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Congestive Heart Failure

DEFINITION

Congestive heart failure is the medical term for decreased pumping function of the heart. The job of the heart is to pump oxygen-rich blood throughout the body so that the tissues can get the oxygen that they need. Depending on the cause of congestive heart failure, the heart can either become big and floppy or too thick and muscular. In both cases, the heart doesn’t pump as well as it should. Congestive heart failure can be caused by a variety of factors including coronary artery disease and previous heart attacks, high blood pressure, defective heart valves, damage to heart muscle (caused by infections, alcohol, medications, and illicit drugs like cocaine), heart defects present since birth, abnormal heart rhythms (arrhythmias), and other diseases. Because the heart doesn’t pump well, the blood both doesn’t get to the organs leading to fatigue and fluid backing up into the lungs and body causing difficulty breathing and swelling in the legs. Medications to treat heart failure cannot cure heart failure, but can greatly increase quality of life and prolong life. Exercising, eating a low salt diet and losing weight can all help improve your symptoms. Heart failure can be classified based on which side of the heart is affected. Left-sided heart failure is more common and causes fluid to back up into the lungs causing shortness of breath. Right-sided heart failure is less common and can be caused by left-sided heart failure. Fluid in right-sided heart failure backs up into the legs and abdomen. Heart failure can also be classified as systolic or diastolic. Systolic heart failure means that the left side of the heart can’t contract well, leading to a problem pumping. Diastolic heart failure means that the left side of the heart can’t relax properly to be filled with blood that is then pumped out into the body. Risk factors for congestive heart failure include high blood pressure, heart attacks, coronary artery disease, irregular heart rhythms, diabetes, sleep apnea, certain medications for diabetes, viruses, alcohol abuse, kidney problems and kidney failure, liver disease, and problems with the heart valves. If untreated, heart failure can worsen over time and ultimately lead to death.

SYMPTOMS
Fatigue, difficulty breathing, swelling of the legs or abdomen, abnormal heartbeat, decreased tolerance for exercise, decreased appetite, weight gain (due to extra fluid), cough with pink frothy sputum, chest pain

DIAGNOSIS
Your doctor will begin by talking to you about your symptoms and how long they have been happening. Your doctor will then do a physical exam focusing on the heart and lungs. Your doctor may want to check your blood to look at your thyroid function, liver function, kidney function, as well as a measure of stretch of the heart called brain natriuretic peptide (BNP). Your doctor may recommend having an x-ray of the lungs done, which can reveal if the heart is enlarged or there is fluid in the lungs. Your doctor may recommend an electrocardiogram (ECG or EKG). An EKG is done by placing small stickers over the chest which are attached to a machine to create a picture of the electrical activity of the heart. This picture can tell a cardiologist what areas may not be working properly and the locations of previous heart attacks as well as if the heart is enlarged. Echocardiogram is particularly important in congestive heart failure because it can be used to look at the ejection fraction (the percentage of blood pumped from the heart with each beat). Further testing can include various ways of looking at the heart including computerized tomography (CT) scans of the heart to look at the arteries, magnetic resonance imaging of the heart which can visualize abnormalities and stress tests (where the heart is induced to pump faster either by exercise or medicine while a picture of the heart’s motion is taken). Your cardiologist may recommend having a coronary angiogram, a procedure done by a doctor with specialized training called an interventional cardiologist. During this procedure, a thin wire is placed in one of the blood vessels in the leg or wrist and fed up to the heart. The cardiologist then injects dye through that small wire and takes pictures of the arteries of the heart. If vessels are found which are too small, the cardiologist may be able to either use small balloons to open them or place stents (tube-shaped wire meshes) which helps keep the arteries open.

TREATMENT
Most of the time, heart failure is a lifelong disease. Rarely, treating the cause of the heart failure may lead to cure of the heart failure. In cases where treating the cause of heart failure does not lead to reversal of the disease, medical treatment can help decrease symptoms and increased longevity. Medications used to treat congestive heart failure include angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), digoxin, beta blockers, diuretics, and aldosterone agonists. You will likely need several medications to treat your congestive heart failure as they work in different ways. If you have other underlying diseases, you may need other medications to help treat those conditions. If you have difficulty breathing, you may need oxygen through a portable oxygen tank. Your doctor may recommend certain surgeries like coronary bypass surgery or heart valve replacement or repair. If your heart function is very poor, your doctor or cardiologist may recommend placing an implantable cardioverter-defibrillator which can deliver a shock to restart the heart if it goes into an abnormal rhythm that could lead to death. Your cardiologist may recommend specialized treatment like biventricular pacing or cardiac resynchronization therapy. In more severe cases, your cardiologist may recommend a heart pump or even heart transplant. You should discuss all of your treatment options with your doctor and cardiologist.

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