By James (Tom) Heywood, MD, Scripps Health
What does it mean when the heart fails? While its name might suggest otherwise, congestive heart failure doesn’t mean the heart has stopped working; instead, it fails to effectively pump enough blood to the body’s organs or to fill without an abnormal increase in pressure. Commonly known as CHF, congestive heart failure affects about five million Americans. It is a serious condition that requires ongoing medical care, but with the proper management, most people with CHF can manage the condition and lead otherwise healthy lives.
CHF can take years to develop or can happen overnight with a large heart attack.; it is one of the most common reasons that people age 65 and older need hospital care. It can be caused by a number of factors, including narrowing of the arteries that supply blood to the heart muscle (coronary artery disease), heart valve disease, or high blood pressure. The heart muscle itself may be diseased or infected. In some cases, CHF results from congenital heart defects which have been present since birth.
The most common symptoms of CHF include breathing problems, sudden weight gain of five pounds or more, and fluid build-up in the legs, ankles and feet. Because the heart cannot pump effectively , blood returning to the heart increases in pressure, causing a build-up of fluid known as congestion in the tissues, especially the lower limbs. Fluid build-up in the lungs may cause shortness of breath. As a result, some people with CHF may find it difficult or impossible to exercise and may become winded just by walking short distances. CHF may also interfere with the kidneys ‘ability to dispose of sodium and water, which can make fluid build-up worse.
Any of these symptoms should be evaluated by a physician, who can diagnose CHF and recommend a plan of action. Depending on the cause, treatment may include dietary changes, lifestyle modifications, medication and/or surgery. For example, if CHF is caused by high blood pressure, a proper diet or medication to control blood pressure may be all that is needed. Damaged valves may be surgically repaired or replaced. In very severe cases, a heart transplant may be an option.
A number of medications may be used to help improve the symptoms of CHF as well as prolong survival. Angiotensin Converting Enzyme (ACE) Inhibitors interfere with the production of angiotensin II, a hormone that may potentially cause heart and circulation problems in CHF patients. ACE inhibitors expand blood vessels, making it easier for blood to flow more efficiently. In multiple studies, these medications have been shown to significantly improve symptoms and help prevent heart failure from getting worse.
Some patients, however, may not be able to tolerate ACE inhibitors; in this case, an alternative is often recommended. Angiotensin Receptor Blockers (ARBs) work slightly differently than ACE inhibitors, but the effect on angiotensin II is similar.
Beta-blockers improve the pumping ability of the heart’s lower left ventricles. Studies have found that beta-blockers are most effective in CHF patients who are also taking ACE inhibitors. Beta-blockers often are started at very low doses and gradually increased until optimal levels are reached.
Digoxin, a medication naturally produced by the foxglove flowering plant, stimulates the heart muscle to contract more forcefully; it also helps improve CHF symptoms and prevent the condition from progressing.
Since CHF patients experience fluid build-up, diuretics are often used to treat or prevent fluid retention in the lungs and other tissues by helping the body dispose of excess fluid and sodium through the kidneys. It is especially important for people with heart failure to weigh daily, at the same time and using the same scale, to monitor any sudden weight gain that may indicate fluid build-up. Patients who gain several pounds over just a few days should let their physicians know immediately.
In order for these medications to be most effective, they must be taken exactly as prescribed. Let the physician know immediately of any side effects, concerns or questions.
Dr. Heywood is a cardiologist with Scripps Health. Scripps offers a free four-week series on Living with Congestive Heart Failure; weekly seminars cover symptom management, exercise, nutrition and heart failure medications. For more information or to register, call 1-800-SCRIPPS.