Congestive Heart Failure

A recognized leader in cardiac care, Harrison excels in the treatment of Congestive Heart Failure (CHF). “Heart failure” is a misleading term. It doesn’t mean your heart has stopped working entirely—it means it isn’t working as well or pumping as hard as it should. About 5 million people in the US have been diagnosed with CHF. It is a syndrome, not a disease—a weakening of the heart brought on by underlying heart or blood-vessel problems.

Heart failure can occur in people of any age, even in young children. However, it is far more common in older people, because they’re more likely to have disorders that damage the heart muscles and valves—and age-related changes in the heart tend to make the heart pump less efficiently. Lifestyle also is a major risk factor, because smoking, poor diet and lack of exercise damage the heart.

Because heart failure usually results from a constellation of factors, we coordinate a multi-faceted team to provide optimum treatment. The team includes:

• You, the patient
• Family members
• Cardiologists
• Electrophysiologists
  
• Surgeons
• Nursing staff
• Nutritionists
• Congestive Heart Coordinator
• Pharmacists
  

This holistic approach, used in concert with internationally proven diagnostic tools and therapies, can make all the difference to improving your heart function—and your life.

CHF symptoms and diagnosis

• Chest pain
• Fatigue and weakness
• Rapid or irregular heartbeat
• Shortness of breath when you exert yourself or when you lie down
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Rapid weight gain of five pounds or more in a day or two
  
• Swelling in your abdomen, legs, ankles, and feet
• Difficulty concentrating or decreased alertness

Because symptoms can be vague or mimic other illnesses, you may have one or several of the following diagnostic procedures:

• EKG (Electrocardiogram): a simple, painless test that detects and records the heart’s electrical activity. It shows whether the walls in your heart's pumping chambers are thicker than normal and reveals signs of a previous or current heart attack.
• Chest X-ray: can show whether your heart is enlarged, whether you have fluid in your lungs, or whether you have lung disease.
• BNP Blood Test: checks the level of a hormone called BNP that rises during heart failure.
• Echocardiography (echo): uses sound waves to create a moving picture of your heart. It shows heart shape and size and how well your heart chambers and valves are working. It also can identify poor blood flow, abnormal contractions, and heart injury. It can be used before and after a stress test.
• Doppler Ultrasound: uses sound waves to measure the speed and direction of blood flow.
• Holter Monitor: records your heart’s electrical activity for a full 24- or 48-hour period, while you go about your normal routine.
• Nuclear Heart Scan: shows how well blood is flowing through your heart and how much blood is reaching your heart muscle.
• Cardiac Catheterization: a long, thin, flexible tube called a catheter is put into a blood vessel in your groin—or sometimes the arm or wrist—and threaded to your heart for a look inside your coronary (heart) arteries.
• Coronary angiography: checks heart blood flow and pumping efficiency.
• Stress Test: diagnoses how your heart functions during activities. It can reveal more than an at-rest view for certain parts and functions of the heart muscle.
• Cardiac MRI: (magnetic resonance imaging) shows the heart and major blood vessels while the heart is beating. It can reveal whether parts of your heart are damaged.

Types of CHF

The heart muscle contracts (or squeezes) and relaxes with each heartbeat. In CHF, the action is impaired:

Systolic dysfunction means the heart’s ability to squeeze is compromised. As a result, the amount of blood pumped to the lungs and to the rest of the body is reduced, and the ventricle usually enlarges. Causes may include prior heart attacks, valve disease, an inherited condition, or autoimmune processes.

Diastolic dysfunction means the heart can squeeze normally but has difficulty relaxing because of thickening of the muscle wall or problems with blood supply. The stiffness leads to high pressure inside the heart that can cause fluid to collect in the lungs and cause breathing problems.

Treatments for Systolic Dysfunction

Depending on the underlying cause, various medical therapies are available to help restore pump function. These include:

• Medications such as ACE-inhibitors, angiotensin receptor blockers, beta blockers and aldosterone antagonists.
• Pacemakers, implantable cardioverter-defibrillators (ICD), or other devices that can be placed in the chest when medicines aren’t enough
• Catheter-based procedures
• Open-heart surgery
• Mechanical support for critically ill patients awaiting permanent treatment such as an implant - or sometimes a heart transplant at a qualified hospital

Treatments for Diastolic Dysfunction

Fluid retention is treated with diuretics, while high blood pressure is controlled with medication. ACE-inhibitors work by reducing how hard your heart works, lowering blood pressure, and reducing fluid retention and swelling. Beta-blockers also may be prescribed to control your blood pressure and slow heart rate.

Strengthen your heart—lengthen your life

We support and encourage you to participate in important clinical decisions and take ownership of your heart health.

• Diet: Following a Mediterranean-style diet can reduce cardiovascular risk by up to 50 percent. Throwing away your salt shaker will make a difference—a singe 1/8 teaspoon “shake” adds more than 250 milligrams of sodium. Most processed food and drinks also have high levels of sodium.
• Weight: Get on the scale at the same time each day and keep track of your progress. Rapid weight loss or gain can be due to body water and salt rather than fat loss or gain, so be sure to alert your doctor if you see rapid shifts. Maintain a healthy weight relative to your height.
• Get active: Get moving. Every bit helps. Exercise in a formal way if you can, but walking your dog two to three times a day is good, too.
• Limit fluids: Think about how much and what you drink. And limit or stop drinking alcohol.
• No smoking. Ever: There are no good reasons to smoke, and there are many reasons to quit. For those with a heart condition, it is imperative to stop smoking and to avoid second-hand smoke.

What you do every day really does make a difference in your heart health—and family support helps. At Harrison, our cardiac care family is here to help you before, during and after your hospital stay.

“When patients are partners in care, they learn to make the good choices that really do make a difference in their long-term heart health and lead a fuller, longer life.”

- Robin C. Houck, MD
  Board Certified Cardiologist