Congestive Heart Failure

10 mins read

Heart failure means your heart cannot pump enough blood to meet the body’s needs. High blood pressure and coronary artery disease are both major risk factors.

Congestive heart failure affects approximately 2 percent of the population in the United States, a figure that changes to 6 – 10 percent by the age of 65. Congestive heart failure is one of the main reasons that persons aged 65 years and above require hospitalization.

Causes
Congestive heart failure often develops after other conditions have damaged or weakened your heart. Heart failure can involve the left side, right side or both sides of your heart. Typically, heart failure begins with the left side — specifically the left ventricle, your heart’s main pumping chamber.

The most common causes are:

  • Coronary artery disease
  • Faulty heart valve
  • Inflammation of the heart muscle (Myocarditis)
  • Hypertension
  • High blood pressure
  • Hypertension or high blood pressure causes increased pressure and stress to the blood vessels and heart. Hypertension means the force of blood is higher through the arteries, which can cause the heart to become weak and stiff over time, leading to heart failure.

Chronic diseases may contribute to heart failure. These include:

  • Diabetes
  • Severe Anaemia
  • Hyperthyroidism
  • Hypothyroidism
  • Emphysema
  • Lupus
  • Hemochromatosis
  • Build-up of proteins in your muscles (amyloidosis)

Symptoms
The symptoms of congestive heart failure vary depending on the severity and the degree to which the rest of the body has compensated for the weakness of the heart. Some people may subconsciously limit their physical activity because of the weakness and fatigue that are common symptoms of congestive heart failure. They may not even realize they have cut back.

Other symptoms include:

  • Swelling (edema) of the ankles and legs or abdomen.
  • Shortness of breath, particularly during exercise and when lying flat. In some instances, patients are awakened at night, gasping for air.
  • A persistent cough or wheezing with white or pink blood-tinged phlegm.
  • Rapid or irregular heartbeat.
  • Increased urination, particularly at night.
  • Nausea, abdominal pain, and decreased appetite.
  • Rapid or irregular heartbeat.
  • Sudden weight gain from fluid retention.
  • Difficulty concentrating or decreased alertness.

Diagnostic tests

  • The initial and an important part of examining for congestive heart failure is enquiring about the patient’s health history, symptoms and a complete physical examination.
  • Using a stethoscope, your doctor can listen to your lungs for signs of congestion. The stethoscope also picks up abnormal heart sounds that may suggest heart failure.
  • The doctor may examine the veins in your neck and check for fluid build-up in your abdomen and legs.

Other tests that are possible to be conducted are:

  • Blood tests: Blood tests can be used to determine the functioning of the kidney and thyroid, since these two organs can be affected by congestive heart failure. Blood tests can also determine the cholesterol levels in the blood.
  • Imaging tests: Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). These scans produce images of your heart and are used to diagnose problems and causes of heart failure.
  • Stress tests: These measure how your heart and blood vessels respond to exertion.
  • Coronary catheterization (angiogram): Helps doctors identify narrowed arteries to your heart (coronary artery disease) that can be a cause of heart failure.
  • Chest x-ray: A chest X-ray can help to measure the condition of the heart and lungs.
  • Echocardiogram (ECG): To monitor the movement of the heart. Part of the Echocardiogram test is the Ejection fraction: measures the strength of each pump of the heart. In a healthy heart, the ejection fraction is about 55 percent — meaning that over half of the blood that fills the ventricle is pumped.
  • Electrocardiogram: Records the heart’s electrical activity. d out with each beat.

Treatment options
Heart failure is a chronic disease needing lifelong management.

