When your heart can’t pump out enough blood to get to the parts of the body that need it, then congestive heart failure can result. If you have congestive heart failure, you are not having a heart attack, and it does not mean your heart has stopped beating. It just means that the demands of the body are more than it can bear and it just cannot quite keep up with the workload. Several underlying conditions, such as coronary artery diseases, high blood pressure, valvular heart disease, and peripheral vascular disease, can all contribute to congestive heart failure.
Congestive heart failure is a fairly common illness. Nearly 3 million people worldwide have congestive heart failure now and 400,000 new cases will be diagnosed this year. Elderly people are more likely to develop congestive heart failure. With each decade over the age of 45, your risk of developing congestive heart failure doubles. If you have diabetes, you are four to five times more likely to develop congestive heart failure than someone without diabetes.
Cardiovascular problems such as angina and coronary artery disease, heart attack and high blood pressure increase the risk of congestive heart failure. If you have diabetes, you are more likely to develop these cardiovascular problems. But diabetes can also contribute to congestive heart failure, even if you don’t have coronary artery disease or high blood pressure. If you have diabetes, the small vessels of your heart cannot dilate well, even with the help of powerful drugs. This makes it hard for your heart to pump and fill properly.
Symptoms of congestive heart failure include shortness of breath, difficulty exercising or even walking across the room, difficulty sleeping, fatigue, palpitations, fluid retention and swollen ankles, feet and legs.
What You Should Do
If you are feeling any of the symptoms of congestive heart failure, talk to your doctor as soon as possible. Congestive heart failure is not an emergency situation, but if left untreated it could be life-threatening. Many underlying diseases such as coronary artery disease, high blood pressure and valvular heart disease can trigger congestive heart failure. In addition, other circumstances such as too much sodium in the diet, can make it worse. Your doctor will ultimately want to treat the underlying causes of congestive heart failure, but before deciding on a course of treatment, may also want to diminish those conditions that worsen the symptoms of congestive heart failure.
An essential first step in dealing with congestive heart failure is to watch your sodium intake. Ask your doctor what your sodium intake should be. Read the labels of everything and make sure you are not taking in more than you should. If you are retaining too much fluid, your doctor may also want to prescribe a diuretic to help you lose fluid and excess sodium. If you have difficulty sleeping, try propping yourself up with extra pillows.
Treatment of congestive heart failure depends on an accurate diagnosis. Your doctor will probably order a chest X ray and an echocardiogram. This will confirm whether your problem is caused by poor forward heart pump function—your heart has difficulty contracting to pump blood out—or poor relaxation. Your heart needs to be able to contract and relax to pump efficiently. If it can’t do one of these functions, it doesn’t work properly and congestive heart failure is the result. Often patients with congestive heart failure have problems with both contraction and relaxation.
Your doctor may first want to treat some of the underlying problems that are contributing to congestive heart failure. If you have any form of congestive artery disease, angina or a history of heart attack, you may be given a beta-blocker or an ACE inhibitor. If you have severe blockages in your arteries, you may need surgical intervention. If you have high blood pressure, you may also be given one of these drugs or another type of drug to reduce blood pressure.
Management of the underlying heart conditions may provide some relief of congestive heart failure. However, if the symptoms do not improve, you may require medications that help the heart pump better. If you have a problem with forward pump functions, your doctor will probably suggest a combination of medications. For example, digoxin increases the force of contraction of the heart, and diuretics can help the body get rid of excess fluid.
Your doctor may also suggest an ACE inhibitor. These drugs block the production of a hormone called angiotensin II, which causes some arteries to constrict. This is a natural process to help direct the flow of blood to the organs that need it most: the brain, heart and kidneys. But when the heart is failing, the effects can be detrimental. It places too much of a burden on an already stressed heart. Blocking this hormone with a drug relaxes these arteries and helps the heart pump more efficiently. ACE inhibitors should be used with caution in people with kidney problems. If you have any concerns, talk to your doctor.
Congestive heart failure is a serious condition that can be avoided or minimized with preventive measures. A key first step is to stop smoking if you are a smoker. If you have trouble quitting, talk to your doctor about intervention programs and medical means to help you stop.
If you have diabetes, keep your blood glucose levels under controls. Maintain a diet that is low in fat and cholesterol and high in fiber, vitamins and mineral. This will help reduce the chance that your arteries will clog up. Your doctor may also suggest a long-term aspirin therapy program to reduce the likelihood of atherosclerosis. If you have high blood pressure, reduce your salt intake and excessive alcohol consumption.
Your doctor may also suggest an exercise or activity program you can live with. Even if you can’t train for the Boston Marathon, try walking around the block once or twice a day or climbing stairs instead of taking the elevator.
Talk to your health care team about other steps you can take to reduce the risk of congestive heart failure. You may need to make major lifestyle changes and may not be able to take all steps at once. If you find that prospect overwhelming, relax and take one step at a time. Even if you can’t do everything, any preventive measure you take is better than no action at all
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Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Congestive Heart Failure by Michael Scott and Michael Winters