Congestive Heart Failure

with Paul Weisman, Cardiologist, Advanced Healthcare

Posted: Feb. 1, 2004

Congestive heart failure occurs when the heart is unable to pump enough blood to support the rest of the body. In a healthy person, the heart pumps at least 50 percent of the blood it receives in a single beat; in a person with congestive heart failure, it pumps significantly less per beat.

Early symptoms of the disease include shortness of breath when active, swelling of the ankles and fatigue.

Paul Weisman, M.D., Cardiologist, Advanced Healthcare "If you have been diagnosed with congestive heart failure, take your medications, see your doctor regularly, tell him or her about any side effects and watch your salt and water intake."

People with more advanced stages might experience palpitations, an inability to lie flat without breathlessness and having to sit up or sleep in an elevated position in order to breathe.

“These symptoms might mean there’s a decrease in heart function which is causing fluid to back up into the lungs making one short of breath,” said Dr. Paul Weisman, a cardiologist with Advanced Healthcare. “The decrease in heart function could be due to a problem with the muscle of the heart itself being weak, or a problem with having had one or more heart attacks caused by blockages in the coronary arteries.”

Exacerbations – worsening of symptoms – can be due to what Dr. Weisman termed “AIII” – cardiac Arrhythmias, Infections, Ischemia (new or worsening blockages) and/or Indiscretion with diet and medications.

Congestive heart failure can be mild, moderate, severe or very severe. If for any reason the heart would become weakened, it will have to work harder in order to move the same amount of blood through the body.

Risk factors
Causes of heart failure may include congenital abnormalities (the most common cause of the condition in children), viruses, heart valve diseases, high blood pressure and coronary artery disease. Heart attacks can cause congestive heart failure because some of the heart muscle can become damaged and replaced with scar tissue, which has no ability to contract appropriately.

About 5 million Americans have congestive heart failure, with an additional 500,000 new cases diagnosed every year.

Despite the number of uncontrollable risk factors, there are things people can do to lower their chances of developing congestive heart failure during their lifetime. Topping the list, said Dr. Weisman, is working to avoid coronary artery disease.

About 5 million Americans have congestive heart failure, with an additional 500,000 new cases diagnosed every year.

To do that, he said, people need to exercise regularly and to be aware of their blood pressure and weight, keeping them within a normal range. Also, cholesterol levels should be checked and treated if needed. Diabetics need to work on controlling blood sugar levels. “And especially,” he said, “don’t smoke.”

Treatment
Studies over the years have resulted in a range of treatment options for congestive heart failure.

“There are various medications which can allow people to live a normal life despite very poor heart function,” Dr. Weisman said.

Vasodilators relax the blood vessels of the body, making it easier for the heart to pump. Diuretics remove extra salt and water from the body, lowering blood volume. One may be asked to take beta-blockers or other drugs such as digitalis. Also, there are intravenous drugs that can be used to treat severe cases of congestive heart failure.

In cases where the condition is due to a blockage, there are other options.

“Often, coronary blockages can be repaired by interventional techniques such as angioplasty, stent placement, bypass surgery or, in some cases, a heart transplant,” he said.

For those diagnosed with the condition but who may not be candidates for a surgical or percutaneous intervention (using catheterization techniques), Dr. Weisman had these recommendations.

“If you have been diagnosed with congestive heart failure, take your medications, see your doctor regularly, tell him or her about any side effects and watch your salt and water intake,” he said. “That’s very important. Excess salt and water can cause the heart to have an increased volume to pump, and if one has a weak heart, the increased volume can make it more difficult for the heart to work efficiently.”

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