Congestive Heart Failure: Risks, Symptoms and Treatment

The heart is one of the most hard-working muscles in the body. Each day, it pumps blood to each and every organ in the body, so the organs can get enough oxygen and work properly. Congestive Heart Failure (commonly known as CHF,) combined with fluid buildup can weaken the heart, thus inhibiting its ability to work as hard as it should. Most often, this causes swelling, (or edema,) in the hands and feet, but can also produce edema in other parts of the body as well. Fluid retention in the lungs can be life threatening. Here are the risk factors, symptoms and treatment options to discuss with your doctor.

Risk Factors:

Hypertension (high blood pressure.)
While a normal blood pressure should read at about 120/80, certain medications can alter your "normal" blood pressure. If your norm reads a little higher or lower due to your medications, discuss this with your cardiologist.

Smoking.
The harmful effects of smoking are staggering. If you are a smoker, the sooner you quit, the sooner your body can begin to recover some of the damage. Think it's too hard to quit? Take it day-by-day or hour-by-hour if necessary… the body can begin to repair some of the damage within the first 6 hours of smoking the last cigarette.

High cholesterol.
Many Americans consume too much saturated fat, and not enough fiber. Just altering your diet to include more fruits and vegetables can help. Start slowly, and try to replace the "bad" fats (processed foods, fast food, animal products) with the "good" fats (omega-3 fatty acids found in fish and vegetable oils.) The results can take 3 to 6 months to emerge, but sometimes can be significant in as little as 4 weeks.

Diabetes (Type 1 and Type 2.)
Diabetes is a condition in which the body either fails to produce insulin (Type 1) or does not properly use insulin (Type 2.) The causes continue to be a mystery, but genetics, environmental factors (obesity) and lack of exercise can all be attributed to this nationwide epidemic.

Obesity.
Carrying around excess weight can put undue strain on not only the heart, but also on the kidneys, liver, and lungs. Maintaining a healthy weight through proper diet and exercise can reduce your risk of developing heart disease, diabetes, and even osteoarthritis.

Physical Inactivity.
Studies show that even 20 minutes of vigorous activity, 3 days per week can greatly increase cardiovascular endurance and lung function. More than 60 percent of adults do not achieve the recommended amount of regular physical activity. In fact, 25 percent of adults are not active at all. Don't have time? Cheat! Park further away at the grocery store; take the stairs instead of the elevator; take two or three 10-minute walks during the day. It all adds up to a stronger and healthier body.

Low HDL cholesterol.
Confused between HDL and LDL? It's really very simple. Aim for your HDL numbers to be "high", and LDL numbers to be "low." HDL levels can be increased by aerobic activity, weight loss, smoking cessation, reducing trans fatty acids (margarine, high-fat foods, processed foods,) increasing monounsaturated fats (canola oil, olive oil, peanut butter,) and, believe it or not, alcohol. Not in excess, of course, but one to two glasses of alcohol can raise HDL levels. Adding soluble fiber (oats, legumes, fruits and vegetables) can also provide added benefit.

Symptoms:

Shortness of breath.
Also called dyspnea, or difficulty breathing, this is the most common symptom of CHF, and is caused by pulmonary edema. Dyspnea can be brought on by exertion, rest, or lying down (sitting up will usually alleviate the symptom.) At times, shortness of breath can be intermittent during the night, in which case pulmonary edema and depression of breath during sleep.

Edema.
Swelling most often occurs in the legs, and is usually more prominent in the afternoon due to gravity of being on your feet all day. Elevating the legs at night can alleviate edema, as well as diuretics to eliminate excess fluid.

Fatigue.
Reduced blood flow to the organs and muscles can cause this common symptom. At times, CHF can cause reduced blood flow to the brain, causing confusion, especially in the elderly.

Coughing/wheezing/raspy breath.
These symptoms may be misconstrued as merely a chest cold or upper respiratory infection. If you experience persistent cough along with the other CHF symptoms, consult your physician for further testing.

Treatment:

Medications.
Even with lifestyle changes, medication may be needed in most patients. Some common drugs to treat CHF include diuretics (to reduce fluid retention,) beta-blockers (to reduce heart rate and output of blood by counteracting hormones like adrenalin,) Digitalis (to increase circulation by increasing the force of heart's contractions,) Angiotension converting enzyme (ACE) inhibitors (to slow or prevent the loss of the heart's pumping capacity,) and Nitrate and/or hydralazine. For those who cannot take an ACE inhibitor, this also helps relax tension in blood vessels and improves blood flow.

Coronary Angioplasty.
In this procedure, a catheter (hollow tube) is inserted through an artery (usually the femoral artery in the groin) into the coronary artery, and to the blockage. A small balloon is inserted through the catheter and then inflated to open the blocked artery. Success rate is high, and the risks are minimal.

Coronary Artery Bypass Graft.
Commonly known as a "CABG" (pronounced "cabbage,") this surgery simply reroutes the artery around the blockage. The surgeon removes a healthy portion of an artery from another part of the body and "grafts" it to the coronary artery so that blood can flow around the blockage.

Implantable Cardiac Defibrillator.
An ICD is a small electronic device that is surgically implanted under the skin in the chest to monitor heart rhythm. When an abnormal rhythm is detected, the ICD delivers an electrical "shock" to restore a normal heart rhythm. ICD may be used to treat severe cases of CHF.

Intra-aortic Balloon Pump.
Inserted through the femoral artery in the groin and then placed in the aorta (main artery,) the IABP is an inflatable balloon that expands and deflates with each heartbeat. This reduces the strain on the heart, increasing blood flow throughout the body, and can be left in place for days or weeks.

Valve replacement.
Like a CABG, a valve replacement is a major surgery. The abnormal valve is replaced by either a porcine valve (from pig tissue,) a homograft valve (from a human donor,) or a mechanical, synthetic valve.

Left ventricular assist device.
Commonly known as the LVAD, this device is used for end-stage heart failure patients awaiting heart transplantation. The LVAD is a mechanical pump that is surgically implanted into the upper abdomen to bypass the left ventricle and pump blood throughout the body.

Receiving a diagnosis of CHF can be one of the scariest moments in a patient's life. Nearly 5 million people are living with this disease, and about 500,000 Americans are diagnosed with CHF every year. And although there is no cure for CHF, patients can live a long, fulfilling life with this disease if they're willing to make changes in their lifestyle. Paying attention to symptoms, evaluating family history and environmental factors, and seeking treatment early can often determine the options available.