugs,
such as digitalis, increase the heart’s pumping efficiency.
Beta blockers decrease oxygen requirements of the heart and relax
the heart muscle. Two classes of drugs that are part of the medication
regimen are the ACE inhibitors and the angiotensin II receptor
blockers that dilate the arteries and ease the workload of the
heart.
If indicated, angioplasty and stent placement or bypass surgery
may be elected to address coronary artery blockage. Improvement
of the blood flow to the heart muscle may alleviate the severity
of congestive heart failure. If a valvular defect is severe and
contributing to the heart failure, repair or replacement of the
valve may be undertaken.
Heart transplant may be considered when severe failure exists
and other options have
been exhausted for effective treatment and life preservation. In
cases of end-stage heart failure when transplant is not possible,
placement of a left ventricular assist device may improve the quality
of the patient’s life and provide symptom relief. This is
an electronic pump implanted within the patient’s abdomen
that receives blood from the left ventricle and more effectively
pumps it outward to the body.
