Congestive Heart Failure (CHF)

The Facts of Congestive Heart Failure

    • Congestive heart failure (CHF) is a condition in which the heart’s function as a pump is now less than adequate to meet the needs of the body.
    • Many disease processes can impair the pumping efficiency of the heart which can cause congestive heart failure.
    • Although the symptoms of congestive heart failure can vary with the individual patient, the most common symptoms include fatigue, diminished exercise capacity, shortness of breath, and swelling.
    • Patients are diagnosed with congestive heart failure based on knowledge of their individual medical history, a careful physical examination, and selected laboratory tests.
    • There can be many factors that contribute to the treatment of congestive heart failure. Lifestyle modifications, addressing the potentially reversible factors, medications, a heart transplant, and even mechanical therapies are involved when trying to recover..
    • The course of congestive heart failure can vary greatly depending on who the patient is.
Picture of congestive heart

What is congestive heart failure?

Congestive heart failure (CHF) is a condition in which the heart’s function as a pump is no longer adequate to deliver oxygen rich blood efficiently throughout the body. Congestive heart failure may be caused by:

        1. diseases that can weaken the heart muscle,
        2. diseases that can cause a stiffening of the heart muscles, or
        3. diseases that can increase the demand of oxygen by the body tissue beyond the capability that the heart has to deliver the adequate amount of oxygen-rich blood.

If you are living on or near Long Island New York and think your body may be suffering from congestive heart failure or the early stages of it, it is crucial to get it checked out and not leave it untreated. Dr.Kavesteen’s offices are here to help.

The heart is made up of upper and lower chambers. The right atrium and left atrium make up the upper chambers and the right and left ventricle make up the two lower chambers of the heart. Ventricles are muscular chambers that pump blood through the heart when the muscles are contracted, also known as systole.

Different diseases can negatively impact the ventricles’ ability to pump. Heart attacks, infections, or toxins like alcohol or other drugs can severely weaken the muscles of the ventricles. When the pumping ability of the ventricles is destroyed because of muscle weakening, it is called systolic dysfunction. The relaxation of the ventricle muscles after each ventricular contraction is called a diastole; this allows the blood to fill the ventricles from the atria.

Diseases like hemochromatosis or amyloidosis can cause the heart to experience something called diastolic dysfunction. This is when the heart muscle becomes stiff and the ventricles’ capacity to relax properly and fill up is impaired. Long-standing high blood pressure is the most common cause of diastolic dysfunction which results in a thickening of the heart. In some patients, the pumping action and filling capacity of the heart could seem normal, but still have an abnormally high demand for oxygen from the body’s tissues, this could make it very hard for the heart to supply the needed blood flow.

Every patient is different and in some individuals, one or more of these factors could be present and a cause of congestive heart failure.

Congestive heart failure can affect many of the organs of the body. Some examples are:

    • Weakened heart muscles may not be able to properly supply the right amount of blood to the kidneys, which then can begin to lose their normal ability to excrete salt (sodium) and water. This diminished kidney function can cause the body to retain too much fluid.
    • The lungs may become congested with fluid (pulmonary edema) and the person’s ability to exercise is greatly decreased.
    • Fluid can build up in the liver, thereby impairing its functional ability to rid the body of toxins and produce essential proteins.
    • The intestines may become less efficient in absorbing nutrients and medicines.
    • Fluid also may accumulate in the extremities, which results in edema (swelling) of the ankles and feet.
Detail diagram of human heart

What are the major causes of congestive heart failure?

Many disease processes can impair the pumping efficiency of the heart and thus causing congestive heart failure. In the United States, the most common causes of congestive heart failure are as follows:

Some less common causes include viral infections for the stiffening of the heart muscle, thyroid disorders, disorders of the heart rhythm, and many others.

