Heart Failure Heart failure is a progressive disorder in which damage to the heart causes weakening of the cardiovascular system.

It manifests by fluid congestion or inadequate blood flow to tissues. Heart failure progresses by underlying heart injury or inappropriate responses of the body to heart impairment. Heart failure may result from one or the sum of many causes. It is a progressive disorder that must be managed in regard to not only the state of the heart, but the condition of the circulation, lungs, neuroendocrine system and other organs as well. Furthermore, when other conditions are present (e.g. kidney impairment, hypertension, vascular disease, or diabetes) it can be more of a problem. Finally, the impact it can have on a patient psychologically and socially are important as well. Heart failure is a cumulative consequence of all insults to the heart over someone's life. It is estimated that nearly 5 million Americans have heart failure. The prevalence of heart failure approximately DOUBLES with each decade of life. As people live longer, the occurrence of heart failure rises, as well as other conditions that complicate its treatment. Even when symptoms are absent or controlled, impaired heart function implies a reduced duration of survival. Fortunately, many factors that can prevent heart failure and improve outcome are known and can be applied at any stage. Hallmarks of Heart Failure Fluid Congestion If the heart becomes less efficient as a pump, the body will try to compensate for it. One way it attempts to do this is by using hormones and nerve signals to increase blood volume (by water retention in the kidneys). A drop in blood flow to the kidneys will also lead to fluid retention. Blood and fluid pressure backed up behind the heart result in excess salt water entering the lungs and other body tissues. However, it is important to note that not all swelling due to fluid retention is a reflection of heart failure. Clinical symptoms due to fluid congestion:

shortness of breath edema (pooling of fluid in lungs and body)

Reduced Blood Flow to the Body The heart's inability to pump blood to the muscles and organs isn't always apparent in early stages of heart failure. Often times, it is unmasked only during increases in physical activity. In advanced heart failure, many tissues and organs may not even receive the oxygen they require for functioning at rest.

Clinical symptoms due to poor blood flow to the body:

difficulty exercising fatigue dizziness (due to low blood pressure)

Heart Failure Classifications The symptoms and physical changes of heart failure have several different classifications based on their location and mechanism. Right vs. Left Sided Heart Failure 1. Right Heart Failure - The inability of the right side of the heart to adequately pump venous blood into the pulmonary circulation. This causes a back-up of fluid in the body, resulting in swelling and edema. 2. Left Heart Failure - The inability of the left side of the heart to pump into the systemic circulation. Back-up behind the left ventricle causes accumulation of fluid in the lungs. As a result of those failures, symptoms can be due to: 1. Forward Heart Failure - The inability of the heart to pump blood at a sufficient rate to meet the oxygen demands of the body at rest or at exercise. 2. Backward Heart Failure - The ability of the heart to pump blood at a sufficient rate ONLY when heart filling pressures are abnormally high. 3. Congestive Heart Failure - Fluid in the lungs or body, resulting from inadequate pumping from the heart and high heart filling and venous pressures. Prevention Hygienic Approaches By choosing a healthy lifestyle you can improve the way you feel as well as lead a fuller life. A healthy diet and exercise regimen will help you stay active and feel your best. Check out our dietary guidelines and use our daily weight chart to keep track of your weight. Doctor Visits A visit to your doctor need not be a stressful experience. Your doctor is there to help you feel better and to monitor your progress. You can help your doctor and yourself out by reporting any symptoms you have, and being specific about when they occurred and how you felt. Find out 10 ways you can be a "good patient". Medical Treatments Medications or surgical procedures may be the best way to reduce your symptoms of heart failure and improve your long term outcome. There are various drugs and

