Heart disease is the leading cause of disability and death in Canada. Congestive heart failure is the end result of many serious heart problems. It appears when the heart loses its normal pumping capacity. With careful management, many people return to long periods of productive living after developing CHF.
The heart is connected to your blood vessels. The blood in these vessels carries oxygen and nutrients necessary for life to the entire body. Day in and day out, your heart pumps about 70 times per minute – over 2.6 billion heartbeats in an average lifetime. Each beat delivers life-sustaining fresh blood to your body's organs. The vital organs receiving this blood are the brain, kidneys, lungs and the muscular wall of the heart itself.
The heart is really a double pump, in which the left and right sides work together. Blood returns to the heart from all parts of the body and enters the right side of the heart. There, the muscular wall pumps the blood to the lungs. Next, the blood picks up oxygen from the air you breathe. Oxygen-rich blood returns to the left side of the heart. From here it is pumped to all parts of the body. The two pumps work together like clockwork. The right side receives used blood from the body and pumps it to the lungs. The left side takes oxygen-rich blood from the lungs and delivers exactly the same amount to the body.
If it is healthy, this wonderful pump works without your awareness. In order to maintain balance, both sides must work together to receive and pump forward enough blood to meet the body's needs. The pumping phase of the heart's action is called the systolic phase. The relaxed phase, where the heart receives blood, is called the diastolic phase.
Many suggestions your doctor gives during a check-up are meant to keep your heart and blood vessels healthy. Preventive maintenance is the best way to avoid problems caused by CHF. Many of the preventive strategies involve things you can do for yourself.
If the heart is unable to pump enough oxygen-rich blood to meet the body's needs at rest and during exercise, congestive heart failure occurs. The heart, which is normally able to receive and pump much more blood than we need, can no longer keep up. With CHF, the reserve is gone. Being unable to increase the output from the heart to meet the needs of a little extra effort makes you feel weak.
The heart may fail because of a problem in the pumping phase and this is known as systolic failure. It may also fail when there is a problem during the relaxing phase between heartbeats. This is known as diastolic failure. The relaxing phase is the time when blood enters the heart. If the heart is too stiff, blood cannot re-enter the heart easily so there is less blood inside the heart to be pumped out during the next heart beat. Often, both types of failure are present and the importance of each varies as the condition progresses. Many signs and symptoms of 'congestion' caused by heart failure come from the fact that blood flow is backed up much like a traffic jam. If blood cannot be pumped forward as it should, it gets backed up. The congested blood backs up into the lungs where the person feels the extra fluid as congestion in the lungs. From there it can back up to the right side of the heart and back to the body where it often results in a congested liver and swollen legs. Making matters worse, the congested blood is not flowing forward to the body so. The organs do not receive enough oxygen and nutrients. This causes the symptoms of weakness and tiredness that mark the onset of CHF.
When blood backs up in the lungs (left heart failure), you feel short of breath and may have a cough. If this collection of blood in your lungs is severe, it is called pulmonary edema. Pink and frothy sputum can go along with the cough of heart failure. As left heart failure progresses there is a further backup of blood through the right side of the heart and into the liver. At this time people typically notice swelling of the legs from this right heart failure.
The job of the kidneys is to eliminate extra fluid from the body. In CHF, changes in circulation also change kidney function. With reduced circulation to the kidneys, less fluid is eliminated in the urine, and it collects in the body.
In effect, CHF means that the heart pump cannot deliver sufficient blood to the tissues. The body does not receive the oxygen and nutrients it needs. The kidneys have trouble eliminating waste and extra fluid. There is a build-up of extra fluids. This fluid traffic jam causes the symptoms of weakness, shortness of breath, swelling and cough.
CHF is the result of other problems. Some of the most common causes of CHF are high blood pressure, coronary artery disease with heart attack, heart valve problems and lung disease. Others exist.
Your doctor will thoroughly examine you and may order a variety of tests, including laboratory and X-ray tests. An electrocardiogram (ECG) at rest or during exercise may be needed to check the electrical pathways of the heart. An echocardiogram (an ultrasound of the heart) or more complicated tests may study the heart movement and pumping action.
Blood vessels and circulation may be the problem. Coronary arteries can be studied using a test called an angiogram. A small tube is inserted into an artery and dye is injected to show the arteries feeding the muscle that makes up the walls of the heart. In coronary artery disease, the blood vessels that nourish the heart muscle are partially blocked. With reduced blood flow, the affected area of heart muscle can die and this is what is commonly known as a 'heart attack'. The proper term is a Myocardial Infarction and if it is large enough, it weakens the pumping action of the heart. CHF results when the outflow from the heart has been reduced enough to cause symptoms.
The first step in managing CHF looks at the underlying cause. With proper treatment the function of the heart can be improved and the fluid traffic jam reduced. Listen to your doctor's explanation of your problem. Knowing how your problem is being managed can give you a feeling of regaining control and restore your confidence. It is also easier to continue your treatment if you understand it.
Modern treatments for CHF usually include proper diet, exercise like walking and medication. Your doctor may advise you to restrict your salt intake by limiting foods high in salt. You should also lower fat and cholesterol intake. If you are overweight, your doctor will outline steps you can take to protect your heart with a program of daily exercise such as walking, combined with a healthy diet.
Your doctor will select specific medication for you. Both traditional medications and more recent ones have specific functions. Digitalis has been used since ancient times in an attempt to improve pumping action and control heart rate. Its role in heart failure is now limited and except for a few special conditions it has been replaced by more effective medicines including the class of drugs called ACE inhibitors. These drugs have a variety of effects that improve heart function. People on these medications generally feel better and live longer. Symptoms from fluid retention may be reduced by diuretics (water pills). Furosemide and Spironolactone are often used to control the excess of fluid in the body. Managing heart rate or rhythm can be helpful. The Beta Blocker family is known to be helpful here. It not only slows the heart, allowing more time for filling, but also prevents strain on the heart. Sometimes, medicine is needed to prevent the blood from coagulating. Irregular heart rhythms are common in CHF. They can cause problems with pumping and increase the chances of getting a blood clot inside the heart that can travel to the brain or other parts of the body causing strokes or other problems.
If your total cholesterol is elevated, you may be given dietary advice and exercises to help reduce bad cholesterol and triglyceride levels. Your doctor may also recommend other medication options. People with heart valve problems may need procedures to improve or replace the damaged heart valves. There are exciting new procedures that do not require major surgery and are now available for some patients with heart valve problems.
In short, medications can be used to treat CHF, relieve symptoms, improve pumping action, reduce fluid retention and blood pressure, manage heart rate and rhythm, lower cholesterol and prevent coagulation problems.
Some patients need more aggressive measures. A pacemaker may be inserted to control heart rate. Narrowed coronary arteries can be treated to restore flow to starving heart muscle and damaged heart valves can be repaired or replaced. A few select patients may even need a new heart via transplant. Again, your doctor can explain the treatment options that might be helpful for you.
Proper management relieves symptoms, lengthens productive living and manages the underlying cause of CHF. From time to time, medications may be added or changed to provide maximum benefit. All CHF patients need careful follow-up by their doctors and often by occasional visits to health care teams at heart function clinics. Those who take an active role in adjusting to a healthier lifestyle can add precious time to their lives. Your doctor can coach you on the best options.