Congestive heart failure


What happens when your heart can't keep up? The good news - death rates from heart attack and stroke are declining. The bad news - the death rate from congestive heart failure is increasing. Why the increase in congestive heart failure? It's because the disease mainly affects older adults, and more people are now living long enough to develop it. In addition, people are surviving other medical problems, such as heart attack, that increase the risk for congestive heart failure. But despite the rise in congestive heart failure, advances in treatment are helping people with the disease live longer and with fewer symptoms.


A weakened pump. While heart "failure" conjures up images of a totally ruined heart, it doesn't mean that your heart isnt working at all. It means that your heart isn't able to pump enough blood to your body's tissues and organs to meet their needs. The term "congestive" refers to fluid buildup that occurs with the disease. With less blood leaving your heart, blood returning to your heart gets backed up. As back pressure builds, fluid from your blood can collect in your vital organs, including your lungs and liver. Fluid can also seep into surrounding tissues, causing swelling. Congestive heart failure is frequently the end result of many cardiovascular problems.


Most common causes:


                       A blockage of blood vessels to the heart (coronary artery disease).

                       A diseased heart muscle (cardiomyopathy).

                       Long-standing high blood pressure (hypertension).

                       Abnormal heart rhythms.

                       Heart valve problems.

                       Congenital heart disease.

                       Toxic substances (including prolonged alcohol abuse).


Symptoms are subtle to severe. At first, you may not experience any signs or symptoms. Then, gradually, you may notice shortness of breath that occurs with exertion. As the disease worsens, shortness of breath becomes more pronounced and may even occur while you're lying down or sleeping. You may also experience fatigue or weakness, swelling in your feet, ankles and abdomen due to fluid buildup, swollen or distended neck veins, rapid weight gain or a chronic cough. And, your heart may gradually become enlarged.


Improvements in treatment


In some cases, congestive heart failure can be corrected by treating an underlying cause. But many times the problem can't be eliminated. Then, the goal of treatment is to prevent further damage to your heart and help it pump as efficiently as possible. This is usually done through use of medications. They generally include: ACE (angiotensin-converting enzyme) inhibitors - These drugs, also used to treat high blood pressure, have become the mainstay treatment for congestive heart failure. They're the only drugs cleorly proven to help people with the disease feel better and live longer. The drugs include enalapril maleate (Vasotec), lisinopril (Prinivil, Zestril), captopril (Capoten) and others. ACE inhibitors allow blood to flow from your heart more easily by decreasing production of a hormone (angiotensin II) that constricts your arteries and raises your blood pressure.


They also decrease production of the hormone (aldosterone) that causes your body to retain sodium and water. ACE inhibitors cause an irritating cough in about 20 percent of people taking them. But it may be best to put up with the cough, if you can, to gain the medications' benefits.


Diuretics - Often called "water pills," diuretics make you urinate more frequently and keep fluid from collecting in your body. Commonly prescribed diuretics include bumetanide (Bumex), furosemide (Lasix) and others. The drugs also decrease fluid in your lungs so you can breathe more easily.


Digoxin - This drug, also referred to as digitalis, increases the strength of your heart muscle contractions. While digoxin doesn't improve overall survival rates, it reduces heart failure symptoms and improves your ability to function with the condition.


Beta blockers - They may improve blood flow and may help prevent some heart rhythm problems. A new drug, canvedilol (Coreg), received Food and Drug Administration (FDA) approval in May. A-II (angiotensin II) antagonists are under study for congestive heart failure treatment, but are not yet approved by the FDA for the condition. These medications losartan (Cozaor) and valsartan (biovan) - work similarly to ACE inhibitors but don't cause a persistent cough. Studies are evaluating whether they are as effective as ACE inhibitors.


Heart transplants


Rarely, another treatment option is a heart transplant. Survival and quality of life following a transplant are excellent, but there's a shortage of donor hearts. Candidates for transplantation are typically people under age 65 who are frce of other life-threatening diseases and whose other vital organs are healthy.


Steps you can take


Important lifestyle changes can often help relieve your symptoms and prevent the disease from worsening. You need to restrict sodium - sodium causes you to retain fluids. You should try to consume less than 3,000 milligrams (mg) daily. You also need to be careful when using salt substitutes. Limit alcohol and fluids - alcohol can further reduce your heart's pumping ability. If you have severe heart failure, your doctor may also suggest you consume fewer beverages to reduce fluid buildup.




Exercise was once forbidden for people with heart failure. But studies have shown moderate exercise helps your heart pump more efficiently, reducing the demands on your heart muscle. Before you start exercising, talk to your doctor about the best type of exercise for you and warning signs that you've done too much and should stop. Weigh yourself - do this each morning after you've gone to the bathroom but before you've had breakfast. Notify your doctor if you experience a rapid weight gain of 3 or more pounds. It may mean your body is retaining fluid and you may need to adjust your medications.