Symptoms We Treat
Congestive Heart Failure
Congestive heart failure (CHF) occurs when the heart muscle, whether from weakness or stiffening, does not pump with sufficient force to circulate the blood properly. As a result, blood backs up in other parts of the body, such as the liver, abdomen, lower legs and lungs, because the heart is unable to keep pace with the body’s circulatory needs. While CHF can occur on either side of the body, it usually begins on the left, where the left ventricle, the primary pumping chamber of the heart, is located.
Types of Congestive Heart Failure
There are four types of congestive heart failure: left-sided, right-sided, systolic and diastolic. Left-sided heart failure results in fluid backup in the lungs, whereas right-sided heart failure causes fluid backup in the abdomen, or legs and feet.
In systolic heart failure, there is a pumping problem: the left ventricle cannot contract strongly enough. Diastolic heart failure indicates that there is a filling problem because the left ventricle cannot fully relax.
CHF can be either chronic or acute.
Causes of Congestive Heart Failure
An unhealthy lifestyle can contribute to congestive heart failure, but congenital defects, coronary artery disease, diabetes or hypertension are also underlying causes.
Coronary Artery Disease
The most common cause of CHF is coronary artery disease, in which there is a buildup of fatty deposits in the arteries that supply blood to the heart muscle. This accumulation of plaque is known as atherosclerosis.
If, as a result of plaque buildup, the arteries rupture, a blood clot forms, blocking blood flow to an area of the heart. This may result in permanent damage that weakens the heart muscle.
When a patient has hypertension (high blood pressure), the heart is working harder than necessary to circulate the blood, causing the heart muscle to thicken. Over time, the heart muscle weakens to the point that it no longer pumps blood efficiently.
Faulty Heart Valves
Blood flow is directed by the heart valves. If a valve is damaged, the blood backs up, causing the heart to work harder than it usually does. Heart-valve damage may be the result of a congenital defect, a heart infection, or coronary artery disease.
Cardiomyopathy (damage to the heart muscle) can result from infection (such as myocarditis), alcohol or drug abuse, chemotherapy, or a disease process. In some cases, cardiomyopathy is caused by genetic factors.
Congenital Heart Defects
Infants may be born with a defective heart in which, because of anatomical abnormalities, the valves or chambers do not work properly, resulting in CHF.
Other causes of CHF include heart arrhythmia, infections and diseases, allergic reactions, certain medications, and blood clots in the lungs.
Symptoms of Congestive Heart Failure
There are a number of symptoms of congestive heart failure, including the following:
- Ascites (abdominal swelling)
- Edema (swelling) in the legs, ankles and feet
- Fatigue and weakness
- Reduced ability to exercise
- Increased need to urinate during the night
- Persistent coughing or wheezing
- Production of pink-tinged phlegm
- Rapid or irregular heartbeat
- Shortness of breath, especially upon exertion
When CHF is caused by a heart attack, patients also experience chest pain.
Diagnosis of Congestive Heart Failure
In order to diagnose CHF, in addition to a comprehensive medical examination, the following tests may be administered:
- Blood tests
- Chest X-rays
- Electrocardiogram (EKG or ECG)
- Stress test
- CT or MRI scan
- Coronary angiogram
In some cases, a myocardial biopsy is performed.
Treatment of Congestive Heart Failure
CHF must be treated; if not, it can lead to kidney failure and death. Medication and surgery are both treatment options.
Medications used to treat CHF include the following:
- Beta blockers
- Digoxin (digitalis)
- Aldosterone antagonists
Angiotension-converting enzyme inhibitors (ACD) or angiotension II receptor blockers are also used to treat CHF.
Surgical treatments are undertaken when medications do not resolve the problem. Several types of surgeries, including the following, can be performed to treat CHF:
- Coronary bypass
- Heart-valve repair or replacement
- Implantation of cardioverter-defibrillators (ICDs)
- Cardiac resynchronization therapy (CRT)
- Implantation of ventricular assistive device (VAD)
In the most severe cases of CHF, implanting a total artificial heart (TAH) or having a heart transplant may be necessary.
Coronary Artery Disease
Coronary artery disease is a buildup of fatty deposits in the coronary arteries, which supply blood to the heart. This buildup of fat, cholesterol and calcium, known collectively as plaque, can cause a hardening and narrowing of the arteries which restricts blood from reaching the heart. Blood clots can also form and completely block the artery. Coronary artery disease develops gradually and can eventually lead to a heart attack or heart failure. Coronary artery disease is the leading cause of death in the United States for both men and women.
Treatment of Coronary Artery Disease
Medications such as beta blockers, nitroglycerin and cholesterol-modifying drugs can help treat coronary artery disease. Aspirin may be recommended to prevent blood clots and thrombolytics may be prescribed to break up any existing clots. Surgical procedures such as angioplasty, stent placement and coronary artery bypass surgery may be necessary to treat severe cases of coronary artery disease.
Endocarditis is an infection of the inner lining of the chambers or valves of the heart. Endocarditis typically affects patients with existing heart conditions and occurs when germs in the bloodstream attach to damaged or abnormal areas of the heart.
Treatment of Endocarditis
Endocarditis is often treated with antibiotics administered intravenously in the hospital. The type of medication a patient receive will depend on the type of infection. Once symptoms subside, treatment can continue in either an outpatient setting or with home-based care. Surgery may be needed for severe cases that have caused heart damage. Patients with existing heart conditions should take preventive steps such as practicing good hygiene with regular brushing and flossing of teeth and proper dental care to avoid the risk of developing endocarditis. For those patients that have particular medical conditions, a course of antibiotics may be required before dental or medical procedures in order to prevent endocarditis. Most people who undergo proper treatment recover fully from endocarditis.
Syncope, commonly known as fainting, is a brief loss of consciousness as a result of a sudden drop in blood pressure and decrease in heart rate which results in an insufficient flow of blood to the brain. Most people regain consciousness after a few moments, but may experience a state of confusion for a short period.
Treatment of Syncope
Because fainting can be an indication of another condition, a patient should alert their doctor about their episode. Treatment for syncope depends on the underlying cause of the condition, and the aim is to prevent more fainting episodes. Treatment may include:
- Support garments to improve circulation
- Biofeedback training
- Pacemaker, to regulate the heart rate
- Foot exercises
- Dietary modification
Patients should talk to their doctor if they have had episodes of syncope.
A heart attack occurs when the coronary arteries, the blood vessels that deliver blood to the heart, are suddenly blocked and cannot supply the heart with blood and oxygen. This blockage causes damage and gradual death of the heart muscle and often requires immediate treatment in order to save the person’s life. Also known as a myocardial infarction, heart attacks most often occur as a result of coronary artery disease, a condition in which plaque builds up inside the arteries. Heart attacks are the leading cause of death for men and women in the United States.
Treatment of a Heart Attack
A heart attack is an emergency that requires immediate treatment. Anyone experiencing symptoms of a heart attack should call 911 right away. Early treatment of a heart attack can help minimize damage to the heart muscle. Treatment for a heart attack usually includes cardiopulmonary resuscitation (CPR) to deliver oxygen to the body and brain, aspirin to prevent blood clots, thrombolytics to break up any existing clots, and nitroglycerin to treat chest pain. In some cases, surgery may be necessary to open blocked arteries, either through balloon angioplasty or a coronary artery bypass.
For more information or to make an appointment for a cardiac evaluation. it’s about time!