Chronic heart failure

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VOL 109 / NO 4 / APRIL 2001 / POSTGRADUATE MEDICINE

More and more people are surviving heart attacks, and many are able to live healthy, normal lives. Sometimes, however, heart attack survivors face another challenge down the road. The problem is called heart failure. The name is misleading because it sounds as though the heart has quit doing its job altogether. Fortunately, that's not the case. The heart is still working, but it isn't able to pump enough blood to meet the needs of all the tissues and organs in the body.

Sometimes, people who have heart failure don't even know it until the problem progresses to a more serious form, called congestive heart failure. The term "congestive" refers to a fluid buildup that occurs when the heart gets behind in its work. With less blood leaving the heart, the returning blood gets backed up and the resulting increase in pressure causes seepage into surrounding tissues. This can lead to swelling, usually of the legs, ankles, or feet. In some cases, fluid seeps into vital organs, such as the lungs and liver. When fluid builds up in the lungs, breathing is difficult.

What causes the problem?
Heart failure occurs under a number of circumstances. The most common cause is damage to the heart resulting from a heart attack. Other causes include narrowing of blood vessels, weakening of the heart caused by high blood pressure, leaking heart valves, birth defects, alcohol use, diabetes, and viral infections.

How do you recognize heart failure?
Shortness of breath--either with exertion or, more ominously, at rest--is the most common symptom. Weight gain and ankle swelling may occur. Fatigue and increased urination at night are common. A person who has heart failure may awaken suddenly from a sound sleep gasping for breath.

Most of the time, your doctor can recognize heart failure by symptoms found during a physical examination. When symptoms are more subtle, a test called an echocardiogram can be done. This test tells the doctor how well the heart is pumping by determining the heart's ejection fraction, which is a measure of its efficiency. People who have a healthy heart usually have an ejection fraction of 50% or more. Most--but not all--people with heart failure have an ejection fraction of 40% or less.

What should you do if you have heart failure?
Heart failure usually doesn't go away completely, but you can do several things to help your heart work better. These include:

• Avoid excessive use of salt or salty food. It may be enough to just stop adding salt to your food, but sometimes more drastic salt restriction is necessary.
• Stop smoking.
• Lose weight, if necessary, to reduce the stress on your heart.
• Rest during the day if you can.
• Watch for sudden weight gain, which is a sign of worsening heart failure. Get in the habit of weighing yourself each day.
• Take the medications your doctor prescribes exactly as instructed.

When should you call your doctor?
If you are concerned about heart failure, weigh yourself regularly. If you notice a sudden and pronounced weight gain, such as a pound a day for several days, call your doctor right away. Also, if you feel dizzy or lightheaded or if you faint, either for no known reason or right after taking your medication, let your doctor know. And if you are having any breathing problems, especially if you can't lie flat at night because of shortness of breath, call your doctor.

Can you lead a normal life despite heart failure?
With proper precautions and appropriate medications, heart failure can often be stabilized and you can return to your usual life and work. Untreated, heart failure may lead to progressive fluid accumulation, difficulty breathing, and further heart damage. A serious abnormal heart rhythm or even death can occur because of inadequate circulation. So don't take any chances; if you suspect heart problems, call your doctor.

Signs and symptoms of heart failure

Call your doctor right away if you notice any of these signs or symp-toms, especially if you have a history of heart disease:

• Shortness of breath, including breathing problems that occur with simple activities or that awaken you from sleep
• Weakness, fatigue, or inability to move about as you normally would
• Swelling of your legs, ankles, or feet
• Rapid weight gain, such as a pound a day for 2 consecutive days
• Swollen or distended neck veins
• Frequent coughing, especially when lying in bed

Common causes of heart failure

Congestive heart failure is often the result of various cardiovascular prob-lems. The most common causes include:

• Narrowing of blood vessels to the heart (also called coronary artery disease)
• Blockage of blood vessels to the heart (heart attack), which can cause sudden congestive heart failure
• Long-standing high blood pressure (hypertension)
• Abnormal heart rhythms
• Problems related to leaky heart valves
• Birth defects (congenital heart disease)
• Disease of the heart muscle (cardiomyopathy)
• Damage caused by toxic substances, including long-term use of alcohol
• Viral infections
• Diabetes

This information is not a substitute for medical treatment.

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