What Are the Treatments for Conjestive Heart Failure?

Congestive Heart Failure (CHF) is a condition that is caused by cardiomyopathy, a group of diseases that affects the heart muscle. In CHF, the heart loses its pumping efficiency, initiating a decrease in blood supply to the rest of the body. Blood backs up into the circulatory system, causing "congestion" in the tissues. The following defines the two general classifications of heart failure, systolic, and diastolic, as well as the causes, diagnosis, and treatment of the condition.

Systolic and Diastolic CHF

• In Systolic CHF, the pumping efficiency of the heart is reduced and weakened. The most common clinical measurement for how hard your heart is working is your Ejection Fraction (EF). Your EF is the percentage of oxygenated blood pumped out by the heart's left ventricle with each heartbeat. This oxygenated blood then flows to the rest of your body. This can be calculated by a test known as an Echocardiogram. A normal EF is one greater than 50 percent. Systolic heart failure produces a decreased EF of less than 50 percent.

  In diastolic heart failure, the heart can contract normally, but is more resistant when it is relaxing and becoming full with blood. This hinders blood from filling into the heart, and instead causes it to back up into the lungs. This condition is more common in patients 75 years of age and older, and particularly affects women with high blood pressure. In this condition, a patient's EF is generally normal.

Causes of CHF

• There are a variety of causes of CHF, but the three most common are heart attack, high blood pressure, and coronary artery disease. Other conditions that may potentially lead to CHF are disease of the heart muscle (cardiomyopathy), an irregular heart rhythm (arrhythmia), congenital heart disease (a condition you were born with), heart valve disease, and diabetes.

Diagnosing CHF

• Diagnosis:
  Physicians generally diagnose CHF by first reviewing a patient's medical history, followed by performing a series of examinations. One of the first steps a physician takes is using a stethoscope to listen for congestion in the lungs, as well as any indication of an abnormal heartbeat. Risk factors such as high blood pressure and a history of heart disease in a patient's family are also carefully reviewed. The following are a variety of tests recommended by physicians to diagnose CHF. These tests aid doctors in establishing the cause of a patient's symptoms and help them in creating a suitable treatment plan for the individual. CHF is often measured by doctors using a scale of one to four. Class I is the mildest case of CHF, in which a patient can properly function when carrying out everyday activities. Class IV is the most severe case of CHF, in which patients display a shortness of breath and general breathing discomfort even at rest. It is also important to note that each patient is diagnosed individually, and not everyone undergoes the same series of tests.

  Chest X-Ray:
  In congestive heart failure patients, an x-ray image may show the heart to appear enlarged, and in some cases an accumulation of fluid may be visible in the lungs.

  Electrocardiogram (ECG):
  By attaching electrodes to the skin, this test records the electrical activity of the heart. Heart impulses are documented as waves, which are displayed on a monitor and then printed on paper. With the help of this test, doctors are able identify and diagnose heart rhythm problems and damage to the heart that may be the result of an underlying condition such as CHF.

  Echocardiogram (Echo):
  An echocardiogram is basically a detailed ultrasound of the heart. This test utilizes sound waves to create a multi-dimensional video image of the heart. With the help of these images, doctors can determine the pumping capacity of the heart, as well as calculate the patient's EF. An echo also works to determine systolic heart failure from diastolic heart failure.

  Coronary Catheterization (Angiogram):
  An angiogram works by inserting a slim, flexible tube known as a catheter into a blood vessel located in the groin area. The tube is directed through the aorta, the heart's main artery, and into the coronary arteries. Through the injection of a dye into the catheter, the arteries then become visible on an X-ray. With the aid of this test, doctors are able to recognize narrowed arteries to the heart, a condition known as coronary artery disease that can be a potential cause of CHF. An angiogram can also aid in determining the strength of the left ventricle, which is the heart's main pumping chamber, as well as the condition of the heart valves.

  Radionuclide Ventriculography or Multiple-gated Acquisition Scanning (MUGA):
  This test is conducted by injecting a small amount of radioactive dye into a vein. Pictures of the heart are then taken as it continues pumps blood. Similar to an "echo," an MUGA test displays the amount of blood the heart has the capacity to pump with each beat.

  Exercise Testing:
  This test is often used to measure the functional capacity of a heart. Exercise testing helps doctors judge a patient's response to therapy, as well as establish a time line of more advanced treatments if necessary.

  Blood tests:
  Blood samples may be taken to indicate and determine various types of heart diseases, including CHF. Specific blood tests look for the levels of a hormone known as B-type natriuretic peptide (BNP). The heart produces high levels of BNP when it is being overworked, and a substantial amount of BNP in the blood may imply CHF.

