Congestive heart failure and treatments
Dr. Dharam Pal Jain, Cardiologist with Columbia St. Mary's
An overview of congestive heart failure
Congestive heart failure is a clinical term rather than a disease. It is used to describe the process in which the heart does not pump enough blood to meet the body's demands. It is characterized by congestion in the lungs and fluid retention in various parts of the body. Symptoms include shortness of breath, weakness and fatigue.
Congestive heart failure usually occurs over time, most often due to a weakness of the heart muscle. Other conditions that can cause it include thickening of heart muscles, or abnormal valves. As the condition worsens, part of the heart may become enlarged or distorted (a condition known as remodeling), creating problems that may be irreversible.
Risk factors
Age is a major factor, and with more people living longer, the incidence of congestive heart failure is rising. According to Dr. Dharam Pal Jain, a cardiologist withColumbia St. Mary's, "It is the number one cause of death in people over 65."
However, congestive heart failure can also occur in infants and children, with congenital heart disease being the main cause.
Learn more about children's heart disorders from Jeanine Swenson, M.D., a pediatric cardiologist with Advanced Healthcare.
Many different problems can lead to congestive heart failure. These include the following:
- High blood pressure is a leading cause of heart disease, but it can also cause the heart muscles to thicken, making them less efficient for pumping blood.
- Coronary artery disease, caused by high cholesterol or diabetes, can cause pumping defects in the heart.
- Heart attacks often damage the heart, and this damage may lead to congestive heart failure in heart attack survivors.
- Cardiomyopathy, a type of disease due to weakness of the heart muscle, may be genetic or caused by an infection.
- Excessive consumption of alcohol or salt, both of which may contribute to hypertension and heart failure.
What are the symptoms?
The name congestive heart failure stems from the fact that the main symptom in the advanced stage of the condition is fluid retained in the lungs, ankles and feet. As the disease progresses, fluid may also collect in the abdomen. Since congestive heart failure can worsen rapidly, particularly in the aged, it is important for people to recognize the early symptoms and report these to their physicians as soon as they are noticed.
These symptoms include:
- Fatigue and shortness of breath, often following minor exertion that in the past had caused no problems.
- A wheezing or dry cough that occurs when lying down, then stops when the patient sits up. The cough may resemble the wheezing of asthma.
- An increasing need to urinate at night.
- Swelling of the ankles and feet.
As the disease progresses, the fatigue will increase, and patients will tend to lose weight due to the low cardiac output and not feeling well. In time, fluid will begin to build up in the lungs, a sign that the condition is becoming more serious.
Dr. Dharam Pal Jain, Cardiologist with Columbia St. Mary's
"The conditions that could lead to heart failure should be treated properly: control of blood pressure, control of diabetes to try to prevent development of coronary artery disease, watching one's weight, and avoiding excess salt and alcohol intake."
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Diagnosis and treatment
According to Dr. Jain, the prognosis for a patient suffering from congestive heart failure will depend to a great degree on what is causing the heart failure. A thorough exam and tests will usually be done to determine this.
"The physical examination is a very important part of the diagnosis," Dr. Jain said. Following that, chest X-rays are ordered, usually along with an electrocardiogram and echocardiogram. In some cases a heart catherization is also done to measure the pressure in the heart's chambers and further pinpoint the source of the underlying problem.
"Today, the basic treatment is medication. This includes diuretics, ACE inhibitors (which may control hypertension as well) and beta blockers (to regulate heart rhythm and slow progression of cardiac dysfunction). Sometimes there are complicated problems that must be corrected surgically. These could include coronary artery disease or defective valves," Dr. Jain said.
Avoiding congestive heart failure
Dr. Jain stresses that the most important way to avoid this problem is to treat the conditions that would lead to it. This would include controlling blood pressure with diet and medication, controlling diabetes, maintaining proper weight and avoiding excess salt and alcohol.
"If you use a lot of salt it will produce a lot of strain on your kidneys, so it is good to avoid excessive salt intake even without the presence of diseases aggravated by it," Dr. Jain said.
Dr. Jain also stressed that with newer treatments, congestive heart failure can be reversed. "I've had many patients, who following treatment, have had significantimprovements in heart function and in quality of life. It is very important that people with this condition see physicians who can provide the most modern treatments," he concluded.
