The Mended Hearts, Inc.
Hearts of Jersey Chapter #179

May 2009

Congestive Heart Failure

Congestive heart failure (CHF) is the number one reason for hospital visits in people age 65 and older. In CHF, the heart cannot fill with enough blood or pump with enough force, or both.

There are two types of CHF, and most cases involve both types:

• Right-sided (diastolic): The heart cannot fill with enough blood and pump it to the lungs to pick up oxygen. Fluid may build up in the feet, ankles, legs, liver, abdomen and veins in the neck

• Left-sided (systolic): The heart cannot pump enough oxygen-rich blood to the body.

The most common causes of CHF are coronary artery disease (in which fatty deposits block blood flow to heart muscle), high blood pressure and diabetes. Heart muscle diseases and defects, heart valve disorders and irregular heartbeats (arrhythmias) can cause CHF. Radiation treatment, chemotherapy, thyroid disorders, HIV / AIDS, alcohol abuse, illegal drugs (cocaine) and too much vitamin E can damage heart muscle and cause CHF. Obstructive sleep apnea can make CHF worse.

The signs and symptoms of CHF include:

• Shortness of breath or trouble breathing;

• Fatigue

• Swelling in the ankles, feet, legs, abdomen and veins of the neck;

• Weight gain;

• Frequent urination; and

• Cough that is worse at night and when lying down.

A combination of methods is used to diagnose CHF, including medical and family histories; and a physical examination and tests, including electrocardiogram, chest X-ray and a BNP blood test that measures the level of a hormone that rises during heart failure. If initial testing indicates CHF, you may be referred to a cardiologist (heart specialist) for further testing, diagnosis and treatment.

Although there is no cure for CHF, therapy can reduce symptoms and prevent CHF from getting worse, improve quality of life and increase your life span, and treat the cause (coronary artery disease, high blood pressure, diabetes). Treatment plans involve:

• Healthful eating: less salt, fat and cholesterol, and enough potassium (found in bananas, strawberries, raisins, beets and greens);

• Staying active;

• Maintaining a healthy weight;

• Avoiding tobacco and illegal drugs;

• Getting enough sleep; and

• Taking medication.

The main medications for treating CHF include digoxin, which makes the heart beat stronger, and the following medications that lower blood pressure:

• Diuretics (water or fluid pills): reduce fluid buildup and swelling;

• Beta blockers: slow heart rate;

• ACE inhibitors: may reduce risk of heart attack;

• Aldosterone antagonists: reduce volume of blood that the heart must pump;

• Angiotensin receptor blockers: relax blood vessels; and

• Isosorbide dinitrate / hydralazine hydrochloride: shown to help African Americans.

Extra oxygen may be needed if breathing difficulty is not relieved by medications.

As CHF worsens, some people may need a pacemaker to help both sides of the heart contract at the same time and an implantable cardioverter defibrillator to correct heart rhythm. People who have CHF at rest may need a mechanical heart pump or a heart transplant.

If your heart is healthy, do the following to prevent heart disease and CHF:

• Follow a diet that is high in fruits, vegetables, whole grains, low-fat dairy products and lean meat; and follow a diet that is low in salt, fat, saturated fat, trans fat and cholesterol, for example. the Therapeutic Lifestyle Changes (TLC) diet and the Dietary Approaches to Stop Hypertension (DASH) eating plan, both developed by the National Heart, Lung, and Blood Institute of the National Institutes of Health.

• Avoid tobacco, secondhand smoke and illegal drugs;

• Maintain a healthy weight; and

• Get 30 minutes of physical activity daily.

If you are obese or have coronary artery disease, high blood pressure or diabetes, follow the steps above and add the following:

• Get treatment and control any conditions that cause CHF;

• Avoid drinking alcohol; and

• Visit your doctor for regular follow-up care.

If you have CHF, follow your treatment plan, avoid respiratory infections, and ask your doctor about getting flu and pneumonia vaccines.

Weigh yourself daily and report any sudden weight gain or loss to your doctor because either one may signal a need to adjust your treatment.

lf you feel depressed from coping with CHF, ask your doctor about treatment to improve your outlook.

Take steps to prevent CHF, or to treat CHF if you have it, and stay healthier longer.