Congestive heart failure (patient information)

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Congestive heart failure

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

Diseases with similar symptoms

Diagnosis

When to seek urgent medical care?

Treatment options

Where to find medical care for Congestive heart failure?

Prevention

What to expect (Outlook/Prognosis)?

Congestive heart failure On the Web

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Directions to Hospitals Treating Congestive heart failure

Risk calculators and risk factors for Congestive heart failure

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview

Heart failure is a clinical syndrome in which the heart can not pump enough blood throughout the body. It can be caused by many types of cardiovascular diseases, such as coronary artery disease, hypertension, diabetes, valve heart diseases and endocrine diseases. Usual signs and symptoms include blood and fluid to back up into the lungs, edema in the feet, ankles and legs, tiredness and shortness of breath. Patient's symptoms, echocardiogram and cardiac MRI can be evidence to assess the heart function. Treatments include treating the underlying cause of your heart failure, medicines, percutaneous coronary intervention, left ventricular assist device (LVAD) and heart transplantation. The prognosis of heart failure varies widely. It depends on the cause of heart failure, left ventricular ejection fraction and the duration of the disease.

What are the symptoms of Congestive heart failure?

  • Early cases of heart failure do not have any symptoms.
  • Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

What causes Congestive heart failure?

  • Heart failure is a long-term (chronic) condition, but it can sometimes develop suddenly.
  • The condition may affect only the right side or only the left side of the heart. These are called right-sided heart failure or left-sided heart failure. More often, both sides of the heart are involved.
  • Heart failure is present when:
  • Both of these problems mean the heart is no longer able to pump enough oxygen-rich blood out to the rest of your body, especially when you exercise or are active.
  • The most common cause of heart failure is coronary artery disease (CAD), a narrowing of the small blood vessels that supply blood and oxygen to the heart.
  • Heart failure can also occur when an infection weakens the heart muscle. This condition is called cardiomyopathy.
  • Other heart problems that may cause heart failure are:
  • Other diseases that can cause or contribute to heart failure:

Who is at highest risk?

Certain factors increase your risk of getting heart disease, then increase your risk of getting heart failure. You are at a higher risk if you are:

Diseases with similar symptoms

There are a variety of diseases that cause shortness of breath, most of them lung diseases like asthma or chronic obstructive pulmonary disease.

Diagnosis

  • Electrocardiogram: This is a simple and painless test that records the heart's electrical activity. It is needed to detect your primary cardiac diseases.
  • Cardiac MRI (magnetic resonance imaging): Cardiac MRI can create both still and moving pictures of the heart and major blood vessels. It can help doctors analyze the structure and function of the heart and decide the treatment protocols for the patient.

When to seek urgent medical care?

Patients with early heart failure can compensate. With the disease developing, the heart function decompensate and patients demonstrate a series of signs and symptoms. Call your health care provider if symptoms of heart failure develops. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:

Treatment

General Measures:

Because heart failure is a clinical syndrome that is the end result of multiple heart diseases, the following measures are important:

Medications:

  • Beta blockers: Beta blockers can reduce heart rate which will lower the myocardial energy expenditure and then prolong the diastolic filling and lengthen coronary perfusion. It can also improve the ejection fraction of the heart and decrease the toxicity of catecholamines on the myocardium. Clinical trials show Bisoprolol, Carvedilol and sustained-release Metoprolol are specifically indicated as adjuncts to standard ACE inhibitor and diuretic therapy in congestive heart failure. Patients with asthma, severe conduction block or severe heart failure may not be appropriate candidates for beta blocker therapy.
  • Digitalis: Digitalis can strengthen the contractility of the heart. But because the pharmacokinetics of digoxin are complex, and the toxic levels are only slightly higher than therapeutic levels, digoxin should be used judiciously under the close supervision of a cardiologist.

Percutaneous coronary intervention (PCI):

Coronary artery disease (CAD) and impaired blood flow to the heart is one of the main causes of heart failure. Removing the blockages in the coronary arteries can improve overall heart function, which may improve or resolve heart failure symptoms. The procedure is usually performed in the cardiac catherization lab. A catheter, a very small tube with a tiny deflated balloon on the end, is inserted through an incision in the groin area and pushed through to the diseased artery. Then the balloon is inflated to push open the artery. The balloon is removed once the artery has been fully opened. A stent may be placed during the procedure to keep the blood vessel open. Clinical trials have demonstrated that percutaneous coronary intervention (PCI) is a very effective and safe procedure to reopen blocked vessels and can improve a patient's symptoms.

