Congestive heart failure's cause varies

Congestive heart failure refers to a large number of conditions that affect the structure or function of the heart, making it more difficult for the heart to supply sufficient blood flow to meet the body's needs.

Dr. Michael E. Silverman of Cardiovascular Specialists of Central Maryland and chief of medicine at Howard County General Hospital writes about the causes of and treatments for the problem.

•Congestive heart failure occurs when one or more of the heart's chambers loses the ability to maintain proper blood flow. This can happen because the heart can't fill well enough with blood or because the heart can't contract strongly enough to propel the blood with enough force to maintain proper circulation. In some people, both filling and contraction problems can occur.

•Major risk factors for developing congestive heart failure include high blood pressure and coronary artery disease. Certain viral infections and substance abuse are also risk factors. Heart valve problems, sleep apnea, and diabetes can lead to congestive heart failure as well.

•The most common signs and symptoms of heart failure are shortness of breath or trouble breathing; fatigue, tiredness, malaise; and swelling in the ankles, feet, legs, and abdomen.

Breathing problems can manifest in several ways. If you are out of breath just from walking stairs or doing simple activities, you have what doctors call "dyspnea." If you wake up at night and are breathless, you have "paroxysmal nocturnal dyspnea." If breathlessness occurs when you're lying flat, you may feel the need to sit up or be propped up with pillows. This inability to breathe easily unless sitting up straight or standing erect is called "orthopnea."

•It should be noted that some heart failure patients have exercise intolerance but little evidence of fluid retention, whereas others complain primarily of swelling and report few symptoms of dyspnea or fatigue. When fluid buildup is present, there also may be weight gain, increased urination, and a cough that worsens at night and/or while lying down.

•An individual with heart failure should first focus on lifestyle changes. Controlling high blood pressure and weight are critical to improving the disease. Your diet should be low in sodium or salt, which not only helps with blood pressure levels but can also help reduce swelling (edema) in your legs, feet, and abdomen. Aerobic exercise (walking, swimming, biking, etc) is very helpful.

Medications are the mainstay of therapy and include diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, vasodilators, aldosterone antagonists, and Digitalis.

Biventricular pacemakers, left ventricular assist devices, and even transplantation are beneficial in a select group of patients with CHF.



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