Heart Failure

Heart Failure ~ Different Classification of heart failure ~ Risk Factors for heart failure ~ The diagnosis ~ Left-sided versus right-sided heart failure  ~ Clinical manifestations and signs and symptoms of CHF ~ Physical examination and diagnostic tests ~ Treatment of congestive heart failure ~ Hospitalization ~ Lifestyle changes ~ Relief and prevention of CHF ~ More Information

Heart Failure
Heart failure occurs when the heart loses its ability to pump enough blood through the body. Usually, the loss in pumping action is a symptom of an underlying heart problem, such as coronary artery disease.
The term heart failure suggests a sudden and complete stop of heart activity. But, actually, the heart does not suddenly stop. Rather, heart failure usually develops slowly, often over years, as the heart gradually loses its pumping ability and works less efficiently. Some people may not become aware of their condition until symptoms appear years after their heart began its decline.
How serious the condition is depends on how much pumping capacity the heart has lost. Nearly everyone loses some pumping capacity as they age. But the loss is significantly more in heart failure and often results from a heart attack or other disease that damages the heart.
The severity of the condition determines the impact it has on a person's life. At one end of the spectrum, the mild form of heart failure may have little effect on a person's life; at the other end, severe heart failure can interfere with even simple activities and prove fatal. Between those extremes, treatment often helps people lead full lives.
But all forms of heart failure, even the mildest, are a serious health problem, which must be treated. 


Different Classification of heart failure
Congestive Heart Failure 

Fluid in the lungs or body resulting from failure of the heart as a pump.
Right Sided Heart Failure 
Failure of the pumping action of the right ventricle resulting in swelling of the body, especially the legs and abdomen.
Left Sided Heart Failure 
Failure of the pumping action of the left side of the heart resulting in congestion of the lungs. 
Forward Heart Failure 
The inability of the heart to pump blood forward at a sufficient rate to meet the oxygen needs of the body at rest or during exercise.
Backward Heart Failure 
The ability of the heart to meet the needs of the body only if heart filling pressures are abnormally high.


Risk Factors for heart failure
1. Coronary Artery Disease

Coronary Artery Disease (CAD) is a condition in which there is a buildup of fatty deposits in arteries supplying the heart muscle. A diet of foods high in cholesterol and saturated fat can increase your risk of this disease. Fatty deposits form silently; you do not know they are there until they become large enough to significantly restrict blood flow to an area of heart muscle. When this occurs, chest discomfort or angina pectoris usually results. Normally a 70% blockage of a coronary artery will cause symptoms of chest discomfort or pain with exercise.

Angina Pectoris
Angina pectoris feels different for different people. It may feel like a heaviness or pressure in your chest, or it may be a distinct pain. If you feel any chest discomfort, you should contact your doctor.Unfortunately, approximately half of patients have a heart attack without prior warning symptoms of angina. Their heart attacks result from the rupture of a plaque (fatty deposit) that takes a moderate lesion to 100% (blockage) due to a thrombus (blood clot).
Other risk factors for coronary artery disease include smoking and hypertension. Obesity increases your likelihood of high blood pressure (hypertension) and coronary artery disease. 

Diagnosis of CAD
The gold standard for diagnosing coronary artery disease is coronary arteriography. In this procedure, a catheter is inserted into the leg or arm, and guided to the heart. A dye is then injected directly into the coronary arteries and x-ray movies are recorded. Other screening tests for coronary artery disease are treadmill testing, stress echocardiograms, and tracer studies.

Treatment of CAD
Treatment of coronary artery disease consists of: 

2 Hypertension
Hypertension is the medical term for high blood pressure. Blood pressure refers to pressure of blood against the walls of the arteries and is measured in millimeters of mercury. Blood pressures vary from person to person, but generally a ``normal" value is 100-160 over 60-90. The first number refers to the peak pressure in the arteries after the heart contracts (systole). The bottom number is the minimum pressure in the arteries when the heart relaxes (diastole) just before the next contraction. 
High blood pressure puts an extra strain on the heart since an increased pressure in the aorta increases the resistance against which the heart has to pump. Over months to years, as the load on the heart increases the heart initially tries to compensate by becoming thicker or dilating, but eventually it becomes exhausted with the extra effort. 
The heart increases in size through a process of heart cell growth called hypertrophy. When only the heart wall thickness increases (h), this is known as ``concentric" hypertrophy. However, if the heart chamber size (r) enlarges as well, this is known as ``dilated" hypertrophy. 
A thick heart resists filling with blood. A dilated heart usually has a less efficient contraction with a decrease in the ejection fraction

3 Valvular Heart Disease 
This occurs when the heart valves are defective at birth or become damaged 

4 Cardiomyopathy
Disease of the heart muscle 

5 Marked Obesity

6 Diabetes

7 Family History of Heart Failure


The "failing" heart keeps working but doesn't work as efficiently as it should. People with heart failure can't exert themselves because they become short of breath and tired. 
As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) results, most commonly in the legs and ankles, but possibly in other parts of the body as well. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down. 
Heart failure also affects the ability of the kidneys to dispose of sodium and water. The retained water increases the edema. 

The diagnosis
Congestive heart failure is not a disease in itself. It is a syndrome in which the heart is unable to pump an adequate supply of blood to meet the oxygen requirements of the body's tissues and organs. As a result, fluid accumulates in the heart and other organs such as the lungs and spreads gradually into surrounding tissues. The fluid accumulates in the part of the heart that is failing. This condition can occur suddenly or gradually. Symptoms for CHF can vary.