Left ventricular assist device (LVAD):

The left ventricular assist device (LVAD) is a mechanical pump-type device that can help maintain the pumping ability of a heart unable to effectively work on its own. One typical type of LVAD will have a tube going into the left ventricle that pulls blood from the ventricle into a pump. The pump then ejects blood into the aorta. LVADs are typically used for weeks to months as a "bridge" to more definitive therapy rather than a final or "destination" therapy.

Heart transplantation

Heart transplant may be the only effective treatment option for patients with severe, progressive heart failure that can not be helped by medications, dietary and lifestyle changes. During a heart transplant procedure, the surgeons connect the patient to a heart-lung machine, which takes over the functions of the heart and lungs. Then the surgeons remove the diseased heart and replace it with the donor heart. Finally, the major blood vessels are reconnected and the new heart is ready to work. The outlook for people with heart transplants is good during the first few years after the transplant. Over 85 percent of patients live for more than a year after their operations.

Medications to avoid

Patients diagnosed with congestive heart failure should avoid using the following medications:


Patients diagnosed with NYHA Class III or IV heart failure should avoid using the following medications:

  • Pioglitazone
  • Rosiglitazone
  • Finogolimod
    If you have been diagnosed with NYHA Class III or IV heart failure, consult your physician before starting or stopping any of these medications.


Patients diagnosed with Overt cardiac failure should avoid using the following medications:

  • Atenolol
  • Labetalol
    If you have been diagnosed with Overt cardiac failure, consult your physician before starting or stopping any of these medications.


Patients diagnosed with Decompensated cardiac failure should avoid using the following medications:

  • Esmolol
  • Fingolimod
    If you have been diagnosed with Decompensated cardiac failure, consult your physician before starting or stopping any of these medications.

Patients diagnosed with Progressive cardiac failure should avoid using the following medications:

  • Mannitol
    If you have been diagnosed with Progressive cardiac failure, consult your physician before starting or stopping any of these medications.


Where to find medical care for Congestive heart failure?

Directions to Hospitals Treating Congestive heart failure

Prevention of Congestive heart failure

Heart failure is a terminal syndrome of heart diseases. And heart disease is the leading cause of the death and a major cause of disability in the U.S. Cardiologists have verified there are many things you can do reduce your chances of getting heart disease. Keeping track of symptoms and reporting any changes that concern you to your healthcare professonal and working more closely with your healthcare team.

  • Monitoring your blood pressure
  • Exercise regularly
  • Quitting smoking
  • Checked for diabetes and if you have it, keep it under control
  • Know your cholesterol and triglyceride levels and keep them under control
  • Eat a lot of fruits and vegetables
  • Maintain a healthy weight
  • Managing stress

What to expect (Outlook/Prognosis)?

The prognosis of people with heart failure can vary dramatically. The following factors may help the doctor estimate the prognosis.

  • The severity of the symptoms: It is well established that patients who have more severe symptoms of heart failure do not survive as long as those who have mild symptoms. For example, patients with class IV heart failure have the poorest prognosis, while patients with class I have the best.
  • The causes of heart failure: Heart failure associated with alcohol use or pregnancy may spontaneously recover itself over time. Heart failure can be caused by treatable conditions such as hyperthyroidism or hypothyroidism, anemia, or vitamin deficiency. The prognosis of these conditions are generally excellent. Heart failure as a result of a valve condition may also be reversible if the valve problem is recognized early and fixed before permanent damage happens. People with heart failure caused by severe hypertension may see considerable improvement of their symptoms when they control their hypertension. But the majority of patients have heart failure as a result of coronary artery disease (CAD) have a worse prognosis and a higher death rate than people who have heart failure that is not a result of CAD.
  • How long you've had heart failure: There is no specific length of time after which your heart function is unlikely to improve. General speaking, the longer you have had heart failure, the poorer prognosis may be even with appropriate treatment.
  • Compensatory factors: "compensatory factors" are various adjustments to correct the effects of heart failure on other organs. When heart failure occurs, various hormone levels including renin, aldosterone, norepinephrine, atrial natriuretic peptide, and prostaglandin, may increase. Increases in these hormonal factors and other compensatory factors often make heart failure worse over time.

Resource

MedlinePlus

References



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