  • The first and perhaps the most basic treatment for this condition is lifestyle modification, which involves:
  • Diet
  • Nutrition
  • Proper exercise
  • Hypertension is a risk factor for congestive heart failure, so low salt diets are recommended, i.e. less than two grams sodium daily.
  • Quit smoking: Smoking damages your blood vessels, reduces the amount of oxygen in your blood and makes your heart beat faster. If you are having problems quitting, your doctor can recommend programs to help you stop.
  • Limiting fats and cholesterol: Cut back on saturated fat, trans-fat and cholesterol in your diet. A diet high in fat and cholesterol is a risk factor for coronary artery disease, which often underlies or contributes to heart failure.
  • Limit alcohol and fluids: Your doctor likely will recommend that you don’t drink alcohol if you have heart failure, since it can interact with your medication, weaken your heart muscle and increase your risk of abnormal heart rhythms. Persons with severe heart failure may be recommended to reduce their intake of fluids.
  • Get a good night’s rest: Rest allows body to heal. If your heart condition is causing shortness of breath and this is interfering with your sleeping, try sleeping with your head propped up at a 45-degree angle using a pillow or a wedge.
  • Aerobic exercises can greatly relieve the signs and symptoms of congestive heart failure. Heavy exercise can also put strain on the heart, so it’s important to talk to your doctor about the right activity level appropriate for you.
  • Medications: There are several drugs commonly used for congestive heart failure, including:
    • Digoxin: Digoxin increases the strength of the heart muscle contractions.
    • ACE Inhibitors: ACE inhibitors widen blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart
    • Beta-blockers: Beta-blockers slow your heart rate and reduce blood pressure.
    • Diuretics: Diuretics increase urination to prevent fluid from collecting in the body, a symptom of heart failure
  • Surgery: In some cases, surgery is recommended to fix the underlying problem that caused heart failure. Common types of surgery include-
    • Heart valve repair and replacement
    • Coronary bypass surgery
    • Insertion of pacemakers
    • Heart-pumps to help the heart contract
    • Cardioverter-defibrillators (ICDs) can also be implanted. These monitor the heart rhythm and shock it back to a normal if the heart beat becomes irregular.

Alternative Therapies

  • Some alternative and natural treatments may help alleviate the symptoms of congestive heart failure.
  • Fish oil or foods can reduce disturbances in the rhythm of the heart and palpitations [1].
  • The hawthorn shrub can act similarly to ACE inhibitors, increasing the dilation of blood vessels and blood flow in the coronary arteries, and decreasing the work load on the heart [2,3].
  • Phylum fiber can help by reducing the levels of cholesterol in the blood.
  • For those who have already had coronary angioplasty, vitamins B12, B6 and folic acid may help in unblocking the coronary arteries [4].
  • Co-enzyme Q10 with its antioxidant properties have shown to benefit patients with CHF [5]. It helps in strengthening the heart cells by improving the metabolism. Research has also indicated the use of co-enzyme Q10 in reducing the blood pressure and swelling in the lungs [6].
  • Preliminary studies have suggested that creatine [7] which is a naturally occurring amino acid helps in improving the heart function. It enhances muscle function and can help in patients with heart failure.
  • Thiamine or Vitamin B1 is utilized by the heart for proper functioning [4]. Although patients tend to loose many nutrients during a CHF, including thiamine. Hence thiamine supplementation can benefit patients with severe heart failure.
  • Arginine [8] and Taurine [9,10] are both required by the heart to carry important functions. Arginine is seen to improve the blood flow to the heart by inhibiting the formation of plaques in the arteries.
  • Studies have shown that yoga [11] and meditation can help reduce the risk factors for cardiovascular diseases such as hypertension, diabetes, obesity etc. Yoga also helps to improve the tolerance of exercise and the levels of inflammatory markers in CHF patients.
  • Acupuncture in combination with western medicine can help in strengthening heart functions in CHF, elevate the therapeutic effects and enhance the prognosis [12,13]. It is also seen to improve the function of skeletal muscles thereby improving the exercise tolerance in acute heart failure patients.

Prevention
The best way to prevent heart failure is to control risk factors and conditions that cause heart failure, such as-coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity. Diet, exercise, stress, sleep, treating depression and smoking are all contributing factors.

Conclusion
Congestive heart failure is a chronic debilitating disease. It is most common in persons over the age of 65. A weakened heart can be treated with medications and possibly surgery. Making lifestyle changes – diet, exercise, low fat and salt diets, eliminating stress and others — will also help eliminate the risk factors.

