Congestive Cardiac Faliure

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Definition:

Heart failure (HF), also known as Congestive Heart Failure (CHF) occurs when the heart muscle is unable to pump the blood to meet the body’s requirement. It is a major health problem in the United States, affecting about 5.7 million Americans. Approximately, 550,000 new cases of heart failure occur each year and this is one of the leading causes of hospitalization in people older than 65. If you have heart failure, you will enjoy better health and quality of life if you keep yourself in balance and take care of yourself. It is therefore important to know how to keep in good balance and when to call your doctor.

Heart Failure Types:

Causes & Risk Factors

The most common causes of heart failure include:

1. High blood pressure
2. Heart attack
3. Cardiomyopathy

Other causes of heart failure are:

• Alcohol or recreational drugs
• Heart valve problems
• An uncontrolled irregular heart rhythm (arrhythmia)
• A viral infection affecting the heart muscle
• Congenital heart conditions
• Some cancer treatments

A single risk factor is enough to cause heart failure, but a combination of factors increases your risk. The risk factors include:

• Coronary artery disease
• High blood pressure
• Diabetes
• Heart attack
• Some diabetes medications
• Congenital heart defects
• Sleep apnea
• Valvular heart disease
• Obesity
• Alcohol use
• Viruses
• Tobacco use
• Irregular heartbeats

Symptoms & Diagnosis

Heart failure can be ongoing (chronic) or your condition may start suddenly (acute). Symptoms of heart failure may include the following:

1. Fatigue and weakness
2. Shortness of breath (dyspnea) when you exert yourself or when you lie down.
3. Rapid or irregular heart beat
4. Swelling or edema in your legs, feet or ankles
5. Persistent cough or wheezing with white or pink blood-tinged phlegm
6. Reduced ability to exercise
7. Swelling of your abdomen
8. Lack of appetite and nausea
9. Increase need to urinate at night
10. Sudden weight gain from fluid retention
11. Chest pain of your heart failure is caused by a heart attack
12. Difficulty concentrating or decreased alertness

Visit your doctor immediately, if you experience one of the above symptoms. Your doctor will ask for your medical history, review your symptoms and perform a physical examination. He/she will use a stethoscope to listen to the signs of congestion, abnormal heart sounds suggesting heart failure. He will examine the veins in your neck and also check the fluid buildup in your abdomen and legs. After physical examination, your doctor will order the following diagnostic tests:

• Stress tests
• Chest X-ray
• Blood test
• Electrocardiogram (ECG)
• Cardiac computerized tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• Echocardiogram
• Coronary angiogram
• Myocardial biopsy

Prevention

Congestive heart failure can be the ultimate result of a number of diseases, or lifestyle choices, that damage the heart. Some of these can be prevented. Others cannot be prevented, but can be treated successfully.

Some examples of illnesses or lifestyle choices that can lead to congestive heart failure are as follows:

• Coronary heart disease (coronary artery disease), including heart attack
• Uncontrolled high blood pressure (hypertension)
• Uncontrolled high cholesterol
• Diabetes
• Congenital heart disease (a heart condition that one is born with)
• Infection (particularly some common viruses that can rarely severely affect the heart and cannot be reliably predicted or prevented)
• Damage to the heart valves (possibly from IV drug use)
• Alcoholism
• Smoking.

In some cases, a family history of heart failure can be present. Many cases are a combination of factors, and in other cases, the cause is unknown.

If you have congestive heart failure, you are at increased risk of developing pneumonia. You probably should receive both the pneumonia vaccination and annual flu shots. Ask your health care provider to be sure.

Treatment

Heart failure treatment focuses on improving the symptoms and preventing the progression of the disease. Heart failure is a chronic disease that requires lifelong management. Usually, doctors correct the heart failure by treating the underlying cause. Sometimes, the heart failure can be treated with medications and in some cases, the devices are used to help the heart beat and contract properly.

