Final Stage of Congestive Heart Failure

Congestive heart failure occurs when the heart is not able to get enough blood to other organs in the body. Although the heart does not stop working completely, slow blood flow coming from the heart causes a backflow of blood traveling back to the heart. The result can be congestion in the tissues or swelling in the legs, arms, ankles and other parts of the body. Fluid can also collect in the lungs, which can cause shortness of breath. Some of the causes of congestive heart failure are coronary artery disease, hypertension or high blood pressure, cardiomyopathy or disease of the heart muscle, infection of the heart valves or heart problems at birth such as congenital heart defects.

Stages

• There are four stages of congestive heart failure, labeled stages A through D. Stage A occurs when a person does not have heart failure, but there is a greater risk for heart failure because the person has other conditions such as hypertension, coronary artery disease or diabetes. Stage B occurs when the person has been diagnosed with congestive heart failure but none of the regular signs and symptoms, such as swelling, are present. A test called the ejection fraction is used to diagnose for congestive heart failure. During this test, if the amount of blood that comes out of the heart is below 40 percent, the person is considered to have congestive heart failure. It is when people have been diagnosed with congestive heart failure and symptoms begin to appear that they enter the final two stages of congestive heart failure.

Diagnosis

• Usually it is years before a person reaches these stages because it may take a long time before the symptoms appear. When a person has been diagnosed and there are signs and symptoms present, he is said to be at stage C. The main symptoms are shortness of breath, swelling, fullness in the stomach that makes it difficult to breathe, insomnia, fatigue and wheezing. Because these symptoms are similar to other diseases and conditions, congestive heart failure may sometimes be misdiagnosed as a respiratory infection, bronchitis, asthma or gallstones. That is why doctors may perform other tests besides the ejection fraction, such as a chest X-ray and an electrocardiogram. A chest X-ray can show if the heart has become enlarged, and an electrocardiogram can determine how well the heart is pumping.

Standard Treatments

• Some of the standard treatments for congestive heart failure, which are used for patients in the first three stages, are also given to those who are in stage D. Patients, especially those with hypertension, are often told to make lifestyle changes. They are told to stop smoking and using drugs and start exercising more. The patient may benefit from taking multivitamins, eating more foods with coenzyme Q10, amino acids, magnesium, and calcium or taking over-the-counter pills containing those substances. Patients are sometimes prescribed diuretics, which contain some of these supplements. Some common diuretics are Lasix and Demadex. Diuretics can especially help increase the amount of magnesium, calcium and Vitamin D in the body.

Medications

• For those who have had previous heart attacks, hypertension or diabetes, doctors may given them medications such as an angiotensin-converting enzyme (ACE) inhibitor or a beta blocker. ACE inhibitors work to expand blood vessels so that blood flows better. Beta blockers prevent the heart from speeding up, which the body may try to force it to do. People who reach stage B may need to undergo surgical procedures, such as coronary artery revascularization and a valve repair or replacement. Coronary artery revascularization can involve a grafting procedure where a vein is taken from a leg or artery and attached to the aorta and to a blocked coronary artery. It is also important for patients to get their cholesterol at healthier levels because higher cholesterol can be one of the factors that leads to congestive heart failure and heart attacks. Some doctors may put patients on statin drugs, which help to reduce cholesterol levels, but patients can also reduce cholesterol by eating fewer fried foods; using substitutes such as lemon juice instead of salt or other condiments and staying away from sweets and fatty foods such as cakes, cookies, cheese, butter and eggs.

Other Treatments

• The last stage of congestive heart failure is stage D. At this stage, symptoms have worsened, and earlier treatments have not been successful. A patient at this stage y may need a heart transplant, ventricular-assist device, continuous IV infusion of inotropic drugs or drugs that are undergoing trials. Ventricular-assist devices use a large tube that takes blood from the ventricle and sends it to the aorta, a large blood vessel in the body.

Trials

• For those who take experimental drugs, it is important to be aware that there are different levels of clinical studies, known as phases. During a phase 1 trial, researchers are looking at the safety of the drugs on humans, which means that they need small groups of participants. During a phase 2 trial, they are both confirming the safety of drugs and looking at their effectiveness. During phase 3 trials, researchers normally look at the effectiveness of medications over longer periods of time, sometimes years, to see how well they work. A 2009 study by Dana G. Kontras and others at the Mayo Clinic was a phase 2 trial that looked at how well a drug known as spironolactone worked with other treatments for congestive heart failure when used in certain doses.