Read More:
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Heal Your Heart The Yoga Way
10 Natural Remedies For Heart Disease
Quick Fix: Hemp Oil For Heart Disease
Heal Your Heart Naturally With Hawthorn
Quick Fix: Chia Seeds For Heart Health
Science Says: Lifestyle Factors Can Cut Heart Failure Risk By 50 Percent
Science Says: ‘Rambo’ Protein Limits Development Of Heart Failure

References

1. DiNicolantonio JJ, Niazi AK, McCarty MF, O’Keefe JH, Meier P, Lavie CJ. Omega-3s and cardiovascular health. Ochsner J. 2014 Fall;14(3):399-412. Review. PubMed PMID: 25249807; PubMed Central PMCID: PMC4171799.

2. Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD005312. doi: 10.1002/14651858.CD005312.pub2. Review. PubMed PMID: 18254076.

3. Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med. 2003 Jun 1;114(8):665-74. PubMed PMID: 12798455.

4. Desai CK, Huang J, Lokhandwala A, Fernandez A, Riaz IB, Alpert JS. The role of vitamin supplementation in the prevention of cardiovascular disease events. Clin  Cardiol. 2014 Sep;37(9):576-81. doi: 10.1002/clc.22299. Epub 2014 May 23. PubMed  PMID: 24863141.

5. Madmani ME, Yusuf Solaiman A, Tamr Agha K, Madmani Y, Shahrour Y, Essali A, Kadro W. Coenzyme Q10 for heart failure. Cochrane Database Syst Rev. 2014 Jun 2;6:CD008684. doi: 10.1002/14651858.CD008684.pub2. PubMed PMID: 24049047.

6. Belardinelli R, Muçaj A, Lacalaprice F, Solenghi M, Seddaiu G, Principi F, Tiano L, Littarru GP. Coenzyme Q10 and exercise training in chronic heart failure. Eur Heart J. 2006 Nov;27(22):2675-81. Epub 2006 Aug 1. PubMed PMID: 16882678.

7. Andrews R, Greenhaff P, Curtis S, Perry A, Cowley AJ. The effect of dietary creatine supplementation on skeletal muscle metabolism in congestive heart failure. Eur Heart J. 1998 Apr;19(4):617-22. PubMed PMID: 9597411.

8. Rector TS, Bank AJ, Mullen KA, Tschumperlin LK, Sih R, Pillai K, Kubo SH. Randomized, double-blind, placebo-controlled study of supplemental oral L-arginine in patients with heart failure. Circulation. 1996 Jun 15;93(12):2135-41. PubMed PMID: 8925582.

9. Ito T, Schaffer S, Azuma J. The effect of taurine on chronic heart failure: actions of taurine against catecholamine and angiotensin II. Amino Acids. 2014 Jan;46(1):111-9. doi: 10.1007/s00726-013-1507-z. Epub 2013 May 31. Review. PubMed PMID: 23722414.

10. Beyranvand MR, Khalafi MK, Roshan VD, Choobineh S, Parsa SA, Piranfar MA. Effect of taurine supplementation on exercise capacity of patients with heart failure. J Cardiol. 2011 May;57(3):333-7. doi: 10.1016/j.jjcc.2011.01.007. Epub 2011 Feb 19. PubMed PMID: 21334852.

11. Pullen PR, Nagamia SH, Mehta PK, Thompson WR, Benardot D, Hammoud R, Parrott JM, Sola S, Khan BV. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail. 2008 Jun;14(5):407-13. doi: 10.1016/j.cardfail.2007.12.007. Epub 2008 May 27. PubMed PMID: 18514933.

12. Middlekauff HR. Acupuncture in the treatment of heart failure. Cardiol Rev. 2004 May-Jun;12(3):171-3. Review. PubMed PMID: 15078586.

13. Kristen AV, Schuhmacher B, Strych K, Lossnitzer D, Friederich HC, Hilbel T, Haass M, Katus HA, Schneider A, Streitberger KM, Backs J. Acupuncture improves exercise tolerance of patients with heart failure: a placebo-controlled pilot study. Heart. 2010 Sep;96(17):1396-400. doi: 10.1136/hrt.2009.187930. Epub 2010 Jun 15. PubMed PMID: 20554511.

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