Depending on your symptoms, your doctor will prescribe the following medications:

1. Angiotensin-converting enzyme (ACE) inhibitors: It helps people with systolic heart failure live longer and feel better. It widens the blood vessels to lower the blood pressure, thereby improves the blood flow and decrease the workload on the heart. Examples of an ACE inhibitor include lisinopril (Zestril), enalapril (Vasotec) and captoril (Capoten).
2. Beta blockers: This class of drugs slows your heart rate and reduces the blood pressure as well as limits or reverses the damage to your heart caused by the systolic heart failure. They reduce the signs and symptoms of heart failure, improve your heart function and help you live longer. Examples include metoprolol (Lopressor), carvedilol (Coreg) and bisoprolol (Zebeta).
3. Angiotensin II receptor blockers: They have the same benefits as the ACE inhibitors and may be used as an alternative for people who can’t tolerate ACE inhibitors. The drugs include valsartan (Diovan) and Cozaar.
4. Diuretics: Also called as water pills, they make you urinate more frequently and keep the fluid from collecting in your body. Diuretics like furosemide (Lasix) may decrease the fluid in your lungs so that you can breathe more easily.
5. Introtopes: These are intravenous medications given to people with severe heart failure in the hospital so as to improve heart pumping function and maintain the blood pressure.
6. Aldosterone antagonists: These are potassium-sparing diuretics that help people with severe systolic heart failure live longer. Examples include eplerenone (Inspra) and spironolactone (Aldactone).
7. Digoxin (Lanoxin): It is also referred as digitalis, increases the strength of your heart muscle contractions and slow the heartbeat. It reduces the heart failure symptoms in the systolic heart failure.

Surgery and Medical Devices:

Heart Valve Repair or Replacement : Your doctor will recommend repairing or replacing the valve, if your heart failure is caused by a faulty valve. The surgeon will repair or modify the original valve (valvuloplasty) to eliminate the backward blood flow. Valve replacement is done with an artificial (prosthetic) valve when the valve repair isn’t possible. Heart valve repair or replacement is can be done through open heart surgery, minimally invasive surgery or cardiac catherization techniques.

Coronary bypass surgery: Your doctor will recommend coronary bypass surgery if your heart failure is caused by severely blocked arteries. During this procedure, the blood vessels from your arm, leg or chest bypass a blocked artery in your heart to allow the blood flow through your heart more freely.

Heart pumps: These are mechanical devices like the ventricular assist devices (VADs), that are implanted into the abdomen or chest and attached to a weakened heart to help it pump blood properly. Often VADs are used in the left ventricle of the heart but it may be used on both the ventricles. Implanted heart pumps can extend and improve the lives of people with severe heart failure and who are not eligible for heart transplantation.

Implantable cardioverter-defibrillators (ICDs): It is a device similar to a pacemaker that is implanted under the skin in your chest with wires leading through your veins and into your heart. An ICD monitors the heart rhythm and tries to pace your heart if the heart starts beating at a dangerous rhythm or if it stops. It can also function similar to a pacemaker by speeding your heart if it is going too slow.

Heart Transplant: It is recommended for people with severe heart failure for whom the medications didn’t help. A heart transplant may dramatically improve the survival and the quality of life in people with severe heart failure.

Other Therapy

A rapidly growing newer therapy is called cardiac resynchronization therapy (CRT) and involves a biventricular pacemaker.

• One pacer is placed in a coronary vein on the back side of the heart, overlying the left ventricle. The other pacer is placed in the usual right ventricle position. This improves the coordination of contraction between the left and right ventricle, especially if the patient has left bundle branch block.
• Biventricular pacing has been shown to improve exercise capacity, and, in a recent clinical trial, it has been found to prolong life.
• Cardiac resynchronization therapy is frequently combined with an ICD to shock a person out of life-threatening arrhythmias, such as ventricular tachycardia or ventricular fibrillation. The worse the left ventricle, the higher the risk for sudden death secondary to these arrhythmias.

