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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Heart attack symptoms? Don't wait

If you saw someone experiencing symptoms of a heart attack, what would you do? Most likely, you would call 911. But if you're a woman and thought you were having a heart attack, your response would probably be different.

Women often hesitate or fail to call 911 when they experience heart attack symptoms. Most women feel they are not really having a heart attack, do not want to raise a false alarm or self-diagnose themselves as having heartburn or other minor health issues.

Women might not even realize they are experiencing a heart attack. Some common symptoms for women are unusual fatigue, shortness of breath, weakness or inability to perform daily activities, nausea, sleep disturbances and indigestion. However, some warning signs are ignored as non-cardiac, such as a burning sensation in the back, arms, shoulders or teeth.

Any intense complaint that is above the waist should be taken seriously as a possible heart attack. Many doctors say that a woman's perception of heart disease may be her biggest risk factor of all.

Minutes matter when a heart attack occurs because every second is critical, as blocked coronary arteries prevent blood from reaching oxygen-starved heart muscle. Women should call 911 first and then chew on an aspirin. Aspirin can improve the chance of survival by reducing the size of the clot (if present) in the coronary artery. By calling 911, assessment begins rapidly on the way to the hospital. The EMS crew can alert the hospital's cardiac team of your arrival and can immediately begin treatment to open the blocked artery that is causing the heart attack. It is also important to remember to never drive to the emergency room because you won't get valuable care that you would otherwise receive from the EMS crew, and you put yourself and other drivers at risk of a crash.

Women must remember to never take a wait-and-see approach to a possible heart attack. The longer you wait, the more damage a heart attack can cause. As the adage goes, it's better to be safe than sorry. Always call 911.


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Getting a second chance

When your young, especially when you're in your 20s, you feel invincible. You feel you can do anything and you expect a lot of things - go to college, get a job, get married, have fun, go to parties, drink beer. You expect you have the world ahead of you, stretched and limitless.

You never expect it could end. You ask yourself, I'm young, energetic and strong. Heart Attack is out of the question. Well, that's the mindset of a young graduate student that is being featured in this blog.

Graduate student Lee Kluck found out that just because you're young, it doesn't mean you're invincible. After having a heart attack at the age of just 28, Kluck had to turn his life around and figure out how to put it back together again.

"It really changes your outlook on things when the surgeon comes up to you and tells you that you've had a heart attack and it should've killed you," said Kluck. "It was a total shock to the system."

It all began on just an average day last spring.

"One day on the way to class my shoulders went slack and I noticed throughout that next week I started having chest pain," he said. "But because it wasn't radiating down the side of my body and I wasn't having cold sweats, I waited about a week before going in to [Student] Health Services. I finally did, though, and they hooked me up to an EKG and consulted a cardiologist. But they told me it wasn't serious and sent me home."

Unfortunately, the pain only got worse.

"Finally on the morning of March 11, I went to the emergency room at Sacred Heart Hospital," he said. "After running tests, they came in and said, as I like to joke, 'Congratulations! You've had a heart attack!'"

After the heart catheterization the next day, a procedure where plastic tubing is inserted into a vein or artery and is advanced to the heart, the doctor said if a blockage was found, then they'd perform a stint, which is a ballooning of the blocked artery, he said.

"Now, I'm awake for the heart catheterization, and they're showing me the different arteries on the screen … and show me that there was a blockage on the backside of my heart, in the left main artery," he said.

After consulting with other doctors, they decided that the only option was open-heart surgery, he said.

"I remember thinking back to the previous Christmas," he said. "I remember telling myself, 'you are 310 lbs. and you are not 22 years old anymore. You need to get in shape, because if you don't you're going to have a heart attack, sooner rather than later.' So I had started walking two miles a day and was trying to curb some of my less savory eating habits."

But the doctor told him that his heart had been working overtime for too long, he said.

"My surgeon and his physician's assistant came in to see me after the procedure, and my surgeon said, 'They tell me you know a little bit about the Navy,'" he said.

Being a Masters student in naval history, Kluck certainly did ­­- devoting his time to studying U.S. Naval Aviation in the Korean War - his way of contributing, he said. So he was, in a way, prepared for his surgeon's direct demeanor.

"My surgeon was a Captain in the Naval Reserve and his physician's assistant is a retired Major in the Airforce and was a combat rescue officer," he said. "And my surgeon says, 'I'm going to give it to you like I give it to those people - blunt, informative, and forward - we need to cut you open. You need between one and three bypasses done."