Treating CHF

• Although in many cases impairment to heart function is not fully reversible, there are a variety of treatments available that can substantially improve a weakened heart and help it to function with as much efficiency as possible. Certain CHF cases can be treated by fixing the underlying cause. Other treatments may include changes in lifestyle, administering the appropriate medications, the implantation of medical devices such as a pacemaker and implantable cardioverter defibrillator (ICD), as well as surgery. All of these treatments can very often increase a patient's life expectancy and quality of life by improving heart function.

  Changes in Lifestyle
  There are certain changes you can make to your everyday life that can help manage and relieve CHF symptoms. Oftentimes, such changes can prevent the disease from getting worse. Some of the most beneficial lifestyle changes include quitting smoking, losing weight if your doctor has determined you to be overweight, limiting or avoiding caffeine and alcohol intake, following a low sodium diet, exercising regularly under the guidance of your doctor, and participating in activities that promote a stress-free living.

  Medications
  CHF is usually treated with specific medications. As well as being prescribed certain heart-failure medications, doctors may also prescribe nitrates to relieve chest pain, calcium channel blockers to lower blood pressure, or blood thinners used for the prevention of blood clots.

  There are many drugs, which are useful in the treatment of CHF. For a reduced EF, the most common drugs used are:
  1. Angiotensin-converting enzyme (ACE) inhibitors
  This particular groups of drugs is known as the primary drug treatment for CHF. They help improve both the life expectancy and the quality of life in CHF patients. Specific examples of this medication include enalapril, lisinopril and captopril. ACE inhibitors work by lowering blood pressure and helping your heart by reducing its workload.
  2. Beta blockers
  This group of medications work by slowing the heart rate and also lowering blood pressure. These drugs also reduce the risk of certain abnormal heart rhythms, also known as arrhythmia. Beta blockers decrease the symptoms of CHF and improve heart function and quality of life. Coreg, also known as Carvedilol, is the most widely used beta blocker prescribed by doctors to treat mild to severe CHF cases.
  3. Diuretics
  These drugs are also known as water pills. Diuretics work by eliminating excess water and salt from accumulating in the body, causing a patient to urinate frequently. The most commonly used diuretics for CHF are Bumetanide and Furosemide (also known as Lasix). These drugs are also known to make breathing easier by reducing fluid in the lungs. A drug known as spironolactone is a diuretic that can be prescribed to severe CHF patients. Sprinolactone has the ability to increase levels of potassium levels in the blood, uncommon to other diuretics.

  Medical Devices
  Some of the most widely recognized medical devices used to treat CHF include heart pumps, pacemakers, and implantable cardioverter defibrillators (ICDs). A heart pump is most commonly implanted into the abdomen and works by helping a weakened heart pump blood. This device is a great alternative for those patients who are not eligible for a heart transplant.

  A pacemaker is a battery-powered electrical impulse generator that is commonly implanted in the chest and is attached to the heart by three wires. A pacemaker works by sending timed electrical impulses to the heart's lower chambers to treat moderate to severe congestive heart failure. The device paces an individual's heart rate, helping the heart muscle to beat in a coordinated fashion.

  Defibrillators, like pacemakers, are also electrical impulse generators that are implanted in the same fashion as a pacemaker. ICDs are implanted in patients who are at a higher risk of sudden cardiac death. The device is programmed to detect any abnormally fast heart rhythms, and brings a patient's heart rhythm back to normal by delivering a jolt of electricity also known as "therapy" to the heart.

  Surgery
  Certain cases of CHF require surgery. Two of the most common procedures include coronary bypass surgery and heart transplant. A coronary bypass is performed on CHF patients when the condition is linked to severely narrowed or blocked coronary arteries. Doctors perform this surgery by taking a section of a healthy blood vessel from a different area of the body and "re-routing" the blood around clogged arteries to initiate better oxygenated blood flow to the heart. A heart transplant is another surgery performed on patients whose CHF is so severe that they would need to have their heart removed and have it replaced it with a healthy heart from a donor.

Personal Experience

• In April of 2006 I was diagnosed with CHF. Due to an undetermined virus, my heart had enlarged to a an massive size, and my EF had decreased to only 5 percent. My symptoms increased over a two- to three-week period, and I suffered from shortness of breath, indigestion, nausea, extreme fatigue, and trouble sleeping. I couldn't walk from one end of the room to the other without feeling like I had run a marathon. My feet and abdomen were swollen, and I was 10 pounds over my normal weight. When I went to the doctor, the nurse immediately realized that something was wrong when my ECG showed my resting heart rate to be 135 beats per minute. I was immediately admitted to the hospital, and underwent a series of tests, which all pointed to CHF. I spent over a month in the hospital and was implanted with a defibrillator, which I still have today. I was prescribed six different medications including drugs to strengthen the heart muscle, a blood thinner, duiretics, ace inhibitors, and beta blockers.

  With the appropriate lifestyle changes, medication, and good blessings, my heart continues to improve, and my EF has now increased to 51 percent. I am down to two medications, Coreg and Lisinopril, both of which work to improve my quality of life and help me live longer.