About 5.7 million people in the United States have heart failure, and the number is growing. About 50% of people die within 5 years of getting the diagnosis. It contributed to about 280,000 deaths in 2008. Occurs more in men, African-Americans, and people age 65 an older. Actually, CHF is the #1 reason for hospital stays in that age group.
Pathophysiology: Congestive heart failure (CHF) is a condition in which the heart can’t pump enough blood throughout the body. The heart can’t fill with enough blood or pump with enough force, or both. Heart failure develops over time as the pumping action of the heart grows weaker. It can affect the left, right, or both sides of the heart. Most cases involve the left side where the heart can’t pump enough blood to the rest of the body. With right-sided failure, the heart can’t effectively pump blood to the lungs
Causes: Any condition that damages heart muscle can lead to heart failure. The three leading causes are coronary artery disease (leads to heart attacks), hypertension, and diabetes. Other causes include cardiomyopathy, diseases of the heart valves, arrhythmias (including atrial fibrillation), congenital heart defects, cancer treatments like chemotherapy and radiation, thyroid disorders, HIV/AIDS, alcohol abuse, and illicit drug abuse (i.e. cocaine).
Signs and symptoms: These depend on the side of the heart affected. The inability of the heart to pump properly causes blood to back up into where it came from (right side—blood backs up into the vena cava, left side—the lungs) and insufficient blood flow to where it is supposed to go (right side—the lungs, left side—the rest of the body including the coronary arteries and the kidneys). Right-sided heart failure includes peripheral edema, ascites (fluid accumulation in the abdominal cavity), enlarged liver, juglar vein distension, weight gain, and frequent urination. Left-sided heart failure includes pulmonary edema (fluid in the lungs), cough at night, shortness of breath with exertion, orthopnea (shortness of breath depending on a person’s body position), and fatigue.
Treatments: If possible, treat the underlying cause of the heart failure, for example, coronary artery bypass graft surgery (CABG) or valve surgery. Lifestyle changes like a low salt diet, weighing oneself daily, restricting the amount of fluid intake, and exercise will also help manage this condition.
Medications: The following medications are used to treat CHF: diuretics—to reduce fluid buildup therefore reducing preload (the amount of fluid going into the heart), ACE inhibitors—to lower blood pressure and decrease afterload (the amount of pressure the heart muscle has to work against to pump out the blood), Beta-blockers—to lower heart rate and blood pressure to decrease afterload, and Digoxin—to allow heart to beat stronger and pump blood more efficiently which increases cardiac output (the amount of blood the heart is able to pump out with each squeeze). If the above do not work and the CHF worsens, heart transplant or mechanical heart pump may need to be considered.
References:
- http://www.hopkinsmedicine.org/heart_vascular_institute/conditions_treatments/conditions/congestive_heart_failure.html
- http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm