Congestive Heart Failure: Causes, Symptoms, and Treatment
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1. Introduction to Congestive Heart Failure
Causes of CHF: There are many causes of heart failure. Most heart failure is a consequence of other cardiac diseases. Often the heart is caused to overwork to the point where it loses its elastic properties and cannot fill with enough blood. This can be caused by an increase in peripheral demand, such as in anemia or thyrotoxicosis, or in high output failure which can be seen in diseases such as beriberi. Mainly though, high output failure is the result of cardiac shunts, where blood bypasses the capillaries that supply the tissues. This shunting can be a result of valvular insufficiencies, regurgitations, or intracardiac shunts. Stepwise, the best understood cause of heart failure is a heart attack. If a portion of the heart is deprived of blood, it will injure the portion of muscle that it supplies. This localized injury will lead to a sequence of events eventually causing ventricular remodeling and dilation. This will later lead to clinical heart failure.
The information that has contributed to this discussion was gathered from current health research and the writer's opinions and experiences in the healthcare field.
Congestive heart failure (CHF) is the general term that describes the heart's inability to keep up with the demands of the body. Patients with heart failure are impaired in their ability to produce enough cardiac output to match the body's needs. This discussion will focus on the causes, symptoms, and possible preventative measures of congestive heart failure. It is important to realize that heart failure is a progressive disease and could potentially lead to death. This discussion is not meant to alarm the reader, but to inform them of an increasingly prevalent disease that has profound implications in the healthcare of today and tomorrow.
2. Causes and Risk Factors
Any of these conditions may only affect the right or left side of the heart and produce right or left-sided heart failure. The most common form of heart failure occurs because both sides are failing. Primary diseases of the heart muscle such as viral infections and inflammatory diseases can also lead to heart failure, but there are less common causes. The heart may become mechanically defective and fail as a pump if the muscle is damaged in a motor vehicle accident, or it may fail acutely if a large portion of heart muscle is damaged from a knife or gunshot wound. While these traumatic situations would be considered secondary causes of CHF, the heart may also be directly affected by certain diseases outside of the cardiac system such as severe anemia, thyroid diseases, and amyloidosis. In these conditions, heart failure occurs because the heart is receiving less of the nutrients it needs to function and is being asked to do more work than it is capable of.
The causes of CHF are classified into two major groups: those that affect the heart and produce a heart malfunction, and those that affect the heart in an indirect way. Anything that damages the heart muscle can cause heart failure. The most common cause of damage occurs from heart attacks, ischemia, and other coronary artery diseases. This is because the heart does not have enough blood supply and therefore the "fuel" it needs to function properly. High blood pressure and diseases of the heart valves also damage the heart in a similar way. These can cause the heart to overcompensate for its decreased pumping ability by developing an enlarged left ventricle, a condition called left ventricular hypertrophy. Although this helps in maintaining the cardiac output for a while, the heart becomes less and less efficient at pumping blood and ultimately goes into failure.
3. Symptoms and Diagnosis
Supposing a person with suspected heart failure has these characteristic features, it will be necessary to make a diagnosis of CHF. The clinical symptoms and signs such as dyspnea, orthopnea, PND, exercise intolerance, bibasal crackles are suggestive, but in the modern era, objective evidence must be obtained.
Bubbling noises from the chest can be made by the patient listening to his heart sounds through a stethoscope. The third heart sound is a lower-pitched sound diastolic filling sound about in mid-diastole (use apical area for listening - left lateral position). The sound of a failing left ventricle is a pansystolic murmur heard best at the apex. Finally, inspiration can create crackles in the lung bases if there is associated heart failure with dilatation of the right ventricle and tricuspid regurgitation.
The forerunner of chronic chest pain can be angina. In case that a person with suspected heart failure exercises, or walks up a flight of steps, and gets pains in the chest, he may be experiencing angina. This will sometimes be due to ischemic heart disease, and such patients do not rigidly fall into the definition of heart failure. On other occasions, the exertional chest pain is due to failure of the left ventricle, and is not angina, but simply the chest tightness or pressure that is common in heart failure, due to the lung venous hypertension. Nevertheless, he must get familiar with this term.
4. Treatment Options
Beta-adrenergic blockers are a type of medication that has recently become popular for treating heart failure. While these medications were originally thought to be harmful for people with heart failure, further research has shown that they can improve symptoms and prolong life for some people with heart failure. Some studies have shown that they are most effective for people with moderate to severe heart failure.
ACE inhibitors are another type of medication that can reduce symptoms and prolong life for people with all types severities of heart failure. They work by blocking the effects of certain hormones that can injure the heart and cause it to function abnormally. Another type of drug that blocks these hormones, called angiotensin receptor blockers (ARBs), is an alternative for those who cannot tolerate ACE inhibitors.
Vasodilators help to decrease the amount of work the heart has to do and can be effective for treating certain types of heart failure. Hydralazine and isosorbide dinitrate (BiDil) is a specific combination of medications that is FDA-approved to treat heart failure in African Americans, but it can be used for other races as well.
Diuretics (water pills) can relieve symptoms of fluid retention. Loop diuretics like furosemide (Lasix) are the most common and effective ones used for heart failure.
Medications. There are a number of different medications that can be used to treat congestive heart failure. The type of medication you need depends on the severity of your condition.
Exercising is another way of controlling your symptoms and improving your health. A supervised exercise program or physical therapy may be useful, particularly for those with moderate to severe heart failure.
Restricting salt and fluid in your diet can help control your symptoms. Weighing yourself daily and establishing limits for weight gain can be a good way of checking for fluid retention.
Making lifestyle changes. Changes to your diet and exercise patterns can help improve your overall health, decrease the severity of your symptoms, and prevent your condition from worsening. If you have mild to moderate heart failure, this may be the only treatment you need.
Treatment for congestive heart failure depends on the severity of your condition, the presence of other diseases, your age and overall health, and your personal beliefs and values. The goal of treatment is to control your symptoms, prevent your condition from becoming worse, and help you live a longer, more active life.
5. Prevention and Lifestyle Modifications
Lifestyle changes are pivotal in preventing the development and progression of heart failure. It is important to curb any source of heart disease because it is a stepping stone in the direction of heart failure. Adhering to a diet that is restricted in sodium intake can aid those who are at risk or those who already have heart failure. Sodium is commonly restricted to 2g per day and can lower the incidence of re-hospitalization due to fluid retention. Consuming fruits and vegetables has shown to have a direct correlation with lower blood pressure and a decreased likelihood of developing heart failure. There is no specific fruit or vegetable that shows significantly more benefit than the others, so the patient can make an informed decision. The DASH diet has shown to decrease the chance of developing heart failure, as well as increasing life expectancy of those who have heart failure. Physical activity can reduce the risk of developing heart failure. A study performed by the Women's Health Initiative Observational Study, which consisted of 81,5 women, showed that women who walked with a speed of >2mph for at least 4 hours per week had a 37% lower chance of developing heart failure. This coincides with the American Heart Association preventive goal of 150 minutes of moderate intensity aerobic activity per week. The activity can also repair a weak heart as a result of heart failure. A safe level of activity will strengthen the heart, improve blood flow to the body, and help the body's use of oxygen. This can allow the heart to beat more efficiently and be less out of breath or fatigued doing tasks in those who have heart failure. However, it is important to avoid excessive activity that requires the heart to work at high levels, as this may have adverse effects on the heart.