It should also be known, that in some patients with underlying heart disease, taking certain medications can lead to the development or worsening of congestive heart failure. This is especially true for those drugs that can cause sodium retention or affect the strength and power of the heart muscle. Examples of some of these medications are the commonly used nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen (Motrin and others) and naproxen (Aleve and others) as well as certain steroids, some medication for diabetes (such as rosiglitazone [Avandia] or pioglitazone [Actos]), and some calcium channel blockers. This is another reason why you should see the doctors of Kavesteen on Long Island, New York. They will work with you to make sure that you aren’t endangering yourself more with medications you may be taking for other conditions.

What are some of the Symptoms of Congestive Heart Failure (CHF)?

The symptoms of congestive heart failure are very different depending on who the patient is according to the particular organ systems that are involved and depending on the degree to which the rest of the body has “compensated” for the weakening of the heart muscle.

    • An early warning sign (symptom) of congestive heart failure is fatigue. While fatigue is a sensitive indicator of the possibility of underlying congestive heart failure, it is obviously a nonspecific symptom that may be caused by many other possible conditions. The person’s ability to exercise may also be diminished. It can be very dangerous because patients might not even sense this decrease and may subconsciously reduce their activities in order to accommodate these limitations.
    • As the body becomes overloaded with fluids from congestive heart failure, swelling (edema) of the ankles and legs or abdomen may be noticeable. This can be referred to as “right-sided heart failure” as failure of the right-sided heart chambers to efficiently pump venous blood to the lungs to acquire oxygen results in buildup of this fluid in gravity-dependent areas such as the legs. The most common cause of this is longstanding failure of the left heart, which may lead to the secondary failure of the right heart. Right-sided heart failure can also be caused by severe lung disease (referred to as “cor pulmonale”), or by an intrinsic disease affecting the right heart muscle (less common).
    • In addition, fluid may build up in the lungs, which could cause breathing difficulties , particularly during exercise and when lying flat. In some instances, patients are awakened at night, gasping for air.
    • Some patients may be unable to sleep unless sitting upright.
    • The extra fluids building up in the body may cause increased urination, particularly at night.
    • Accumulation of fluids in the liver and intestines may cause nausea, abdominal pain, and a decreased appetite.

How can congestive heart failure be diagnosed?

The diagnosis of congestive heart failure is usually a clinical one that is based on knowledge of the patient’s relevant medical history, a careful physical examination, and selected laboratory tests.

A thorough patient history may disclose the presence of one or more of the symptoms of congestive heart failure that were described above. In addition, a history of significant coronary artery disease, prior heart attack, hypertension, diabetes, or significant alcohol use can be major clues.

The physical examination is focused on detecting any extra fluids that may be found in the body (breath sounds, leg swelling, or neck veins) as well as carefully characterizing the condition of the heart itself (pulse, heart size, heart sounds, and murmurs).

Useful diagnostic tests such as the electrocardiogram (ECG) and chest X-ray to detect previous heart attacks, arrhythmia, heart enlargement, and fluid in and around the lungs. One of the single most useful diagnostic test is the echocardiogram, which uses ultrasound to image the heart muscle, valve structures, and blood flow patterns. The echocardiogram is extremely helpful in diagnosing heart muscle weakness. In addition, the test can suggest possible causes for the weakening of the heart muscle (for example, prior heart attack, and severe valve abnormalities). Nearly all patients in whom the diagnosis of congestive heart failure is suspected should ideally undergo echocardiography as early as possible in their physical assessment.

Nuclear medicine studies assess the overall pumping efficiency of the heart and examine the possibility of inadequate blood flow to the heart muscle. Heart catheterization allows the arteries to the heart to be visualized with angiography (using dye inside of the blood vessels that can be seen using a chest X-ray). During catheterization the pressures in and around the heart can be measured and the heart’s performance properly assessed. In rare cases, a biopsy of the heart tissue may be recommended to diagnose for specific diseases. This biopsy can often be accomplished through the use of a special catheter device that is inserted into a vein and be maneuvered into the right side of the heart.

