Congestive Heart Failure

Causes of Congestive Heart Failure

The normal heart is usually able to meet any temporary extra demand by
simply beating faster and more vigorously. Jogging, swimming and other
physical exercise, for example, create extra burdens that any healthy
heart can respond to immediately and with ease. The danger arises when
a burden becomes continuous or excessive, as in cases of sustained high
blood pressure (hypertension), where the effort to keep pushing blood
through inelastic blood vessels so overtaxes the heart that it begins
to fail. Any local insult to the muscle of the heart, such as would
result from a blockage in a coronary artery (a heart attack), can
weaken the strength of the heart’s contraction and thus produce heart
failure. Heart failure can also result from damage or a structural
change in one of the heart valves, which may have been caused by
rheumatic fever or a bacterial infection and may lead to internal
obstruction or to valvular leakage. Even disorders that are not
directly related to cardiac function can result in heart failure. A
case in point is severe anemia, a problem that decreases the blood’s
oxygen supply and may dangerously overwork the heart by forcing it to
circulate under-oxygenated blood around the body at an increasingly
exhausting pace. Severe vitamin B deficiency has also been implicated
in heart failure, as has a hyperactive thyroid. In an already weakened
heart, chronic infection with recurrent fever may also produce heart
failure.

Symptoms of Congestive Heart Failure

As the heart’s pumping action grows weaker, blood no longer circulates
in an adequate flow to the body’s major systems. The result is a series
of increasingly debilitating symptoms, many of which seem to have
little to do with heart disease. Some problems originate in the brain,
where the body’s respiratory centers, lacking adequate oxygen, begin
malfunctioning. The kidneys, too, may no longer effectively filter
excess fluid out of the blood. Or the fault may be with the damaged
heart itself, which is unable to move the now increasingly waterlogged
blood at its usual brisk pace through the circulatory system.
Consequently, the water begins backing up into the lungs, liver and
tissues of other organs, producing one of the most telltale signs of
heart failure–congestion. This is why physicians often refer to the
disorder as congestive heart failure. Its most common symptoms include:

Shortness of breath. Medically, this symptom is known as
dyspnea, and it is often the earliest warning signal of heart failure.
Usually, it appears gradually. In fact, the patient rarely notices it,
until the first time he is left breathless by climbing a flight of
stairs or must stop at the end of a short walk to catch his breath.

Rapid heartbeat. At about the same time, he may also notice that his
heart occasionally beats very rapidly. This is called tachycardia; it
is another early symptom of heart failure, and it occurs because the
overtaxed cardiac muscle attempts to compensate for its inability to
pump the normal amounts of blood per beat by beating more frequently.

Swelling. Caused by the buildup of fluids, this symptom
announces itself by an unexpected and seemingly unaccountable weight
gain of 5, 10 or 15 pounds. Usually, the ankles are the first place the
swelling shows up; typically, they become puffy and bloated during the
day, then return to normal with sleep. As the swelling increases,
excess weight may also become noticeable on the arms and legs.

Nocturnal breathlessness. This occurs in two forms, both of
which are associated with the later stages of heart failure. The less
serious and less dramatic type is related to sleep position: If a
person lies flat on a bed with only a single pillow, he may awake
coughing and choking. Far more terrifying, however, is to be awakened
by a feeling of imminent suffocation. Known as paroxysmal nocturnal
dyspnea, this sensation is usually accompanied by a racing pulse, and
it may last anywhere from a few minutes to an hour or more.

Treatment of Congestive Heart Failure

As with most disorders, the earlier that congestive heart failure is
diagnosed, the more likely treatment will succeed. This is why it is
important to be able to spot the first signs of the disorder and to
seek prompt medical attention when they appear. More than likely, your
doctor will recommend on or more of the following steps.

A complete physical. Often, the most effective way to treat
congestive heart failure is to treat its underlying cause, and the
chief purpose of a thorough examination is to identify that cause. If
the cause is high blood pressure, for example, lowering it will almost
automatically make the heart failure more amenable to treatment. On the
other hand, if the underlying problem is a heart attack, bed rest and a
program of coronary care may be instituted.

Drugs. An effective treatment of progressive heart failure is a
drug called digitalis. When given in small doses, digitalis not only
slows the heart’s rate but also increases the force of each beat, so
that each of these beats can move more blood. In certain cases,
nitroglycerin may also be prescribed to ease the discomfort. New
vasodilator drugs to widen the blood vessels are also increasingly used
for easing the load on a failing heart. Diuretics are used to reduce
fluid retention.

Life-style factors. When appropriate, a physician may also
recommend weight loss, suggest that salt intake be restricted since it
promotes water retention and urge that the individual rest frequently
during the day.

Summing Up

Congestive heart failure–related to a relative breakdown in the
heart’s ability to pump blood–is a highly treatable condition when its
symptoms are recognized promptly and brought to a physician’s
attention. In most cases of early detection, it is a reversible
syndrome that can be improved with proper treatment and life-style
adjustments.