Congestive Heart Failure: Symptoms,Diagnosis and Treatements

The words "heart failure" sound alarming, but they do not mean that your heart has suddenly stopped working. Instead, heart failure means that your heart is not pumping as well as it should to deliver oxygen-rich blood to your body's cells.

Congestive heart failure (CHF) happens when the heart's weak pumping action causes a buildup of fluid called congestion in your lungs and other body tissues. CHF usually develops slowly. You may go for years without symptoms, and the symptoms tend to get worse with time. This slow onset and progression of CHF is caused by your heart's own efforts to deal with its gradual weakening. Your heart tries to make up for this weakening by enlarging and by forcing itself to pump faster to move more blood through your body.

Who is at risk for developing CHF, and what are its causes?

According to the American Heart Association, people 40 and older have a 1 in 5 chance of developing CHF in their lifetime. This is because people are living longer and surviving heart attacks and other medical conditions that put them at risk for CHF. People who have other types of heart and vessel disease are also at risk for CHF.

Risk factors for CHF include

• Previous Heart Attacks
• Coronary artery disease
• High blood pressure (hypertension)
• Irregular heartbeat (arrhythmia)
• Heart valve disease (especially of the aortic and mitral valves)
• Cardiomyopathy (disease of the heart muscle)
• Congenital heart defects (defects you are born with)
• Alcohol and drug abuse

What are the symptoms?

Symptoms can help doctors find out which side of your heart is not working properly.
If the left side of your heart is not working properly (left-sided heart failure), blood and fluid back up into your lungs. You will feel short of breath, be very tired, and have a cough (especially at night). In some cases, patients may begin to cough up pinkish, blood-tinged sputum.

If the right side of your heart is not working properly (right-sided heart failure), the slowed blood flow causes a buildup of fluid in your veins. Your feet, legs, and ankles will begin to swell. This swelling is called edema. Sometimes edema spreads to the lungs, liver, and stomach. Because of the fluid buildup, you may need to go to the bathroom more often, especially at night. Fluid buildup is also hard on your kidneys. It affects their ability to dispose of salt (sodium) and water, which can lead to kidney failure. Once CHF is treated, the kidneys' function usually returns to normal.

As heart failure progresses, your heart becomes weaker and symptoms begin. In addition to those listed above, here are some other symptoms of CHF:

• You have trouble breathing or lying flat because you feel short of breath.
• You feel tired, weak, and are unable to exercise or perform physical activities.
• You have weight gain from excess fluid.
• You feel chest pain.
• You do not feel like eating, or you feel like you have indigestion.
• Your neck veins are swollen.
• Your skin is cold and sweaty.
• Your pulse is fast or irregular.
• You feel restless, confused, and find that your attention span and memory are not as good as they were.

How is CHF diagnosed?

Most doctors can make a tentative diagnosis of CHF from the presence of edema and shortness of breath.

• With a stethoscope, a doctor can listen to your chest for the crackling sounds of fluid in the lungs, the distinct sound of faulty valves (heart murmur), or the presence of a very quick heartbeat. By tapping on your chest, doctors can find out if fluid has built up in your chest.

• A chest x-ray can show if your heart is enlarged and if you have fluid in and around your lungs.

• Electrocardiography (ECG or EKG) can be used to check for an irregular heartbeat (arrhythmia) and stress on the heart. It can also show your doctor if you have had a heart attack.

• Echocardiography can be used to see valve function, heart wall motion, and overall heart size.

Other imaging techniques, such as nuclear ventriculography and angiography, can provide a firm diagnosis and show doctors how diseased your heart is.

How is CHF treated?

Many therapies can help to ease the workload of your heart. Treatment may include lifestyle changes, medicines, transcatheter interventions, and surgery.

Lifestyle Changes

• If you smoke, quit.
• Learn to control high blood pressure, cholesterol levels, and diabetes.
• Eat a sensible diet that is low in calories, saturated fat, and salt.
• Limit how much alcohol you drink.
• Limit the amount of liquids you drink.
• Weigh yourself daily to watch for fluid buildup.
• Start an aerobic exercise program that has been approved by your doctor.

Medicines

The following medicines are often given to patients with CHF:

• Diuretics, which help rid your body of extra fluid.

• Inotropics, such as digitalis, which strengthen your heart's ability to pump.

• Vasodilators, such as nitroglycerin, which open up narrowed vessels.

• Calcium channel blockers, which keep vessels open and lower blood pressure.

• Beta-blockers, which have been shown to help increase your ability to exercise and improve your symptoms over time.

• ACE inhibitors, which keep vessels open and lower blood pressure.

• Angiotensin II receptor blockers, which keep vessels, open and lower blood pressure.

Percutaneous Coronary Interventions

• Angioplasty is a procedure that is used to open arteries narrowed by fatty plaque buildup. It is performed in a cardiac catheterization laboratory. Doctors use a long, thin tube called a catheter that has a small balloon on its tip. They inflate the balloon at the blockage site in the artery to flatten the fatty plaque against the artery wall.

• Stenting is used along with balloon angioplasty. It involves placing a mesh-like metal device into an artery at a site narrowed by plaque. The stent is mounted on a balloon-tipped catheter, threaded through an artery, and positioned at the blockage. The balloon is then inflated, opening the stent. Then, the catheter and deflated balloon are removed, leaving the stent in place. The opened stent keeps the vessel open and stops the artery from collapsing.

• Bi-ventricular pacemaker is recommended for patients with Moderate to severe heart failure who have a low ejection fraction , as the name suggests this device stimulates both the heart ventricles simultaneously so that they co-ordinate in synchrony. This improves the ejection fraction (which is a measure of the pumping capacity of the heart) thereby improving the quality of life of the patient. Commonly known as a CRT device is a device which is smaller than the palm of an adult hand. A specially trained cardiologist implants the device.

• Studies have shown that Heart Failure patients are at a higher risk for Sudden cardiac arrest. Special CRT devices are available which can potentially stop life threatening ventricular fibrillation (very fast heart rates) by delivering an electrical shock (called defibrillation in medical terms) to the patient. This device is a combination of a conventional Implantable Cardioverter Defibrillator (the “shock box”) and the pacemaker. It is commonly called as a “Combo” device or a CRT-D (D stands for Defibrillator).

Recent studies have shown that CRT devices not only improve the quality of life but also offer significant mortality benefits. Patients who have been implanted with a CRT device had a 36% reduction in all-cause mortality, over 18 months, as compared with patients in the control group.

Surgical Procedures

• Heart valve repair or replacement
• Correction of congenital heart defects
• Coronary artery bypass surgery
• Mechanical assist devices
• Heart transplantation

The best way to prevent heart failure is to practice healthy lifestyle habits that reduce your chances of developing a heart problem. It is also important to find out if you have any risk factors that contribute to heart failure, such as high blood pressure or coronary artery disease. Many patients with congestive heart failure can be successfully treated, usually with a percutaneous coronary intervention.Patients should carefully follow their doctors' advice. In doing so, they can continue to live full and productive lives.

Dr V. RAJASEKHAR a Consultant Cardiologist and Electrophysiologist with Kamineni Wockhardt Hospital. He has successfully implanted many CRT devices and is considered to be one of the leading experts in this field. He can be contacted on enquiries@wockhardthospitals.net