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From his column To Your Health

to-your-health-09-13-1Congestive Heart Failure (CHF) is the leading cause of hospitalization in Americans older than 65. An estimated six million suffer from it, with an additional 650,000 being diagnosed annually. It is important to understand that CHF is not an actual disease itself, but rather a condition that is the result of several different heart problems.

Simply put, CHF is a condition in which the heart is unable to pump the amount of blood needed by the body. When the body is at rest, demands on the heart are less, so the rate of pumping (pulse) and the volume of blood needed are less. When the pace of activity increases, the volume of blood needed also increases. This requires heart muscle contractions to increase to supply adequate oxygen and nutrients throughout the body. If the heart cannot keep up, consequences can be both immediate and long term. So when we hear the phrase, “heart failure” we should wonder about the cause.

The most common cause of CHF is coronary artery disease. You may recall that this is the condition in which there is narrowing or blockage of the arteries carrying blood to the heart. If blood flow is inadequate, the heart muscle is damaged (a heart attack) and cannot pump as effectively as it should.

Heart valves are a critical part of the movement of blood through the heart. These valves are situated between the heart chambers and serve as a means of keeping blood in the chamber to which it has been pumped. For example, when the heart is in the relaxation phase of its pumping action, the blood is not allowed to return to the chamber from which it has just come. If the valves are damaged or diseased, the efficient flow of blood through the heart is impeded and one or more of the heart chambers become overloaded causing the heart to fail. This is known as valvular heart disease and may further be defined by the valves involved, such as aortic or mitral valve disease. Sometimes surgery is required to repair or replace these valves.

Heart failure may be caused by disease in the muscle fibers of the heart causing them to fail to contract effectively. This is referred to as cardiomyopathy. It may be caused by viral infections of the heart muscle or by the use of toxic substances, such as excessive alcohol use or drugs.

Another cause of CHF is long-term uncontrolled high blood pressure which causes strain when the heart muscle becomes overstretched, inhibiting the fibers from contracting effectively. This is preventable by maintaining good control of blood pressure.

Rhythm disturbances of the heart also may lead to CHF. When the electrical impulses that contract the heart become irregular and uncoordinated, the heart does not contract in an efficient manner and may fail. You may have heard of atrial fibrillation which is a type of rhythm problem.

Symptoms of CHF may include any of the following: shortness of breath while exerting yourself; shortness of breath while lying down—particularly awakening at night suddenly short of breath; swelling in the abdomen, legs, ankles or feet; chronic cough or wheezing not explained by other existing conditions; a rapid or irregular heartbeat; rapid weight gain of one to two pounds per day for two to three days; loss of appetite; and a general onset of weakness not otherwise explainable. If you have any of these symptoms, it does not necessarily mean you have CHF. Only your physician can determine this by putting together all the pieces of the puzzle.

If CHF is suspected, a doctor usually evaluates the situation with tests of the blood and urine, a chest X-ray, an EKG (determines the heart’s electrical pattern), and an echocardiogram (sonogram of heart blood flow).

CHF is generally effectively treated with the use of a combination of medications, depending on the underlying condition. Diuretics (water pills) such as HCTZ or Lasix are used. Some commonly used blood pressure medications include ACE inhibitors (Lisinopril, Quinapril, Benzapril, etc.) or beta blockers (Metoprolol, Carvedilol or Coreg, etc.). Avoiding excessive salt use not only helps CHF but also is beneficial in controlling blood pressure.

Finally, it is important to carefully follow your physician’s instructions. Changes in symptoms listed above could be an indicator that CHF is getting worse and should be reported to your doctor sooner rather than later. In some situations, the physician will have you daily monitor your weight.

Remember that having CHF is no excuse for not following an exercise program prescribed by your physician. This might require you to exercise in a monitored environment, such as a cardiac rehab area in your local hospital. That is a good thing!

If you have a diagnosis of CHF, take it seriously, be diligent in following your physician’s instructions, and be consistent with follow up.

Dr. Paul Wardlaw is a board-certified family physician who has enjoyed the practice of medicine in various settings for 40 years.

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