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FirstHealth of the Carolinas
Congestive heart failure By Dick Broom
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Congestive heart failure

If you are in the hospital, but not for surgery or to have a baby, then you are probably over 65. And you are very likely in the hospital because of congestive heart failure.

Heart failure, in medical terms, doesn’t mean that your heart has stopped beating. It means your heart is failing to function properly. It isn’t pumping blood out to the other organs and the rest of the body as efficiently as it should.

That can lead to blood backing up into the lungs and fluid seeping out of the bloodstream to cause lung congestion. This is what is known as congestive heart failure.

“When the lungs become wet, they have less ability to exchange oxygen, and that translates to shortness of breath, which is the main symptom of congestive heart failure,” says Olujide Lawal, M.D., a cardiologist with Sandhills Cardiology in Rockingham.

“I used to tell medical students that the heart does just two things: It pumps and it relaxes. A failure to do either one adequately can cause congestive heart failure.”

A common misconception is that only people with weak hearts have congestive heart failure, says Joseph Hakas, M.D., a cardiologist with Pinehurst Medical Clinic.

“It is actually fairly common to have a strong heart that is inefficient,” he says. “Perhaps 40 percent of people with congestive heart failure have hearts that contract normally. It’s the relaxing they have problems with.”

That is frequently the case in people with high blood pressure.

“When the heart muscle is having to work against the blood pressure, it gets thicker, just like any muscle would,” Dr. Hakas says. “It may squeeze well, but it won’t relax properly.”

What causes heart failure?
Coronary artery disease is the number one cause of heart failure. When one or more of the arteries carrying blood to the heart is narrowed by the buildup of plaque, the heart doesn’t get enough blood. Over time, that weakens the heart to the point that it begins to pump sluggishly.

If a section of the heart becomes so starved of blood that some of the heart tissue starts to die, that is a heart attack, which is another cause of congestive heart failure.

The heart also can be weakened by viruses, excessive alcohol use, thyroid disease and certain inflammatory problems of the heart muscle. Physicians can diagnose pre-symptomatic heart failure with electrocardiograms (EKGs) and congestive heart failure with blood tests.

Olujide Lawal, M.D.
 
Joseph Hakas, M.D.

If someone is diagnosed with heart failure but doesn’t have symptoms, he or she often can be treated effectively with medications without having to be hospitalized. Congestive heart failure often requires at least a few days of hospital care.

“The first thing we want to do is relieve their shortness of breath,” Dr. Lawal says. “So, while they are still in the Emergency Department, we give them diuretics to reduce the volume of fluid the heart has to pump and allow their wet lungs to dry.”

After that, physicians often give patients medications to suppress the production of adrenaline. Adrenaline causes the heart to beat faster and the arteries to constrict, so blood pressure goes up.

“If we block that effect, the blood pressure stays low and the heart rate slows down, so it gives more time for the heart to fill between beats,” Dr. Hakas says. “This reduces mortality, too, partly because it helps prevent heart rhythm problems. People with weak hearts, in particular, are prone to dying from rhythm disturbances.”

If someone’s heart failure is caused by a viral infection, thyroid disease or alcohol, the heart can sometimes be restored to normal health by eliminating the underlying problem. But in most cases—that is, when heart failure is caused by coronary artery disease or high blood pressure—the damage can’t be reversed.

“In most patients, it isn’t curable, but we can often manage it pretty well,” Dr. Hakas says. “If we keep their blood pressure low, the heart can become efficient again so, in a sense, their congestive heart failure is fixed. But they remain on blood pressure medication so that it doesn’t happen again.”

Excess weight and salt
Two of the greatest threats to people who are at risk for heart failure are excess weight and excess salt.

“The more obese you are, the higher your risk of developing hypertension and diabetes, which can lead to heart relaxation failure,” Dr. Lawal says. Salt causes the body to retain fluid, which increases the volume of blood and puts a greater burden on the heart.

“It’s very common for us to pinpoint salty food as the trigger when people come into the hospital with congestive heart failure,” Dr. Hakas says. “We see a lot of that a few days after Thanksgiving and Christmas. They have done really well with their diet, but then they go to a relative’s house for the holiday and have a big, salty meal.”

According to Dr. Hakas, the average American diet contains too much salt and is much higher in salt than someone with heart failure can tolerate.

“We can have you on the perfect combination of medicines,” he says, “but if you’re eating the wrong foods with too much salt, you’re going to get into trouble.”

FirstHealth of the Carolinas offers a special program for patients with congestive heart failure. For more information, call (800) 213-3284.