Another very helpful diagnostic test is a blood test called a BNP or B-type natriuretic peptid level. The levels found in this form of testing can vary with age and gender but is typically elevated from heart failure and can aid in the diagnosis, and can be very useful in following the response to treatment of congestive heart failure. The choice of tests depends on each patient’s individual case and is based on the suspected diagnoses.

If you think you may be experiencing any or all of these symptoms, these treatments may be right for your condition. If you live on or near Long Island, NY you can easily get the needed services for your condition at Dr.Kavesteen’s office.

What are the treatments of congestive heart failure?​

Lifestyle modifications

After congestive heart failure is diagnosed, treatment needs to be started immediately.

Probably the most important and yet often most neglected aspect of treatment involves lifestyle modifications. Sodium has been proven to cause an increase in fluid accumulation in the body’s tissues. Because the body is often congested with excess fluid, patients become very sensitive to the levels of sodium and water intake. Restricting the intake of salt and fluid is often recommended because of the tendency of fluid to accumulate in the lungs and surrounding tissues. An American “no salt added” diet can still contain 4 to 6 grams (4000 to 6000 milligrams) of sodium daily. In individuals with congestive heart failure, an intake of no more than 2 grams (2000 milligrams) of sodium per day is highly advised. Reading food labels and paying very close attention to total sodium intake is critically important. Severe restriction of alcohol consumption is  strongly recommended as well.

The total amount of fluids consumed must be regulated also. Although many people with congestive heart failure take diuretics to aid in the elimination of excess fluid, the action of these medications can be overwhelmed by an excess intake of water and any other fluids. The maxim that “drinking eight glasses of water a day is healthy” definitely does not apply to patients with congestive heart failure. In fact, patients who show a more advanced cases of congestive heart failure are often advised to limit their total daily fluid intake from all sources to only 2 quarts. The above guidelines for sodium and fluid intake may vary greatly depending on the severity of congestive heart failure in any given individual patient and should be discussed at length with their physician.

An important tool for monitoring an appropriate fluid balance is the frequent measurement of individual body weight. An early sign of fluid accumulation is an increase in overall body weight. This may occur even before shortness of breath or swelling in the legs and other body tissues (edema) symptoms are detected. A weight gain of 2 to 3 pounds over 2 to 3 days should prompt an immediate call to the physician, who may order an increase in the dose of diuretics or other methods designed to stop the early stages of fluid accumulation before it can become more severe.

Aerobic exercise has recently been shown to actually be beneficial in maintaining overall functional capacity, quality of life, and perhaps even improving patient survival, even though it was one known to be bad for the health of congestive heart failure patients. Each person’s body has its own unique ability to compensate for a failing heart. Even given the same degree of heart muscle weakness, individual patients may display widely varying degrees of limitation of function. Regular exercise, when tailored to each person’s tolerance level, appears to provide significant benefits and should be used only when the individual is compensated and stable.

Addressing the potentially reversible factors

Depending on the primary cause of congestive heart failure, potentially reversible factors should definitely be explored. Some examples are:

    • In certain persons whose congestive heart failure is caused by an inadequate blood flow to their heart muscle, restoration of the blood flow through coronary artery surgery or catheter procedures (angioplasty, intracoronary stenting) may be considered.
    • Congestive heart failure that is due to severe disease of the valves may be alleviated by valve surgery in certain appropriate patients.
    • When congestive heart failure is caused by chronic, uncontrolled high blood pressure (hypertension), aggressive blood pressure control will often improve this condition.
    • Heart muscle weakness that is due to longstanding, severe alcohol abuse can improve significantly with an abstinence from drinking any alcohol.
    • Congestive heart failure that is caused by other disease states may be similarly partially or completely reversible with appropriate measures.

Dr.Kavesteen’s office is the right place to go for advice and treatments on any cardiology issues that you may be suffering from. If you are living on Long Island, he has four convenient locations and a mobile medical unit for you in Plainview, North Babylon, Massapequa, and Middle Island.

by a Doctor on 10/8/2013 and 6/9/2014.

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