After getting a few hours to let the information soak in, Kluck decided to go through with the surgery, despite the risks that it could either cause excessive bleeding, stroke, or death, he said. And after six hours on the operating table and a double bypass, Kluck woke up in the Critical Care Unit of Sacred Heart Hospital.

Then began his long recovery, with the knowledge that things would never be the same.

"After spending over three weeks in the hospital, I was finally sent home," he said. "I had to withdraw from school and move back home to heal. I had a diet of basically veggies, brown rice, and white meat and a scar that ran from my neck to the top of my belly. I was in unbelievable pain."

So Kluck began the steps he needed to take to start his new life.

"Before I could get into shape, I had to build up my stamina again," he said. "I started walking on a treadmill and started off being able to only walk for about seven minutes before getting exhausted."

But Kluck sticks to his diet and keeps up the exercise - his life depends on it.

"The surgeon said that in five to 15 years, I'll need to have surgery again," he said. "I'm doing everything I can to push that date out. It's my turn to work hard to keep myself healthy because all of the doctors and nurses worked so hard to help me. If I don't, I'll feel like I've let them down."

And even after this traumatic event, Kluck decided to go right back to school the very next semester.

"A lot of who I am has changed even," he said. "I used to have problems sharing opinions. Now I always share what's on my mind. Because when it comes down to it, nothing's as tough as that moment when they look at you and tell you you've had a heart attack and shouldn't be here."

Continuing work on his thesis in U.S. Naval history, Kluck definitely has been given a second chance.

"It was a traumatic experience, but it was a good thing, too, because now I have a new appreciation for life and made the necessary changes to protect it," he said. "Every day's a great day because I'm here."


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Inhaling a Heart Attack: How Air Pollution Can Cause Heart Disease

University of Michigan tests show short-term exposure to fine particle air pollution
can drive up high blood pressure, raise risk of heart attack.

It's well known that measures such as exercise, a healthy diet and not smoking can
help reduce high blood pressure, but researchers at the University of Michigan Health System
have determined the very air we breathe can be an invisible catalyst to heart disease.

Inhaling air pollution over just two hours caused a significant increase in
diastolic blood pressure, the lower number on blood pressure readings,
according to new U-M research.

The study findings appear in the current issue of Hypertension, a publication
of the American Heart Association.

Nearly one in three Americans suffer from hypertension, a significant health
problem that can lead to heart attack, heart failure, stroke, and other
life-threatening problems.

"Although this increase in diastolic blood pressure may pose little health
risk to healthy people, in people with underlying coronary artery disease this
small increase may actually be able to a trigger heart attack or stroke," says
Robert D. Brook, M.D., lead author and vascular medicine physician at the U-M
Cardiovascular Center.

In the study, researchers hoped to identify which air pollutants are harmful
and how the pollutants work to damage the cardiovascular system.

Eighty-three people in Ann Arbor and Toronto were involved in testing and
breathed air pollution, concentrated by a mobile air quality research
facility, that was similar to what would be found in an urban environment near
a roadway.


"We looked at their blood vessels and then their responses before and after
breathing high levels of air pollution," explains Robert Bard, M.S., overall
research project manager.

Ozone gases, a well-known component of air pollution, were not the biggest
culprit. Rather, small microscopic particles about a 10th of the diameter of a
human hair caused the rise in blood pressure and impaired blood vessel
function, tests showed. The blood pressure increase was rapid and occurred
within two hours, while the impairment in blood vessel function occurred later
but lasted as long as 24 hours.

It's believed these fine particles deposit deep into the lungs and certain
components may gain entrance to the blood stream, or cause an inflammatory
response throughout the body.  There is also evidence that functions in the
body's nervous system are also disrupted.

The research is the latest in the relatively new field of Environmental
Cardiology which looks at the association between air pollution and heart
disease. Brook says that at the very least the findings support efforts to
maintain current ambient air quality standards set by the Environmental
Protection Agency.

"It really bolsters and strengthens the importance of maintaining air quality
for human health," says Brook.

There are practical ways to avoid exposure to high levels of air pollution,
such as avoiding unnecessary travel or commutes and not exercising during rush
hour, or near busy roadways, Brook says. In modern society, the burning of
fossil fuels is the primary source for air pollution.

"If air pollution levels are forecasted to be high, those with heart disease,
diabetes or lung disease should avoid unnecessary outdoor activity," he says.


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