Congestive Heart Failure

I’m Rajan Krishnamani and a heart specialist working at Atrium Medical Center with Advanced Cardiovascular Institute.

What is Congestive Heart Failure?

Congestive heart failure is a serious medical condition where the heart is unable to pump enough blood to meet the demands of the various organs of the body. Congestive heart failure does not mean the heart is going to stop or the heart has stopped. What it means is that the heart is not able to pump enough blood so there is an increase in the back flow of the blood into the lungs which causes patients to have shortness of breath. On the right side, again, this back pressure and condition can cause swelling of the feet and sometimes swelling of the stomach. There’s a reduction in appetite and since the muscles are not getting blood they feel very tired and fatigued and your exercise tolerance comes down.

Causes of Congestive Heart Failure

Congestive heart failure in most of the patients is caused by damage to the heart muscle following a heart attack. Physicians use the term ischemic cardiomyopathy. However, there are various other conditions which can cause weakness of the heart muscle. Sometimes it runs in families. There are certain drugs and toxins that can cause weakening of the heart muscle like significant alcohol or cocaine use. In many patients it is secondary to problems with the heart valves or rhythm problems of the heart. In patients who are diabetic and have high blood pressure, they are more likely to have stiffness of the heart muscle and have diastolic heart failure as well.

Diagnosing Congestive Heart Failure

First, the diagnosis of heart failure has to be confirmed. Usually the physician can take a history, examine the patient and then arrange for some tests which can help diagnose heart failure. We usually use an electrocardiogram or EKG which is an electrical tracing of the heart, an echocardiogram which is an ultrasound of the heart and some blood tests to identify heart failure. Once heart failure is identified, the physician may order other tests to find if there is a specific reason to have heart failure. Once heart failure is diagnosed, then we look into what are the treatment options. Diet is extremely important; you need to watch a low-salt diet. The amount of fluid you take must be regulated, especially in people having advanced heart failure. There are certain medications which can help reduce the progression of heart failure and in some conditions can actually help improve the heart function. You need to partner with your physician to know how these medications work and what the side effects of the medication are and how to regulate the use of these medications. Medication and diet noncompliance are one of the common causes for patients with heart failure to be readmitted to the hospital with acute decompensated heart failure but patients have more symptoms and need to come to the emergency room for further treatment.

Communication is Key

You need to communicate with your family physician if you have a family history or family member who has had problems with their heart. If you have hypertension and diabetes, these need to be kept in control to prevent heart failure. These patients are at risk for heart failure. Also, you need to avoid toxins to the heart like significant alcohol use and cocaine use because these can cause further weakening of the heart muscle. It is also important to keep your cholesterol under check as this can predispose someone to have a heart attack and then cause weakening of the heart muscle.

Family History

If you have a very strong family history, you physician may arrange for you to have a screening echocardiogram to evaluate the heart function and see if you have any evidence of  asymptomatic LV systolic dysfunction which means you’ve not developed symptoms of heart failure but you do have some weakness of the heart muscle. In medical terms we call it Stage B heart failure.

Time Matters

The sooner we diagnose someone to have diastolic dysfunction and the earlier the treatment is started, the less the progression of the disease and that has been shown in clinical trials as well and the rate of progression of heart disease has been reduced. There is more stress to find our patients early on for having problems so we can prevent this progressive condition.

Treating Congestive Heart Failure

Heart failure is one chronic condition that has a very high mortality rate. The 10-year mortality rate can be as high as 40 percent. This can be significantly reduced if you partner with your physician, be compliant with your medications and learn to identify signs and symptoms of worsening of your clinical condition so if can be treated early on. This can actually prevent hospitalization. There’s a huge boost to reduce the readmission rate in heart failure. If you get admitted to the hospital with heart failure, there’s a one in four chance that you will be readmitted to the hospital within the next 30 days with an episode of heart failure. Given that high incidence, it is very important that you follow up with your physician preferably within a week of discharge from the hospital so that your medications can be adjusted. Sometimes even though the patients are taking the medications on an appropriate basis, if you take over-the-counter medications this can interact and reduce the efficacy of your heart failure medications and cause a worsening of your symptoms.

Living with Congestive Heart Disease

With adequate treatment, most patients with congestive heart failure can live an active life. So, it is not all doom and gloom. It is important that you partner with your physician and get to know your medications and self-adjust your treatment options. Exercise is good in heart failure. We would prefer you to walk, jog, run, and get to your ideal body weight. Isometric exercises however, are not recommended for patients with advanced heart failure.