Peterborough Regional Vascular Health Network
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What is congestive heart failure (CHF)? This term describes failure of the heart to pump enough blood from your lungs and to your organs. The problem has many causes including damage to the heart muscle from heart attacks, leaking or narrowed heart valves, and stiffness or scarring of the heart muscle from untreated high blood pressure. Rhythm disturbances can also cause CHF.
Why is CHF a concern? Two reasons: The symptoms it causes often lead to reduced quality of life and frequent hospitalizations. CHF also reduces life expectancy. Fortunately, new treatments help improve both symptoms and life expectancy.
What symptoms does CHF cause? Shortness of breath is the most common symptom. This can occur with exercise and even at rest. Swelling of the ankles or fluid in the abdomen can also occur. Fatigue is another common symptom.
What is the main focus of treatment? First we try to reduce the extra fluid in the body using water pills. Then the function of the heart muscle is improved by using a number of medications that usually includes ACE inhibitors, beta blockers, and sometimes digoxin. Drugs to prevent heart attack and normalize cholesterol are also used. Care is taken to ensure that potassium levels in the blood are in the normal range. Appropriate limitation of salt intake, diet, weight control, exercise, and rest are all important aspects of treatment. Doses of water pills are often adjusted according to weight and symptoms and patients can make a major contribution to the success of their therapy by being well informed and involved in the medication adjustments.
What medications will I need? Almost everyone needs to be on ACE inhibitors (any drug that ends in “pril”), or ARB’s (any drug that ends in “sartan”). Most will be on water pills, usually hydrochlorothiazide (HCT) or furosemide (LASIX). Beta blockers (any drug that ends in “olol”) are used in all that can tolerate them – if you have definite asthma, this class of drugs will likely be avoided – and digoxin (LANOXIN) is often used to strengthen the heart.
What investigations will I need? The history of your symptoms and the physical exam by your doctors is usually sufficient to make the initial diagnosis of heart failure. A chest x-ray is often done to confirm the presence of fluid in the lungs. Everyone with a current or previous diagnosis of CHF should have at least one echocardiogram (ultrasound) test of the heart. This allows your doctor to know what caused the CHF and helps in the planning for long term therapy. Many patients will also benefit from having a Holter monitor (tape recorder of rhythm) test performed. If coronary disease is a contributor to your problem, some form of stress test will likely be performed and you may need an angiogram to define the extent of coronary disease and determine if bypass or angioplasty will help. Sometimes valve surgery can help as well.
What about more advanced treatments? Because of the large numbers of patients affected by CHF around the world, major research projects are ongoing with many new and exciting treatments. A special type of pacemaker has been found to be effective in a selected group of patients who have specific ECG abnormalities in addition to their CHF. Heart specialists will know if you are among those who would benefit. Ultimately, heart transplant is a therapy that is needed in a small number of cases.
What are the specifics of exercise and rest? Everyone is different and each patient will need a personalized prescription from the heart specialist or cardiac rehabilitation doctor. However, regular and sufficient sleep (at least 8 hours per night) is important and sometimes a nap in the afternoon is advisable. A graduated exercise programme of walking can improve your endurance and resistance training with light weights can be used for improved conditioning as well.
What about diet? A balanced diet that maintains your weight around ideal levels is appropriate. Significant excess weight creates extra work for your heart. Extreme thinness can also be a problem. You will need to customize your diet according to the advice of your doctor and specialists. In general efforts to moderate salt intake are advised – try not to add salt at the table – and follow a diet low in saturated fat.
You may be on a number of medications for the treatment of congestive heart failure. Diuretics, usually in combination with digitalis are used to initiate therapy. Ace inhibitors have become the mainstay of therapy. Other drugs may include beta blockers and vasodilators. It is essential that your doctor and pharmacist know about all the products you take even if they are not on a prescription. Your pharmacist is committed to helping you understand your medications and their proper use. Therefore, please follow these guidelines:
· General measures can include oxygen therapy, anti-embolism stockings, and fluid and sodium restriction.
· Be sure to discuss with the pharmacist dietary advice on salt and water restriction, weight reduction if appropriate, and low fat diet to retard coronary artery disease.
· Be sure to tell the pharmacist about other medications you may have recently received, especially aspirin containing drugs, arthritis drugs, diabetic pills, and all other heart drugs.
· Be sure to notify the pharmacist if you are taking over-the-counter remedies or herbal medicines.
· Be sure to rest after meals and follow appropriate exercise program. Gradual increase in activity with walking will help increase strength.
· If using nitrate patches or oral tablets, make sure you have a nitrate-free period of at least 10 or preferably 12 hours each day to prevent loss of nitrate effect.
We hope that this information will help you understand CHF better and give you insight in to its treatment. If you have further questions you should ask your doctor, pharmacist, or visit the Peterborough Regional Vascular Health Network Website, which you can access at: www.kawarthacardiology.com.