Congestive Heart Failure

Q: I have high blood pressure and have been reluctant to take blood pressure pills. I’ve become short of breath lately, and my doctor says I have congestive heart failure (CHF). That’s scary! What is CHF, and what should I do about it?

A: There are different causes, and types of, congestive heart failure. There are four stages of severity determined by how debilitating your symptoms are.

CHF is almost always a progressive condition, so take this seriously and do everything in your power to slow the progression to end-stage disease. Get your blood pressure under control! CHF is a serious complication of high blood pressure. Take your medications as prescribed, and see your doctor regularly for dosage adjustments.

Lifestyle modification is essential. Eat a healthy, low sodium diet, lose weight if necessary and exercise as much as you can tolerate (per your doctor or cardiac rehabilitation therapist’s recommendation). Quit smoking, keep blood sugar and cholesterol under control, and reduce or eliminate alcohol as it may cause hypertension as well as damage the heart muscles. Check weight and blood pressure daily. Notify your doctor of weight gain, increasing shortness of breath (with exertion or lying down), or increased swelling. It’s better to see your doctor more often than to risk hospitalization.

Heart failure occurs when the heart muscles that pump your blood (aka ventricles) are not working effectively. Fluid backs up into your lungs (left heart failure) and/or into your legs, belly and organs (right heart failure). This may occur suddenly (acute CHF) when your ventricles fail after a heart attack (MI). Or it may develop slowly (chronic CHF) because of conditions like high blood pressure.

The left ventricle, the right ventricle, or both may fail. Systolic heart failure means the left ventricle can’t pump hard enough, and diastolic heart failure means the left ventricle can’t fully relax to fill completely. The ventricles may be too muscular or too dilated, depending on the cause.

The most common cause of congestive heart failure is atherosclerotic heart disease. Some other causes of CHF are: excessively tight (or loose) heart valves, irregular heartbeats, diabetes, sleep apnea, diseases of the thyroid, HIV, hemochromatosis or amyloidosis. Dilated ventricles may be caused by heart attacks, hypertension, damaged heart muscle from excessive alcohol, infections, some drugs, lupus, obesity, or genetics.

In the case of hypertension, the left ventricle may have been overworked for a long time from pumping blood against the high pressure in your arteries, so it became enlarged and stiff. When the left ventricle becomes too stiff to receive all the oxygenated blood returning from the lungs, fluid backs up into your lungs instead of being pumped into your body. This causes shortness of breath.

Other symptoms of CHF include wheezing (cardiac asthma), coughing up blood (pulmonary edema), not being able to walk as far as usual, feeling weak and tired, or irregular heartbeats. Notify your doctor immediately if you feel your condition is worsening.

In the case of hypertensive left-sided heart failure, the ejection fraction of the heart (percent of blood leaving your heart with each heartbeat) may be normal even though the ventricle is not working properly. The ejection fraction should be at least 50 percent. If it’s less than 40 percent, you already have Stage B CHF.

Some of the tests that determine ejection fraction are echocardiogram and cardiac catherization. A cardiac catheterization is one of the tests that determines whether you have atherosclerotic blockages in your coronary arteries (the most common cause of CHF).

Other useful tests are BNP (blood test), chest x-ray, EKG, stress testing, and/or imaging studies. Serious complications of CHF include pulmonary edema, life-threatening arrhythmias (irregular heartbeats), blood clots, strokes, heart attacks, and sudden death.

In advanced cases of heart failure, pacemakers, implantable cardiac defibrillators, bypass, or even heart transplantation surgery may be necessary. So make healthy lifestyle modifications now for the best prognostic outcomes in the future.

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