Left-sided versus right-sided heart failure
CHF may occur in one or both sides of the heart. As one side of the heart begins to fail, the other side can continue to function normally. The increased strain on the heart can lead to heart failure. Congestive heart failure usually begins with the left side of the heart and progresses backward until the right side, too, fails. The left side of the heart receives oxygen-rich blood from the lungs and pumps it to the rest of the body. When the left side of the heart begins to fail, the blood flow backs up into the lungs. Blood flow to the rest of the body may be impeded as well. With right-sided failure, the heart is unable to effectively pump blood to the left side and blood flow backs up to other parts of the body including the legs and feet, liver and gastrointestinal tract. Some of the symptoms overlap.


Clinical manifestations and signs and symptoms of CHF 

Physical examination and diagnostic tests 
The clinical symptoms of congestive heart failure may be different in each patient. The goal in diagnosing CHF is to determine its underlying cause. The primary diagnostic procedures are as follows:
An extensive history and physical will be performed. The complete physical examination may reveal many things. The heart rate may be rapid or irregular. Respiratory rate may be increased (how fast you breathe). Skin may be cold, sweaty or dusky. There may be unexpected weight gain, distended neck veins, and swelling noted in the feet, ankles or abdomen. The liver may feel enlarged. The physician will listen to the patient's chest with a stethoscope and may hear crackling sounds indicating fluid around the lungs. Abnormal heart sounds may be heard. There may be blood pressure changes. A chest x-ray will be performed to check for enlargement of the heart and for fluid in and around the lungs. An ECG (EKG) will be performed to check for arrhythmias and cardiac stress. It will also show any history of previous heart events. An echocardiogram may be performed to observe valve and heart wall motion. It may also show decreased heart function and abnormalities. Blood and urine tests may also be taken to help determine the cause of heart failure.


Treatment of congestive heart failure 
There are several goals in the treatment of congestive heart failure patients. The underlying health problem that precipitated the heart failure should be treated. If the underlying cause of the CHF is untreatable, then the goals for treatment are aimed at improving heart function and helping the heart pump more efficiently. The prevention of further damage to the heart, and relieving the patient of clinical symptoms are also goals of treatment. Treatment of congestive heart failure can include hospitalization, medication therapy, surgery, and lifestyle changes. CHF requires appropriate medical attention by a qualified health care provider.

Medications are often used in the treatment of congestive heart failure. It might be necessary for a patient to take more than one kind of medication. It is especially important for patients to take their medicine exactly as prescribed. There are many types of medications that may be prescribed. They include Vasodilators, which make the blood vessels widen or open up. Vasodilators make it easier for blood to flow and reduce the heart's work load. Ace-inhibitors are also included in this group. (examples include Capoten and Vasotec)

Diuretics can be used to help the kidneys dispose of excess fluid. Diuretics can help patients breathe more easily as they help decrease fluid in the lungs (examples include Lasix, Zaroxolyn, and Demadex).

Inotropics can also be used in the treatment of CHF. This group of medications is used to strengthen the heart's ability to contract (examples include Digoxin and Primacor). Beta Blockers are used to help the heart work more efficiently over time. They are, however, prescribed only in stabilized heart failure patients and by expert physicians (examples include Coreg and Toprol).


Hospitalization might be required for the patient diagnosed with CHF if the symptoms are too severe or if the patient is unable to respond to initial forms of treatment. Surgery may be indicated for some patients. Surgical options include, but are not limited to, correcting congenital defects, repairing or replacing defective valves, angioplasty, bypass surgery, and transplantation as a last resort.

Lifestyle changes
Lifestyle changes are important in the treatment of congestive heart failure. They include dietary restriction of sodium (salt), smoking cessation, limiting the consumption of alcohol and fluids, exercise and weight control. All lifestyle modifications must be monitored by appropriate medical personnel.

Relief and prevention of CHF
There are many therapeutic measures a patient can follow each day to help relieve and prevent the progression of congestive heart failure. Some of these are:

Know the signs and symptoms of CHF and immediately report any to your physician: edema, increased shortness of breath, distended neck veins, weight gain (of greater than 3lbs overnight), persistent cough, and increased urination at night 

Congestive heart failure is a disorder that can lead to serious complications and death. For this reason, it is important to know the warning signs and to follow your physician's plan of care. Symptoms can be controlled with appropriate treatment and the correction of underlying health problems.


More Information

Congestive Heart Failure
Guidelines for the Evaluation and Management of Heart Failure
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Heart failure - causes and treatment
Congestive Heart Failure Guide
Facts About Heart Failure - FAQs
NHLBI, Heart Failure
Welcome to Heart Failure Online
COHIS: Cardiovascular Diseases: Heart Diseases: Congestive
MEDLINEplus: Heart Failure
Heart Failure: The Physiologic Basis for Current Therapeutic
Issues in Heart Failure: Cardiomyoplasty
Clinical Practice Guide 11: Heart Failure
Clinical Practice Guide 11: Heart Failure
Congestive heart failure a growing problem
Congestive Heart Failure and Pulmonary Edema
Evaluation and Management of Heart Failure Guidelines:Heart
WebMD - Congestive Heart Failure
Heart Failure Readings
Virtual Hospital: Department of Internal Medicine: Heart
Virtual Hospital: Department of Internal Medicine: Heart
Heart Care - Congestive Heart Failure - Methodist Health
Heart Care - Heart Failure - Methodist Health Care System
News TOPIC: Congestive Heart Failure and Transplantation
Update on Digoxin Therapy in Congestive Heart Failure
Update on Digoxin Therapy in Congestive Heart Failure
Heart Failure: lifeclinic.com
Heart Failure Audit Data Collection Form: 1 patient per form
Heart Failure Protocol
Essentials of the Diagnosis of Heart Failure