surgical procedures used to treat heart failure. Keep in mind that many treatments do not require hospitalization. Remember that medical treatments should always be complemented with a healthy lifestyle. Lifestyle It's your lifestyle Choosing a healthy lifestyle means avoiding smoking, restricting alcohol to no more than a glass of wine per day, maintaining a healthy weight, and making use of social support structures. Your emotional health is also important in coping with heart failure. Your family and friends can provide support and allow you to voice any emotions you may be feeling. Communicating with others is a good way to rid yourself of fears and apprehensions about heart failure. Diet A diet low in salt and fat can help your circulation stay in balance. Additionally, avoiding excess fluid intake is also useful. With heart failure due to coronary artery disease, a diet keeping cholesterol levels under control is important. A dietitian can help you design a personalized diet that will improve the way you feel. If your heart failure is advanced, you may actually be losing muscle weight (cardiac cachexia)and may go unrecognized because you are gaining fluid weight. You may feel too weak or short of breath to prepare and eat regular meals. If you are consistently losing weight try a high calorie, high protein diet. Also try eating smaller more frequent meals. Click here for more details. Exercise Just because you are diagnosed with heart failure does not mean that you cannot remain active. In fact, moderate aerobic exercise is an integral part of improving stamina and quality of life. Activities such as walking or stationary biking 20-30 minutes once or twice a day can strengthen your muscles, heart, and cardiovascular system. Specific exercise prescriptions can be given by a qualified exercise physiologist. Procedures and Surgeries

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Percutaneous Transluminal Coronary Angioplasty (PTCA) In some cases coronary arteries are too severely blocked for medical treatment alone. Your doctor may suggest a revascularization procedure such as angioplasty or stenting.

During an angioplasty, a catheter with a balloon on the end of it is threaded up to the arteries that supply the heart. The heart and it's blood vessels are imaged by an x-ray machine while this is done. This way, the doctor can see exactly what area of the coronary artery is narrowed. The balloon is then positioned in that area and inflated to open the artery. To see a graphical representation of this, please click here. If the blood vessel is large and may re-narrow after the procedure, a stent may be used. A stent is a hollow slotted tube that is threaded on a balloon catheter and placed in the coronary vessel at the place of narrowing. There is a chance that the stented area may narrow with time but it is less than with balloon angioplasty alone. Pictures of the stenting procedure can be viewed here. Coronary Artery Bypass Graft Surgery The coronary artery bypass graft or CABG procedure involves using an artery in the chest wall or removing veins from the legs and grafting them to coronary arteries. A healthy vessel is used as a detour around the diseased area. In this way, the narrowed area of the coronary artery is bypassed and blood flow to the heart muscle redirected. Valve Surgery Severely blocked or leaky heart valves can be repaired or replaced by a heart surgeon during an open heart operation. Tissue valves (usually from pigs) often do not require the patient to take blood thinners. Mechanical valves can last longer than tissue valves but do require blood thinners. Heart Transplantation In end stage heart failure, the best option may be replacing your worn out heart with a new one. Unfortunately, there are fewer donor hearts than are needed by patients. Because of the shortage of donors, heart transplant recipients may wait months or years for a new heart. Currently, cardiac transplantation survival in appropriate individuals is 95% perioperative, 85% one year after transplantation, and 65% five years after transplantation. LVAD

Some patients not candidates for heart transplant, may benefit from placement of a left ventricular assist device. Treatment Heart failure and other cardiac disorders are hot areas of research. With so many new drugs and emergent technologies becoming available, it is critical that you educate yourself on what is available to you. Building a basic knowledge of the types of drugs and treatments that are now used as well as how they work will facilitate your learning process. Outpatient treatments Your doctor can prescribe several treatments for heart failure that do not require hospitalization. These treatments include diuretics, ACE inhibitors, vasodilators, beta-blockers, digitalis, and anticoagulants. Inpatient treatment In cases of advanced heart failure, your doctor may choose to keep you in the hospital for close supervision. He or she may prescribe intravenous (IV) medications since some medications are not active when taken orally. Compliance It is important to follow your doctor's instructions carefully. Don't alter the dosage of your medications or stop any medication suddenly. Keep follow-up appointments and inform your doctor of any new symptoms. Procedures and Surgeries Your doctor may suggest surgical treatment for your heart failure. Many of the options available are relatively non-invasive procedures. When called for, however, there are many more aggressive surgeries that can be used. Possible options are angioplasty, coronary bypass surgery, valve surgery, or heart transplantation.

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