Congestive Heart Failure: A Guide for Patients - Helping You to Understand Your Diagnosis and Prevent Complications

The human heart is composed of four chambers. The two upper chambers are termed atria, and the two lower chambers are the ventricles. Blood returns from your body and enters the two upper chambers or atria and then enters the ventricles where it is pumped back out to the body.

Congestive Heart Failure (CHF) is a condition in which the heart is unable to effectively pump blood out of the ventricles and into the body's circulation. It can be caused by various factors including heart disease, a previous heart attack, untreated or poorly managed high blood pressure, diseased heart valves, or congenital heart defects. With these disease processes, the heart must work harder to pump out a sufficient amount of blood to supply your body's needs. When you think of the heart, remember that it is a "muscle". When any muscle works hard it gets larger. In normal muscle we consider this to be a good thing. We become stronger and burn more calories. However, when the heart enlarges, it is unable to pump effectively. The larger the heart becomes, the less blood it will be able to pump out. When the heart becomes enlarged to an extent that an adequate amount of blood cannot be pumped out, you have congestive heart failure. If the heart is not pumping blood out well, then the blood that is returning to the heart has no where to go and can back up into the lungs. Congestive heart failure can be noted on a chest x-ray by revealing an enlarged heart. Your doctor may order an echo-cardiogram. This is an ultrasound of your heart. It can tell your doctor how effectively your heart is pumping.

Early in the course of the disease, you may notice that you are short of breath and are unable to do the things that you once could do. As the condition progresses, you may experience symptoms of swelling in your ankles, feet, and legs and shortness of breath while resting, especially at night. Shortness of breath that occurs at night usually requires the person to prop themselves up on pillows. This is termed orthopnea. Your doctor may ask you how many pillows that you have to use at night. Some people require two or three pillows. Others may require a bed that allows them to raise the head of their bed. If you have swelling in your legs and then lie down at night, the extra fluid volume in your legs enters your circulation which makes it harder for you to breathe at night. To help alleviate the extra fluid from pooling in your legs, it is recommended that you wear support stockings or TED hose during the day. You may require oxygen to wear at all times, or you may only need to wear it as needed, especially at night.

When you are diagnosed with Congestive Heart Failure, you will be started on specific medications. It is very important that you keep a written list of all of your medications and doses with you at all times. Medications that you may be started on can be broken down into "categories". These include:
1) ACE Inhibitors such as Lisinopril, Enalapril, and Ramipril
2) BETA Blockers such as Sotalol, Atenolol, and Carvedilol
3) Diuretics such as Furosemide, Bumetanide, and Spironolactone
4) Vasodilators such as Isosorbide and Hydralazine
5) Digitalis with common names of Digoxin and Digitek

ACE Inhibitors and Vasodilators can open up the blood vessels in your body which decreases the amount of work that your heart must do. Imagine trying to
force fluid through a very small straw. The fluid flows easier through a larger opening.
BETA Blockers help the left ventricle pump the blood out more effectively.
Diuretics remove extra fluid volume from your body. This will cause you to urinate more often and some people do not like to take their diuretics because they
feel that they are constantly going to the restroom. But, this is a very important part of managing your heart failure.
Digitalis increases the pumping action of your heart.

Some of these medications can also lower your blood pressure and your heart rate, so it is very important that you take them as prescribed and learn to monitor your blood pressure and heart rate. Your health care provider can teach you how to do this. You will also need to have certain lab tests done to monitor your electrolytes, especially your sodium and potassium. Some diuretics pull potassium out of your body and some do not. All diuretics will pull sodium out of your body. Digitalis is monitored by a lab test called a "digoxin level". For these reasons, it is very important that you keep your regularly scheduled physician appointments and learn what side effects to watch for.

Other things that are very important in managing your heart failure include:
*Restricting the sodium content of your diet. Always read food labels because there is hidden sodium in processed food. A general rule is to limit your total sodium intake to less than 2000 milligrams or 2 grams per day. Foods to avoid are processed meats including bacon, sausage, and lunch meats. There are varieties that are low sodium but always check the label. Eat fresh or frozen vegetables instead of canned. Do not add salt to food already prepared. Learn to replace salt with different herbs for flavor. Do not use a salt substitute unless your physician tells you that it is ok.
*Weigh yourself every morning when you first get up, after you empty your bladder. Keep a written log of your weight. If you gain more than two pounds overnight then you are retaining fluid. If your weight increases by more than three pounds per week, contact your physician. You may need an additional dose of your diuretic to remove the excess fluid before it causes you to go into acute heart failure requiring hospitalization. Each pound that you gain represents one liter of fluid that your body is holding. Some people will notice a change in their weight before they notice an increase in the amount of swelling in their legs.
*Exercise daily but stop and rest when you are short of breath. Learn to pace your activities and rest when you are tired.
*Take your medications as prescribed. Get a pill box from your local pharmacy and prefill it for one week at a time. If you get one that has the days of the week labeled, then you will know if you took your medication or not by looking at your pill box.
*If you smoke, stop.

This article is only a general guideline and should not be considered a substitute for seeking and following the care of your physician. Always be proactive in your own health care and ask questions if you don't understand. If you need help learning to monitor your heart failure and learning about your medications, you can request a visiting nurse.