Congestive heart failure
What happens when
your heart can't keep up? The good news - death rates from heart attack and
stroke are declining. The bad news - the death rate from congestive heart
failure is increasing. Why the increase in congestive heart failure? It's
because the disease mainly affects older adults, and more people are now living
long enough to develop it. In addition, people are surviving other medical
problems, such as heart attack, that increase the risk for congestive heart
failure. But despite the rise in congestive heart failure, advances in
treatment are helping people with the disease live longer and with fewer
symptoms.
A weakened pump.
While heart "failure" conjures up images of a totally ruined heart,
it doesn't mean that your heart isnÕt working at all. It means that your heart
isn't able to pump enough blood to your body's tissues and organs to meet their
needs. The term "congestive" refers to fluid buildup that occurs with
the disease. With less blood leaving your heart, blood returning to your heart
gets backed up. As back pressure builds, fluid from your blood can collect in
your vital organs, including your lungs and liver. Fluid can also seep into
surrounding tissues, causing swelling. Congestive heart failure is frequently
the end result of many cardiovascular problems.
Most common
causes:
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A blockage of blood vessels to the heart (coronary artery disease).
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A diseased heart muscle (cardiomyopathy).
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Long-standing high blood pressure (hypertension).
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Abnormal heart rhythms.
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Heart valve problems.
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Congenital heart disease.
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Toxic substances (including prolonged alcohol abuse).
Symptoms are
subtle to severe. At first, you may not experience any signs or symptoms. Then,
gradually, you may notice shortness of breath that occurs with exertion. As the
disease worsens, shortness of breath becomes more pronounced and may even occur
while you're lying down or sleeping. You may also experience fatigue or
weakness, swelling in your feet, ankles and abdomen due to fluid buildup,
swollen or distended neck veins, rapid weight gain or a chronic cough. And,
your heart may gradually become enlarged.
Improvements
in treatment
In some cases,
congestive heart failure can be corrected by treating an underlying cause. But
many times the problem can't be eliminated. Then, the goal of treatment is to
prevent further damage to your heart and help it pump as efficiently as
possible. This is usually done through use of medications. They generally
include: ACE (angiotensin-converting enzyme) inhibitors - These drugs, also
used to treat high blood pressure, have become the mainstay treatment for
congestive heart failure. They're the only drugs cleorly proven to help people
with the disease feel better and live longer. The drugs include enalapril
maleate (Vasotec), lisinopril (Prinivil, Zestril), captopril (Capoten) and
others. ACE inhibitors allow blood to flow from your heart more easily by
decreasing production of a hormone (angiotensin II) that constricts your
arteries and raises your blood pressure.
They also
decrease production of the hormone (aldosterone) that causes your body to retain
sodium and water. ACE inhibitors cause an irritating cough in about 20 percent
of people taking them. But it may be best to put up with the cough, if you can,
to gain the medications' benefits.
Diuretics - Often called
"water pills," diuretics make you urinate more frequently and keep
fluid from collecting in your body. Commonly prescribed diuretics include
bumetanide (Bumex), furosemide (Lasix) and others. The drugs also decrease
fluid in your lungs so you can breathe more easily.
Digoxin - This drug, also
referred to as digitalis, increases the strength of your heart muscle
contractions. While digoxin doesn't improve overall survival rates, it reduces
heart failure symptoms and improves your ability to function with the
condition.
Beta blockers - They may
improve blood flow and may help prevent some heart rhythm problems. A new drug,
canvedilol (Coreg), received Food and Drug Administration (FDA) approval in
May. A-II (angiotensin II) antagonists are under study for congestive heart failure
treatment, but are not yet approved by the FDA for the condition. These
medications losartan (Cozaor) and valsartan (biovan) - work similarly to ACE
inhibitors but don't cause a persistent cough. Studies are evaluating whether
they are as effective as ACE inhibitors.
Heart
transplants
Rarely, another
treatment option is a heart transplant. Survival and quality of life following
a transplant are excellent, but there's a shortage of donor hearts. Candidates
for transplantation are typically people under age 65 who are frce of other
life-threatening diseases and whose other vital organs are healthy.
Steps you can
take
Important
lifestyle changes can often help relieve your symptoms and prevent the disease
from worsening. You need to restrict sodium - sodium causes you to retain
fluids. You should try to consume less than 3,000 milligrams (mg) daily. You
also need to be careful when using salt substitutes. Limit alcohol and fluids -
alcohol can further reduce your heart's pumping ability. If you have severe
heart failure, your doctor may also suggest you consume fewer beverages to
reduce fluid buildup.
Exercise
Exercise was once
forbidden for people with heart failure. But studies have shown moderate
exercise helps your heart pump more efficiently, reducing the demands on your
heart muscle. Before you start exercising, talk to your doctor about the best
type of exercise for you and warning signs that you've done too much and should
stop. Weigh yourself - do this each morning after you've gone to the bathroom
but before you've had breakfast. Notify your doctor if you experience a rapid
weight gain of 3 or more pounds. It may mean your body is retaining fluid and
you may need to adjust your medications.