Congestive heart failure, or CHF, affects almost 5 million people in the United States, according to the American Heart Association. It is more common in older people, but can even affect children. CHF is a serious disease for which there is no cure. Left unchecked, its symptoms range from shortness of breath and generalized fatigue to debilitating declines in function and a lower quality of life. CHF can be successfully managed, however, with a combination of medications, lifestyle changes and surgical procedures.
Understanding the Disease
The heart is divided into right and left sides with two chambers in each. Blood in the body that has been depleted of its oxygen is sent to the right side of the heart and then on to the lungs to become re-oxygenated. The oxygen-rich blood then returns from the lungs to the left side of the heart, ready to be pumped back out to the rest of the body. A healthy heart pumps effectively, leaving little residual blood in the chambers. A heart that suffers from congestive heart failure is unable to pump effectively, leaving a significant amount of blood behind in the chambers after each pump. This causes a back-up of blood and fluid in the lungs and eventually in other parts of the body. Doctors call the back-up of fluid congestion.
Symptoms
It is essential that a person with congestive heart failure learn the symptoms to watch for in order to successfully manage this disease. The most common symptoms of worsening disease are shortness of breath; a generalized, whole-body feeling of malaise; sudden weight gain of 2 or more lbs. over 24 hours; edema, or swelling, of the lower extremities; decreased ability to sleep soundly due to breathing difficulties when laying down; chronic cough; and a rapid, sometimes erratic heartbeat. The more quickly symptoms are brought under control, the less likely hospitalization is necessary for disease management.
Medications
MayoClinic.com notes that the initial treatment for CHF is usually prescription medication. Physicians often order a diuretic, or water pill, to increase urine output and lessen the build-up of fluids in the body. The extra fluid in the lungs is also reduced, which decreases shortness of breath symptoms. ACE inhibitors are given to aid in dilation of the blood vessels, resulting in lower blood pressure and less exertion on the heart. Beta blockers make the heart rate slow and also help to reduce blood pressure. Digoxin helps the heart to pump more effectively with each beat. Sometimes, one medication alone is not enough to keep CHF in check and medications from different classifications are prescribed in combination to optimize results. If the disease progresses so that breathing is extremely difficult, a physician may order oxygen as an adjunct therapy to the above medications.
Lifestyle Management
A person with congestive heart failure should actively manage the disease by making smart lifestyle choices every day. Eating a low-fat diet keeps weight in check and lowers cholesterol. Cutting out salt is crucial to controlling high blood pressure and fluid retention. Daily weigh-ins and accurate record-keeping allow early identification of fluid retention, when it can still be managed with medications. People with CHF should cut out all tobacco and alcohol use. Getting a moderate amount of exercise--the American Heart Association advises at least half an hour most days of the week--is essential to keeping the heart healthy. It is, after all, a muscle and requires regular training to keep it working well.
Surgical Management
Physicians decide which surgical procedures are warranted based on the underlying disease causing the congestive heart failure. Blockages in the heart's blood vessels can cause regions of the heart muscle to die off. This requires a coronary artery bypass graft, or CABG, procedure to return the blood supply to normal. A heart valve that no longer works properly, allowing blood to remain in the heart's chambers, can be repaired or replaced. For hearts with irregular and ineffective beats, a pacemaker or defibrillator keeps the pumping of the chambers synchronized. Certain types of congenital malformations also cause CHF and may be repaired via surgery. Heart transplants are often the last option for people whose CHF is poorly managed with any of the above treatments.
References
- "Circulation"; Ethnical/Racial Differences in Prevalence of Congestive Heart Failure and Their Relation to Serum Vitamin D Concentrations Among American Elderly; L. Liu, H.J. Eisen; October 2006
- Mayo Clinic: CHF Symptoms
- Mayo Clinic: Heart Failure Treatments and Drugs
- American Heart Association: Physical Activity Recommendation
- MedlinePlus: Congestive Heart Failure