Whether biventricular pacing will work so well as to prevent deterioration of the left ventricle and the need for heart transplantation is unknown.

Next Steps-follow up

If you have congestive heart failure, you will need frequent, regular medical attention to adjust your medications and watch for side effects. Schedule regular visits with your health care provider as he or she recommends because congestive heart failure is a serious medical condition that requires constant monitoring. Educate yourself as much as possible about this life-threatening condition.

• Establish a daily routine for taking medication properly and on schedule.
• Weigh in daily. Every morning, record the weight in a diary, and take it to the health care provider every visit. An accurate bathroom scale is helpful in monitoring weight gain or loss from day to day. This will help to see fluid retention.
• Keep a list of all medications, with the exact name and dose, and know why each one is taken. Bring them to each follow-up visit so the doctor can double check to make sure you are on the correct medication and dose.
• Reminder boxes for medications are helpful.

Be sure to keep all these medications away from small children who may accidentally swallow them. Many of the drugs prescribed for congestive heart failure are more dangerous in overdose than other medications

Outlook

Heart failure is a major health problem that comes with the graying of America. Today, many more people are surviving heart attacks and other heart diseases. This allows them many more years of quality life, but can eventually lead to the development of heart failure.

In recent years, more effective medications have been developed that improve the outlook of heart failure. Medications are the mainstay of therapy with congestive heart failure.

• New and sophisticated treatments are allowing people to live longer. These results are proven by clinical trials where patients volunteer to take new therapies under strict ethical and scientific monitoring.
• Pacemakers and implantable defibrillators have improved and now offer the ability to control rare but life-threatening disturbances of heart rhythm in some people.
• Some people may even benefit from sophisticated treatments such as heart transplants and newer forms of temporary mechanical hearts.

Support Groups and Counseling

Having the support of health care providers, family, and friends is essential to effectively coordinate all of the needs of a person with heart failure.

People with severe heart failure have special needs beyond standard medical care.

• Advance directives are legal documents that tell doctors and hospitals what treatments you might not want, should you become unable to speak for yourself.
• A living will provides instructions while you are still alive, for example, if you have specific wishes if your heart or breathing stops.
• A medical durable power of attorney allows someone you designate to make medical decisions on your behalf, if you become unable to make these decisions.
• Hospice care may be required when you and your physicians agree that your prognosis for survival is poor. Professional hospice caregivers emphasize pain control and emotional support.

Heart Failure Treatment in India

Doctors and researchers in India have actively contributed in developing new ways to diagnose and treat people having heart failure. Doctors who are internationally trained in heart care evaluate and treat thousands of people having congestive heart failure. The cardiologists and other specialist staff at heart failure clinics in India work together as a team for diagnosing and treating all forms of congestive heart failure. The advanced facility in most of the hospitals in India is devoted to surgically advanced heart failure treatment.

FAQ’s

• How common is heart failure?
• Approximately 5 million people in the United States have heart failure. It contributes to 300,000 deaths each year. It is the number one cause of hospitalizations for people over the age of 65.

 

• Who is at greatest risk for heart failure?
• Heart failure is more common in
• People who are 65 years old or older
• African-Americans
• People who are overweight
• People who have had a heart attack
• Men.

 

• How long will I be in the hospital?
• Hospital stays differ widely between patients and depend on the reason for hospitalization. Patients with heart failure should be discharged from the hospital when:
• Symptoms of heart failure have been adequately controlled
• Reversible causes of morbidity have been treated or stabilized
• Patients and caregivers have been educated about medications, diet, activity and exercise recommendations, and symptoms of worsening heart failure
• Adequate outpatient support and follow-up care have been arranged

 

• How do I make an appointment with the best cardiologist in India?
• All you have to do is send us your medical report and be rest assured. We will choose the best suitable surgeon for you, after consulting the experts.