Congestive Heart Failure
An increasing number of people now live with congestive heart failure. This serious condition requires long-term treatment. Medical research is now keeping pace with a steady supply of new treatment breakthroughs.
What is congestive heart failure?
Congestive heart failure (CHF) is a chronic condition in which the heart loses its ability to pump efficiently. It develops when disease weakens the heart muscle or when the valves that control blood flow out of the heart close improperly. Because each heartbeat now pumps out less blood, the oxygen-depleted blood returning to the heart from the rest of the body backs up, collecting in the lungs and leaking into tissues. Many symptoms of CHF result from this fluid buildup. The underlying cause, however, is usually heart disease, high blood pressure, diabetes, or an abnormal heart rhythm. Untreated CHF can cause body systems to shut down.
Congestive heart failure is most common on the left side of the heart, which receives freshly oxygenated blood from the lungs and does most of the work to pump it out to your organs, but it can also occur on the right side, which receives oxygen-depleted blood and sends it to the lungs to be reoxygenated. Because the two sides are codependent, failure on one side usually leads to failure on the other.
Who is at risk for congestive heart failure?
You are at greater risk if you:
- Are over age 70. People over age 70 have a 10 percent chance of experiencing heart failure.
- Are of African descent. Your risk is 25 percent higher than that of Caucasians.
- Have high blood pressure, which doubles your risk of congestive heart failure.
- Have had a heart attack, which puts you at five times greater risk.
- Have a family history of early heart failure caused by diseases that damage the heart.
- Are sedentary.
- Drink too much alcohol.
Treatment for congestive heart failure
As frightening as the phrase “heart failure” might sound, restoring the heart’s ability to pump efficiently is a fairly simple process. Once you are feeling better, the main task will be to determine why your heart started to perform poorly in the first place. The cause may have nothing to do with your heart: It may be the result of another ailment (such as diabetes, emphysema, thyroid disease, alcohol abuse, sleep apnea, anemia) or the use of certain medications (including muscle-enhancing steroids).
But if your episode of congestive heart failure is like most people’s—a consequence of an existing cardiac condition—you’ll need to work with your doctor to deal with the underlying ailment. The ultimate goal is to allow you to resume your normal activities while preventing a heart attack, stroke, or other complication down the road.
To treat congestive heart failure, your doctor will probably begin by prescribing medicines to expel fluids from your tissues, open your blood vessels, and strengthen your heart. The earlier you start such a regimen, the better your long-term outlook. Portable pumps and other technological advances are revolutionizing treatment for CHF. Such devices can ease your symptoms and they may reverse some of the damage to your heart, forestalling the need for a heart transplant. Lifestyle measures, from relaxation to exercise, are also important for anyone with CHF.
Medications for congestive heart failure
If you’ve been diagnosed with congestive heart failure, your doctor will probably prescribe a host of medicines to get the condition under control. These drugs are often remarkably effective in making you feel better quickly and can reduce your risk of complications if taken long-term. You may not have to be on medications forever: That depends on how well you respond and how reversible your heart damage is.
First on the list is a broad group of drugs known as diuretics. Commonly called “water pills,” they help your body get rid of excess fluids that can build up in your legs, lungs, and belly during congestive heart failure. That relieves such symptoms as cough, swelling, and shortness of breath. Less fluid allows your heart to pump more easily. You may receive one or more of these drugs: spironolactone (Aldactone), hydrochlorothiazide (HydroDiuril), and/or the extra-potent furosemide (Lasix). Your doctor will gradually adjust your dose to promote optimal fluid loss and periodically monitor you for such side effects as fatigue or irregular heart rhythms.
Diuretics are usually used along with angiotensin-converting enzyme (ACE) inhibitors, such as captopril (Capoten), ramipril (Altace), or lisinopril (Privinil, Zestril). By opening up blood vessels, these drugs lower your blood pressure and reduce strain on your heart. Unfortunately, studies show, ACE inhibitors are under-prescribed. That’s partly due to worries about side effects, including a persistent dry hack that’s the infamous "ACE-inhibitor cough." If you can’t tolerate ACE inhibitors, you may get similar benefits from the more expensive angiotensin-receptor blockers, such as losartan (Cozaar, Hyzaar) and valsartan (Diovan), which have fewer side effects, or from vasodilators such as hydralazine or nitrates.
Once you’re stabilized on diuretics and ACE inhibitors, beta-blockers, which slow the heart down and make the pumping action easier, may prove a useful addition to the mix. Researchers are finding that beta-blockers, which also lower blood pressure and normalize rhythm, can be quite beneficial in strengthening the heart, as they lessen symptoms and help prolong survival in people with heart failure. Studies show these drugs reduce the chance of rehospitalization and even death due to congestive heart failure. Commonly prescribed beta-blockers include carvedilol (Coreg) and metoprolol (Lopressor, Toprol). Your doctor will have to monitor you closely at first: In rare cases, these drugs worsen heart failure or cause nightmares, depression, fatigue, or other annoying side effects. Interestingly, beta-blockers may work better for whites than for African-Americans.
Digitalis drugs, such as digoxin (Lanoxin), might be useful for those who don’t respond to other medications. Also called glycosides, these drugs strengthen the heartbeat and increase blood flow to the kidneys, promoting fluid removal. Your doctor will check regularly for irregular heartbeats, digestive upset, visual disturbances, and other harmful side effects.
Other drugs used for congestive heart failure include injectable vasodilators for emergency situations, amiodarone (Cardarone) for irregular heartbeats, and lung-strengthening asthma drugs.
Simple changes can improve your quality of life and help you stay out of the hospital.
