Congestive heart failure: What are your options if you have it?

1/5/08 Posted in Sports  |  0 Comments

by Dr. Divyakant B. Gandhi

The heart performs two primary functions in the body. The right side of the heart collects deoxygenated blood from the body and pumps it into the lungs, that purify, filter, and oxygenate the blood. The left side of the heart, then, collects the blood from the lungs and pumps it throughout the body to maintain its oxygen, nutritional and metabolic requirements. These functions are carried out by well-designed and synchronous actions of the top and bottom chambers of the heart, along with careful and coordinated actions of the valves of the heart. Overall, this is maintained by the electrical system of the heart, which was discussed in detail in the October 2007 issue of Healthy& Fit Magazine. Any failure of the cyclical function of the heart at any level results in a condition which may lead to congestive heart failure (CHF).

As one can imagine, a lot of conditions could lead to heart failure. In order to simplify the understanding of various causes of CHF, the medical community has proposed a number of classifications—none of which encompass all known causes of CHF. Therefore, in order to understand this, the utilization of multiple classifications is necessary but may often lead to confusion and conflicting opinions regarding management strategy of various conditions.

Broadly speaking, the causes of CHF include:

• Hypertension and Coronary Artery Disease – commonest in the older population, accounting for about 75% of cases within that age group.
• Diseases of the Heart Valves – Aortic Stenosis and Regurgitation and Mitral Stenosis and Regurgitation. The latter was discussed in the November 2007 issue of Healthy & Fit Magazine.
• Cardiomyopathy – heterogeneous group of diseases of the heart muscle associated with mechanical or electrical dysfunction causing dilation and/or thickening of the lower chambers of the heart. This may be:
  • Primary – predominantly confined to the heart muscle, either genetic or acquired.
  • Secondary – involving the heart muscle as a part of generalized multiorgan disorders.
  • Pericarditis – inflammation, along with fibrosis, of the membrane covering the heart causing restriction of the movement of the heart.
  • Arrhythmia
  • Atrial Fibrillation – usually rapid and irregular heartbeat (October 2007 Issue of Healthy & Fit Magazine)
  • Ventricular Arrhythmias – (i.e. Ventricular Tachycardia) Bradycardia – slower-than-normal heart rate (i.e. complete heart block)
  • Tachycardia – any type of persistent, rapid heartbeat

The symptoms of CHF that one may experience are varied and not always apparent. Due to the fact that CHF is usually slow to develop, people in the very early stages of this disease may not notice any symptoms at all; while others will dismiss their symptoms as being age-related. Still, many individuals will have obvious and persistent symptoms such as:

• Shortness of breath, especially with physical activities or exercise
• Orthopnea – difficulty breathing unless sitting up straight or standing erect
• Swelling of the feet and legs
• Lack of energy or general feeling of tiredness or lethargy
• Swollen or tender abdomen, loss of appetite
• Cough with “frothy” sputum
• Increased urination at night
• Confusion, impaired memory

The statistics reported by The American Heart Association exemplify the scope of the problem that our healthcare system faces. Individuals over the age of 40 have a 1 in 5 chance of developing CHF. At the present time, 5 million people in the United States suffer from Congestive Heart Failure—with 550,000 new cases being diagnosed each year, thus, accounting for a significant financial burden on America’s healthcare system.

Fortunately, a team approach to the management of this debilitating condition could improve the quality of life and longevity for these patients. Diagnosis of the cause of this condition is the pillar on which the entire treatment is based. As can be concluded from the multitude of causes of this condition, a large number of tests may be necessary in order to diagnose the problem.

These tests may include a Chest X-ray, EKG, Echocardiogram, Stress Tests, Nuclear Studies, MRI, CT Angiogram and Cardiac Catheterization. Laboratory blood tests are necessary and include blood count, kidney function tests, electrolytes studies, hormonal studies, and genetic testing.

The goals of treatment for CHF are improvement in quality of life, avoid occurrences of acute episodes of decompensation and hospitalization and improved length of survival. This goal also includes the reduction in the likelihood of irregular heartbeats and sudden death syndromes.

The use of medications is the mainstay of treatment for CHF in a large proportion of patients. A large number of medications are available, and multiple regimens may be necessary to ensure optimal response. These options should be carefully monitored by the healthcare provider, including doctors and nurse practitioners. More importantly, lifestyle changes including dietary restrictions, weight loss, smoking and alcohol cessation, are the pillars of successful long-term management of this debilitating condition.

Certain conditions causing CHF have surgical treatment options, and these will be discussed in detail in the February issue of Healthy & Fit Magazine.