Heart failure, also called congestive heart failure, is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body's other organs. The heart keeps pumping, but not as efficiently as a healthy heart. Usually, the loss in the heart's pumping action is a symptom of an underlying heart problem.
Heart failure may result from any/all of the following:
- heart valve disease - caused by past rheumatic fever or other infections
- high blood pressure (hypertension)
- infections of the heart valves and/or heart muscle (i.e., endocarditis)
- previous heart attack(s) (myocardial infarction) - scar tissue from previous attacks may interfere with the heart muscle's ability to work normally
- coronary artery disease - narrowed arteries that supply blood to the heart muscle
- cardiomyopathy - or another primary disease of the heart muscle
- congenital heart disease/defects (present at birth)
- cardiac arrhythmias (irregular heartbeats)
- chronic lung disease and pulmonary embolism
- drug-induced heart failure
- excessive sodium (salt) intake
- hemorrhage and anemia
Heart failure interferes with the kidney's normal function of eliminating excess sodium and waste from the body. In congestive heart failure, the body retains more fluid - resulting in swelling of the ankles and legs. Fluid also collects in the lungs - resulting in shortness of breath.
The following are the most common symptoms of heart failure. However, each individual may experience symptoms differently. Symptoms may include:
- shortness of breath during rest, exercise, or lying flat
- weight gain
- visible swelling of the legs and ankles (due to a build-up of fluid), and, occasionally, the abdomen
- fatigue and weakness
- loss of appetite and nausea
- persistent cough - often produces mucus or blood-tinged sputum
- reduced urination
The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been lost.
The symptoms of heart failure may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
In addition to a complete medical history and physical examination, diagnostic procedures for heart failure may include any, or a combination of, the following:
- chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- echocardiogram (Also called echo.) - a noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.
- electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
- BNP testing - B-type natriuretic peptide (BNP) is a hormone released from the ventricles in response to increased wall tension (stress) that occurs with heart failure. BNP levels rise as wall stress increases. BNP levels are useful in the rapid evaluation of heart failure.
Specific treatment for heart failure will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
The cause of the heart failure will dictate the treatment protocol established. If the heart failure is caused by a valve disorder, then surgery is usually performed. If the heart failure is caused by a disease, such as anemia, then the disease is treated. And, although there is no cure for heart failure due to a damaged heart muscle, many forms of treatment have proven to be successful.
The goal of treatment is to improve a person's quality of life by making the appropriate lifestyle changes and implementing drug therapy.
Treatment of heart failure may include:
- controlling risk factors
- losing weight (if overweight)
- restricting salt and fat from the diet
- stop smoking
- abstaining from alcohol
- proper rest
- controlling blood sugar if diabetic
- limiting fluids
- medication, such as:
- angiotensin converting enzyme (ACE) inhibitors - to decrease the pressure inside the blood vessels, or angiotensin II receptor blockers if ACE inhibitors are not tolerated
- diuretics - to reduce the amount of fluid in the body
- vasodilators - to dilate the blood vessels and reduce workload on the heart
- digitalis - to increase heart strength and control rhythm problems
- inotropes - increase the pumping action of the heart
- antiarrhythmia medications - keep the rhythm regular and prevent sudden cardiac death
- beta-blockers - reduce the heart's tendency to beat faster by blocking specific receptors on the cells that make up the heart
- aldosterone blockers - block the effects of aldosterone which causes sodium and water retention
- biventricular pacing/cardiac resynchronization therapy - a new type of pacemaker that paces both sides of the heart simultaneously to coordinate contractions and improve pumping ability. Heart failure patients are potential candidates for this therapy
- implantable cardioverter defibrillator - a device similar to a pacemaker that senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm
- heart transplantation
- ventricular assist devices (VADs). These are mechanical devices used to take over the pumping function for one or both of the heart's ventricles, or pumping chambers. A VAD may be necessary when heart failure progresses to the point that medications and other treatments are no longer effective.
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