How do we know when we have heart failure? This condition could be in its early stage that the individual may not even have enough symptoms to know he/she has it. And if there are symptoms, even moderate to severe, the diagnosis usually eludes a lay person. In the United States alone, there are about 5.1 million persons who have heart failure today.
What is heart failure?
Heart failure, also known as congestive heart failure (CHF), refers to a condition where the heart muscles become too weak to pump enough blood to satisfy the body’s needs. There are two main ventricles of the heart responsible for pumping blood, the right and left ventricles. The right ventricle pumps used blood back to the lungs for oxygenation; the left pumps oxygenated blood from the lungs to the entire body. CHF does not mean the heart is about to stop or to have a heart attack. It simply means the heart muscles (usually both the right and left) have been weakened and need help.
What causes heart failure?
The following can cause CHF: Coronary heart disease (with blockage of the arteries supplying oxygen and nutrition to the muscles of the heart), actual heart attack, high blood pressure and diseased heart valves (both increase the work of the heart), cardiomyopathy (either due to alcohol abuse, toxic agents, cocaine, and other illegal drugs, or radiation, chemotherapy), viral myocarditis, congenital heart defects, diabetes, thyroid or kidney diseases, blood clots in the lungs, HIV/AIDS, or even vitamin B deficiency (beri-beri) in very poor regions of the world where malnutrition is rampant. Too much vitamin E has been reported to also contribute to heart failure. And so with obesity, which makes the heart work more.
Does sleep apnea cause heart disease?
Obstructive Sleep Apnea (OSA), breath-holding for prolonged and repeated periods while asleep, especially among those who snore, significantly contributes to increased risk for heart attack, high blood pressure (eventually to heart failure), stroke, diabetes, and even cancer. Sleep apnea deprives the person of vital oxygen and the episodes could occur dozens of times in a minute, leading to hypoxia (seriously low level of oxygen), which is bad for all organs. Sudden deaths from sleep apnea have been reported. Once diagnosis is established by a Sleep Study, the primary treatment is the use of CPAP (Continuous Positive Airway Pressure) machine during sleep for life. This could prevent premature deaths.
What are the signs and symptoms of CHF?
These usually include shortness of breath, especially when they lie flat (with impairment of sleep as a result), dry hacking cough or wheezing, distended neck veins, extreme fatigue, leg swelling, ascites (abdominal fluid formation from swollen liver and other organs), and in severe cases, anasarca (total body swelling), bloating stomach, poor urine output, and weight gain from retained fluid. The nail beds and tips of finger might be bluish from lack of oxygen. Loss of appetite and nausea, dizziness, and rapid or irregular heart beats may also be present.
How is the diagnosis made?
The physician can make the diagnosis clinically after interviewing and examining the patient. Laboratory tests may include: comprehensive blood chemistry, including thyroid functions, EKG, stress test, chest X-ray, BNP or NTpro (blood test to confirm heart failure), echocardiography, Doppler Ultrasound, nuclear heart scan, cardiac MRI, and cardiac catheterization/coronary angiogram. Any of them may also be used as needed.
Is there a cure for CHF?
In general, heart failure has no cure. The exception is if the CHF is caused by coronary heart blockage or heart valve disease, then surgery could dramatically tame the heart failure. Basically, the regimen is aimed at managing the associated diseases and the symptoms to make the patient comfortable, improve quality of life and allow the patient to be active again, or even productive once more. The role of prevention is essential.
What is the treatment?
While curing to the point of heart normalcy is not achievable today, the main aim of the therapy is to improve the quality of life and endurance of the patient. The strategy includes treating the primary cause and the contributing illnesses (those listed above); adopting a low-salt diet; taking specific medications to eliminate the excess fluid in the body; and minimizing the cardiac and lung overload, lessening the work of the heart and boosting the strength of the heart muscles and improve overall cardiac output. Sleeping with the upper part of the body on several pillows elevated or elevating the head of the bed helps the patient breath better. Bed rest and oxygen are prescribed as needed.
What are the medications used?
Among the medications used in various combinations, according to the patient’s condition, are diuretics (water fills), angiotensin receptor blockers and Isosorbide dinitrate/hydralazine (to relax blood vessels abd lower blood pressure and workload of the heart), ACE inhibitors (to reduce strain on the heart), Aldosterone antagonists (to eliminate salt and water through urination), beta blockers to slow heart rate and blood pressure to minimize the work of the failing heart), and digitalis to help the weakened ventricles.
What is the role of prevention?
Avoidance of the causes, if possible, is obviously the key. Abstinence from cigarettes, alcohol, and other toxic agents, low-salt diet (since salt intake makes the body retain fluids and increases blood pressure), fluid restriction, compliance with medications, regular medical follow-up, and shifting to a healthy lifestyle would greatly help. The patient and family members may also benefit from professional counseling to reduce the fear, anxiety, stress, depression that could adversely affect all of them. Joining a patient support group of peers could provide emotional support and help the patient adjust to his life with heart failure.
Does surgery have a role?
As stated above, coronary bypass to correct the heart blockages and prevent heart attack, and surgery to repair diseased heart valves, can significantly improve cardiac recovery. But as heart failure worsens, the standard treatment outlined above may no longer help. If the patient’s heart rhythm is disrupted, a cardiac pacemaker may be installed. For life-threatening arrythmias, an automatic implantable cardioverter defibrillator (AICD) may be implanted. Left ventricular restoration/remodeling, mechanical pump called left ventricular assist device, or even heart transplant, when the patient is deemed a qualified candidate for any of those procedures, may be done as a life-saving measure for end-stage heart failure where all other treatments have failed.
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
