Heart Failure

Heart failure interferes with the kidneys’ normal function of eliminating excess sodium and waste from the body. In congestive heart failure, the body retains more fluid, resulting in swollen ankles and legs. Fluid also collects in the lungs, resulting in shortness of breath. Heart failure may affect either the right ventricle, which pumps blood into the lungs for oxygenation, or the left ventricle, which pumps oxygenated blood to the body’s tissues. In either case, the ventricle may not contract strongly enough to expel most of the blood it holds, or it may be too stiff to relax adequately between contractions and thus won’t fill completely. It is usually a symptom or result of one or more of the following conditions:

• Heart valve disease, which may be caused by past rheumatic fever or other infections
• High blood pressure (hypertension)
• Infections of the heart valves and/or heart muscle
• Previous heart attack(s) resulting in scar tissue that may interfere with the heart muscle’s ability to work normally
• Coronary artery disease—narrowed arteries that supply blood to the heart muscle
• Cardiomyopathy or another primary disease of the heart muscle
• Cardiac arrhythmias (irregular heartbeats)
• Chronic lung disease and pulmonary embolism
• Heart-muscle damage caused by certain drugs, including doxirubicin used in treating breast cancer
• Excessive sodium intake
• Hemorrhage and anemia
• Diabetes
• Peripartum cardiomyopathy. In rare instances, and for unexplained reasons, women may suffer heart failure in the month before or within a few months after giving birth. If treated promptly, the condition can be reversed, but has a high risk of recurrence in future pregnancies.

Symptoms of Heart Failure

The symptoms of heart failure vary according to the severity of the disease and may resemble other conditions or medical problems. They usually include one or more of the following:

• Shortness of breath during rest, exercise or lying flat
• Weight gain
• Swollen legs and ankles, and, occasionally, the abdomen
• Fatigue and weakness
• Loss of appetite and nausea
• Persistent cough, which often produces mucus or blood-tinged sputum
• Reduced urination

Diagnosing Heart Failure

In addition to a complete medical history and physical examination, a combination of any of the following may be used to determine whether symptoms are due to heart failure:

• Chest x-ray
• Echocardiogram
• Electrocardiogram (ECG or EKG)—a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias) and detects heart muscle damage
• BNP testing. B-type natriuretic peptide (BNP) is a hormone released from the ventricles in response to increased wall tension (stress) that occurs with heart failure. BNP levels rise as wall stress increases. BNP levels are useful in the rapid evaluation of heart failure. The higher the BNP levels, the worse the heart failure.

Treating Heart Failure

Therapy for heart failure is designed to reduce symptoms and forestall the progress of the disease. It may include:

• Controlling risk factors, including losing weight, restricting salt and fat from the diet, stopping smoking, abstaining from alcohol, getting proper rest, keeping blood sugar levels under control and limiting fluids
• Angiotensin-converting enzyme (ACE) inhibitors to decrease the pressure inside the blood vessels, or angiotensin II receptor blockers if ACE inhibitors are not tolerated
• Diuretics to reduce the amount of fluid in the body
• Vasodilators to relax the blood vessels and reduce workload on the heart
• Digitalis to increase heart strength and control rhythm problems
• Inotropic drugs, which increase the pumping action of the heart
• Antiarrhythmia medications to keep the rhythm regular and prevent sudden cardiac death
• Beta-blockers to reduce the heart’s tendency to beat faster by blocking specific receptors on the cells that make up the heart
• Aldosterone blockers to stop the effects of aldosterone, which causes sodium and water retention
• Biventricular pacing/cardiac resynchronization therapy, which paces both sides of the heart simultaneously to coordinate contractions and improve pumping ability
• Implantable cardioverter defibrillator—a device similar to a pacemaker that senses when the heart is beating too fast and delivers an electrical shock to convert the fast rhythm to a normal rhythm
• Ventricular assist devices (VADs)
• Heart transplantation

Nutrition and Prevention

Reference these links for information on how to prevent heart disease and how to live a healthy lifestyle.

• Lifestyle Changes
• Exercise
• Healthy Diet
• Reduce Stress
• Stop Smoking
• Healthy Cholesterol Levels
• Reduce Sodium