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Congestive Heart Failure
Congestive heart failure, also called heart failure, is a heart problem involving an inability of the heart to adequately pump blood throughout the body. It is a long term, chronic condition that usually develops gradually but can develop suddenly, depending on the cause of the disease. There is right sided heart failure and left sided heart failure; alternatively, both sides of the heart can be affected. Heart failure can occur when the heart muscle is weak and cannot push blood out of the heart. This is referred to as "systolic heart failure". If the heart muscles are stiff and cannot allow the heart to fill up with blood easily, it is known as "diastolic heart failure".
In heart failure, blood is backed up in other parts of the body. It can build up in the lungs, the GI tract, the arms and legs or in the liver. These organs and parts of the body do not get adequate oxygenation and nutrition and they do not work the way they are supposed to.
Congestive heart failure has many causes. The most common cause of heart failure is coronary artery disease, which is narrowing or blockage of coronary artery vessels that cause a part of the heart to be damaged. The heart can weaken altogether due to inflammation or a virus; this is called cardiomyopathy and is a cause of congestive heart failure. Congenital heart disease, heart valvular disease, heart attack and heart rhythm problems can cause congestive heart failure. Systemic diseases, such as asthma, emphysema, severe anaemia, hypothyroidism or hyperthyroidism can cause the disease of CHF to become worsened.
As mentioned, the symptoms of heart failure occur most often very slowly. They begin when you are more active and eventually worsen to occur when you are lying down. Finally it is worse when you are sitting or standing. The major symptoms include shortness of breath, swelling of the feet or ankles, abdominal swelling, cough, weight gain, rapid pulse or irregular pulse, difficulty sleeping, fatigue, faint feelings, palpitations, loss of appetite, and indigestion. In severe cases, you can get nausea and vomiting, decreased level of consciousness, decreased urine output and a need to get up at night to urinate often.
Symptoms are made worse with anaemia, abnormal heart rhythm, activity, hyperthyroidism, fever and kidney problems.
Doctors need to do a complete history and physical examination to identify congestive heart failure. The lung sounds may be diminished or may show crackles in the lungs secondary to fluid in the lungs. There can be an irregular heartbeat noticed by stethoscope evaluation and there can be obvious leg swelling. The neck veins can be distended due to backup of blood and swelling of the liver can be noted on physical examination of the abdomen. A chest x-ray can show fluid in the lungs and an enlarged heart. An ECG can be abnormal and an echocardiogram can be done to show poor flow of blood through an enlarged heart. Exercise stress tests can show stress on the heart with exercise and a CT scan of the heart can be done to show its size and the chambers of the heart. In some cases an MRI of the heart can be done and cardiac catheterization can show what the blood vessels of the heart look like.
Blood tests for blood counts, kidney function, liver function, uric acid, sodium and potassium can be assessed to see how the CHF is affecting the whole body.
Heart failure is treated by careful monitoring and medications to control symptoms. You will need to monitor your weight to see if there is worsened fluid retention. You need to limit the salt intake in your diet. You should not smoke and should be as active as you can be. If you are overweight, you should lose weight.
Medications that work for heart failure include ACE inhibitors that open up the blood vessels so the work of the heart is less. You may need diuretic medication like Lasix or hydrochlorothiazide and digoxin medications are used to strengthen the heart. Angiotensin receptor blockers are used for those who do not tolerate ACE inhibitors and work in much the same way as these medications.