What is Congestive Heart Failure?
Millions of people have some form Cardiovascular disease (CVD). One major form of CVD is Congestive Heart Failure (CHF) and kills up to 300,000 people each year in the United States. Congestive Heart Failure is when the heart is not able to pump adequate amounts of blood throughout the body. This could be due to the supply of blood to the heart, contraction of the heart, of the resistance of blood flow to the heart. This loss in the heart’s pumping ability can cause many symptoms, such as shortness of breath, fatigue, and most importantly fluid backup in the lungs and edema in the feet, ankles and legs.
What are some Signs and Symptoms?
There are many signs and symptoms of Congestive Heart Failure. One of the most important S&S is persistent coughing along with shortness of breath, also known as dyspnea. One can cough up pink blood tinted mucus, or have trouble breathing while lying flat on their back. This occurs due to the blood “backing up” in the pulmonary veins returing blood to the left ventricle of the heart. The heart is not able to keep up with the returning supply of blood, causing fluid to leak into the lungs. As the blood flow to the body slows down, the blood returning to the heart through the veins also backs up causing fluid retention in the tissues, also known as edema. One compensatory mechanism to rid the body of the excess fluid is the kidneys to dispose of sodium and water. With Congestive Heart Failure, the kidneys are not able to recieve adequate amounts of blood for filtration, so they are less capable of disposing of sodium. The problem with this is that where sodium goes, water flows. When sodium cannot be filtrated, more fluid retention occurs in the tissues. This can also result in renal failure.
Other signs and symptoms include fatigue as well as increase in one’s heart rate. Fatigue is due to the body diverting blood to more important organs of the body, such as the heart and the brain. Less blood flow to the other extremeties of the body results in lactic acid to buildup in the muscles and limbs. Lactic acid therefore results in fatigue and and weakness of the muscles.
The increase in heart rate is a compensatory mechanism of the heart. Since less blood is being pumped and distributed throughout the body, the heart tends to beat faster. This can cause chest pain and hypertension.
Lifestyle changes:
It is important for people with Congestive Heart Failure to make daily lifestyle changes and to seek a healthcare professional for the right medications. Some lifestyle changes that could drastically decrease symptoms of CHF would be:
-Avoid alcohol consumption
-Avoid smoking
-Engage in physical activity
-Wathcing food intake
-limit foods high in sodium, cholesterol, and trans fats
-Monitor your blood pressure daily
-Monitor/maintain one’s weight
Do medications really work?
Along with daily lifestyle changes, one’s healthcare physician will also most likely prescribe medications to help with the chronic Congestive Heart Failure. Most people will be on these medications the rest of their lives. Some of these medications include Diuretics, Positive Inotropic Drugs, and ACE inhibitors.
Diuretics increase the rate of urine formation. They allow the kidneys to prevent sodium reabsorption, decreasing water absorption, decreasing blood volume. This decrease in blood volume allows the body to control blood pressure by decreasing the preload (volume) returing to the heart. Diuretics can drastically help with pulmonary edema and peripheral edema, two major S&S of CHF. Diuretics are usually given with other Heart Failure drugs, such as Digoxin.
Digoxin is a Positive Inotropic Drug that increases the contractility of the heart. When given with Diuretics, the diuretics decrease the supply of blood to the heart while Digoxin increases the contraction and dispensing of blood throughout the body. Sounds like the perfect pair right? No, one major problem with prescribing both these drugs for CHF is the risk of Hypokalemia (too low potassium in blood). Hypokalemia is a very serious side effect that can cause nausea, vomitting, and most importantly cardiac dysrhythmias. Either a potassium supplement will be prescribed or a Potassium-Sparing Diuretic will be prescribed along with the Digoxin to reduce the fatal chances Digoxin Toxicity.
One more class of drug that is popularly prescribed for CHF would be ACE inhibitors. ACE inhibitors lower one’s blood pressure by decreasing blood volume and preload to the heart. They work this way by inhibiting the hormone aldosterone (hormone used by body to hold onto sodium) allowing the kidneys to rid of sodium and water reducing the risk of high blood pressure, pulmonary and peripheral edema.
More people need to realize the major risks that can be fatal when one has Congestive Heart Failure. Even if one does not have CHF, daily lifestyle changes can reduce the risk of getting CHF in the future. Daily lifestyle changes and medications can alleviate symptoms, slow down the progression of the disease, and improve one’s heart and overall body function. Seek healthcare professional help if you have any doubt in the function of your heart, or if you have any of the Signs and Symptoms listed earlier. Better to be safe than sorry.
References:
Well this was a good post. However I would like to add some additional info about medications for CHF. Depending on the degree of CHF, other diuretics can be used in combination with furosemide to counteract potassium losses. Agents that reduce afterload, such as captopril or enalapril and beta-blockers, have recently been employed to further manage severe CHF.
Also I would have further addressed the SEs of the ACE inhibitors..there is a large incidence of non-compliance for people put on ACE inhibitors because they develope a dry, persistant cough that begins to impede their sleep, interfere with their abilities to maintain a conversation, and even make it hard for them to eat and drink.
I have been a nurse for 19yrs and have seen many pt’s debilitated with CHF. It is a very complex disease and affects a person in so many ways. Very few patients are able to grasp the concept of the disease because it is so hard to understand in the literature that they are able to find in medical books and on the internet. This article is easy to read and easy to understand because it is put into terms that the non-medical person can grasp. It is very informative and makes the person understand what they can do to help themselves.
Very good point Jess. Some other side effects that can occur with ACE inhibitors are first does hypotension, tachycardia, angioedema, and that hard cough that affects a good 25% of patients on an ACE inhibitor. I would also like to mention that a woman who is pregnant or is planning on getting pregnant should be informed by her physician of the high risks of miscarriages and Fetal abnormalities.
Another drug given for CHF wold be Angiotension Receptor BLockers of ARB’s. These drugs have less side effects and do not leave a presence of a dry persistent cough or angioedema. ARB’s may present a headache, back pain, nasal congestion, and fetal abnormalities, but are less physical threatening than an ACE inhibitor
It seems like CHF would be the type of disease that many people don’t get treated for until it has progressed pretty far. The symptoms sound like the types of things a person might attribute to other sources like stress, overwork or poor eating habits and just ignore it or try to correct with their daily habits. Is it common for patients to not get treated for this disease until it is in more advanced stages?
Hey TK!
To answer your question, it is actually very common for the disease to be in more advanced stages before treatment is received.
It is also common that a person could have minimal signs and symptoms of the disease and not really think much of it but then a life-threatening cardiac event (like a heart attack or stroke) before receiving treatment for heart problems.
That is why a yearly doctor visitation is so important, especially in people over 40 and with a family history of heart disease.
Even if someone thinks they are completely healthy and have no cardiac problems, it is better to be safe and get checked out regularly than risk having a life-threatening cardiac event!
I am a nurse and have taken care of many patients with CHF. I have found that one of the most important jobs of the nurse is to teach the patient and their family members about the medications for CHF. Furosemide, digoxin, metoprolol and others are very strong medications and the family needs to know how to give them, what are the side effects, and when to call the doctor. I once saw a patient come to the hospital with a pulse in the 30′s whose daughter was giving him 5 digoxin tablets a day because she thought that was the right dose. It was a totally uninformed medication error that almost caused her father his life.