- Go easy on the salt. Aim for 2,000 mg or less of sodium a day. Too much salt makes the body retain fluids, and that raises your blood pressure. Salt also causes small blood vessels to constrict.
- Exercise. Once actively discouraged for those with heart failure, a moderate exercise program has proven beneficial for many with CHF. A few minutes of walking or light weights, two to five times a week, may be all it takes. Be sure to consult your doctor before starting any type of exercise program.
- Seek support. People who are married or who have a strong social network generally fare much better than those who go it alone. Try to cultivate friendships and join a local support group.
- Practice stress-reduction techniques. Yoga, progressive muscle relaxation, or meditation have all proven effective. They lower blood pressure and provide other cardiac benefits, too.
Related Procedures for Congestive Heart Failure
If your congestive heart failure worsens and medications no longer relieve your symptoms, a heart transplant or other procedure may be in order.
Heart transplants are usually reserved for those with severe disease marked by discomfort with any physical exertion and overt symptoms even at rest. A candidate for a transplant should generally have no other major illness and be younger than age 60 (although success has been achieved in older persons). With surgical advances, 85% of transplant recipients are now alive after one year, and 65% survive more than five years.
Due to a shortage of organs, many very sick patients must wait months for a suitable donor heart. However, a growing array of heart-stabilizing devices has proven useful as a “bridge to transplant” in these people. A left-ventricular assist device (LVAD), for example, is implanted in the chest or abdomen to take over the action of the left ventricle, the heart’s main pumping chamber. (Some examples of these devices include the HeartMate, Thoratec, and Novacor.) Sometimes an LVAD allows the failing heart to recover, improving symptoms so much that a transplant is no longer necessary.
Another type of device, the biventricular pacemaker (such as the InSync system), is designed for the up to 50% or so of congestive heart failure sufferers whose left and right ventricles don’t work together. This small device is implanted under the shoulder, with wire leads that deliver electrical signals to both sides of the heart. Patients who receive one generally show improved quality of life, are able to walk longer distances, and spend half as many days in the hospital as those without a pacemaker. There is also growing interest in the implantable cardioverter-defibrillator (ICD) as a treatment for potentially fatal heart rhythms in those with heart failure.
Despite bleeding, blood clots, infections, and other complications, these and related devices are increasingly becoming end treatments in themselves, eliminating the need for a transplant.
Alternative Therapies for Congestive Heart Failure
A few small studies indicate that the amino acids taurine (500 mg L-taurine twice a day) or arginine (1,000 mg twice a day) may offer some therapeutic benefits for those with congestive heart failure. Along with coenzyme Q10 (100 mg twice a day) other supplements have been proposed for treatment. Large studies of these substances are lacking, however, and none can cure heart failure. A healthy diet, rich in whole grains, fish, olive oil, and fresh fruits and vegetables, is always a good strategy.
Questions for Your Doctor
- What was the actual cause of my congestive heart failure? Is there anything I can do to keep it from getting worse?
- What damage has been done to my heart? How long will I need to stay on medications?
- Would a pacemaker help my condition?
- Am I a good candidate for a heart transplant?
Living with Congestive Heart Failure
If you have CHF, here are some quick tips to help you take control of it:
- See a heart specialist (cardiologist). Nonspecialist doctors are less likely to prescribe ACE inhibitors and other useful medicines, possibly because of misplaced concerns about side effects.
- Weigh yourself daily. Gaining more than three pounds in a week may mean you’re retaining fluids; your doctor may need to change your medications or up your dose. Rapid weight loss (10 to 15 pounds over six months) may signal a serious problem.
- Be careful of NSAIDs, such as aspirin, ibuprofen (Advil), and naproxen (Aleve). If you have CHF, these common pain relievers may increase the risk for relapse. Check with your doctor before using these over-the-counter drugs.
- Watch it in the winter. Surveys show that people with heart failure show up in emergency rooms more often during the winter months. That’s probably a result of strenuous activities like shoveling snow. Other bad times: Mondays or any day between 8 am to 3 pm.
- Avoid overheating. Warm baths (up to 106°F) and saunas (up to 140°F), once considered taboo for those with congestive heart failure, may actually offer benefits, provided you limit your exposure to 10 minutes or so. Check with your doctor. Never soak or sit in a sauna without letting someone know.
- Monitor your symptoms. If your skin suddenly becomes clammy and pale, your breathing is laboured, or your symptoms rapidly worsen, go to an emergency room immediately.
Prevention of congestive heart failure
- Reduce salt. It causes your body to retain fluids, so limit your intake to less than 4 to 6 grams a day.
- Limit alcohol. Drink no more than one alcoholic beverage a day. Excessive alcohol consumption can reduce your heart’s pumping ability.
- Get going. Exercise helps prevent congestive heart failure. And while it was once forbidden for those with CHF, studies show that moderate exercise strengthens your heart. Talk to your doctor before starting.
- De-stress. Reducing stress may lower the levels of certain hormones in your body that can have a negative impact on your immune system and heart. Try yoga, tai chi, guided visualization, or meditation.
- Step on the scale. If you’re already taking medication for CHF, weigh yourself daily before breakfast (after you’ve urinated). If you suddenly gain more than two pounds, you may be accumulating fluids. Call your doctor immediately.
- Ask for help. If you live alone or lack support at home, you’re at greater risk for readmission to the hospital or death from uncontrolled CHF. Many hospitals offer follow-up programs to help you make positive lifestyle changes and take your medications as directed.
Adapted from Looking After Your Body: An Owner's Guide to Successful Aging, Reader's Digest; Know Yo