Congestive Heart Failure

Overview

As with any chronic illness, heart failure is best controlled by early diagnosis and prevention. Some heart failure is idiopathic (another name for "cause unknown"), but in many cases, lifestyle is a major factor.

One additional note: Claims that women are less vulnerable to heart failure than men are untrue. Heart failure affects women and men equally, so both men and women need to be aware of the condition and how to prevent it from occurring or progressing.

This section discusses heart failure and:

• Coronary artery disease and heart attack
• Damage to the heart valves or a heart murmur
• Heart enlargement
• High blood pressure
• Diabetes
• The family link
• Women

Congestive heart failure and coronary artery disease

Coronary artery disease can cause damage to your heart muscle, which, in turn, may cause heart failure. So think of angina or a prior "coronary event," such as a heart attack, as a timely warning that you need to stop your CAD from progressing and causing further damage.

For starters, remake your lifestyle. High blood pressure, high blood levels of lipids (LDL, total cholesterol, and triglycerides), diabetes, smoking, and obesity are risk factors for coronary artery disease. The prescription:

• If you smoke, stop or at least cut down.
• Exercise on most days.
• Get your cholesterol checked regularly, and treat high blood levels.
• Lose weight if you are overweight.
• Eat a diet low in fat, particularly trans fats.
• Control high blood pressure and diabetes.
• Take the medications your doctor prescribes to improve the function of your heart and stop further damage.
• Consider coronary artery bypass surgery or an interventional procedure to treat narrowed blood vessels.
• See your doctor for regular follow-up visits. Consult a heart specialist (cardiologist) in addition to your primary-care physician for the purpose of adding preventive medications.

Heart failure and valve disease

The heart's valves ensure that blood flows in one direction through the heart. Heart valve disease causes the valves either to not close properly (resulting in a leaky valve) or to not open fully (resulting in a narrowed valve opening). Both types of valve disease cause the heart to work harder, which over time may lead to heart failure.

Heart valve disease is caused by infection, congenital heart disease, and aging. The decision to prescribe medical treatment or proceed with surgical repair or replacement is based on the type of valve disease you have, the severity of the damage, your age, and your medical history.

Heart failure and an enlarged heart

An enlarged heart, also called dilated cardiomyopathy, is an increase in the size of the heart. Your doctor may notice this during a physical exam or chest X-ray. One cause of an enlarged heart is a condition that causes the heart to work harder, such as hypertension or valve disease. An enlarged heart puts you at risk for heart failure. Your doctor will evaluate you to determine why your heart has grown bigger and will treat you to improve heart function as well as to prevent further progression.

Heart failure and high blood pressure

Untreated high blood pressure, or hypertension, can lead to an enlarged heart and heart failure. In addition, hypertension is a risk factor for heart disease, stroke, peripheral vascular disease, kidney disease, and hemorrhages in the blood vessels of the eye.

If you are "prehypertensive" or have high blood pressure you will need to:

• Eat foods low in fat and salt, and rich in fruits, vegetables, and low-fat dairy products
• Lose weight if you are overweight
• Limit your intake of alcohol
• Exercise regularly
• Quit smoking
• Take high blood pressure medicine if your doctor prescribes it. There are several types of medications for treating high blood pressure. Your physician will base your therapy on blood pressure readings and your other medical conditions. Medications must be taken regularly and in the correct dosage; studies show that blood pressure drugs are the most ignored of all prescribed medications. How important is it to get your blood pressure numbers down? The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) noted in its recent report that 55-year-old individuals with blood pressure of 115/75 mm double their risk of developing cardiovascular disease with every rise of 20 mm in systolic pressure and 10 mm in diastolic pressure. You can learn more about the JNC7 guidelines at: http://www.nhlbi.nih.gov/hbp/index.html

Congestive heart failure and diabetes

Diabetes is a risk factor for coronary artery disease, which can lead to heart failure. But diabetes itself also is a risk factor for both systolic and diastolic heart failure, and the risk of heart failure rises with poor control of blood sugar, so individuals with diabetes need to pay close attention to controlling blood sugar.

If you have diabetes, keep the condition under control with diet, exercise, faithful monitoring of blood glucose, and other measures recommended by your doctor. The hemoglobin A1c test, often called the "diabetic report card," provides an average blood sugar level over two to three months. Your result should be less than 7 percent if you have diabetes and less than 6 percent if you do not. Your doctor may ask to check your blood sugar with a glucose monitor several times each day. Give your doctor written records of your monitor's reports.

Take your medicine at the time and in the dosage your doctor recommends. You may need to take oral medication or insulin injections for improved control. Resist the temptations of fast food, bakery windows, and dinner-party indulgences; your diabetic diet may be your best protection against heart failure. A diabetic specialist and a nutritionist can help you control your diabetes and ward off heart failure.

Congestive heart failure and the family link

If any first-degree relatives (parents, siblings, or children) have or had diabetes, kidney disease, high blood pressure, coronary artery disease, cardiomyopathy, or other heart problems, you and your doctor need to be on the lookout for early signs of these conditions so steps can be taken to ward off heart failure. Parents with these conditions, whether or not they have heart failure, need to be aware that many of these are at least partly inherited. In these families especially, creating a healthful home is vital to preventing future illness.

Heart failure and women

About 2.5 million women in the United States have heart failure, and they account for nearly half of all hospital admissions for the disease. Many features of the disease are similar in women and men, but there are important differences:

• Women tend to develop congestive heart failure at an older age than do men.
• Women tend to develop diastolic heart failure with a more normal ejection fraction than do men. (Ejection fraction is the measurement of how much blood is being pumped out of the left ventricle of the heart.) Heart failure can occur as a result of a weakened heart muscle (systolic heart failure) or a stiff, inflexible heart muscle (diastolic heart failure). The causes of heart failure in women are often linked to high blood pressure and diabetes mellitus.
• Although the signs and symptoms of heart failure are the same in men and women, women tend to have more symptoms (such as shortness of breath and difficulty exercising) than do men.
• Women generally survive longer than men with heart failure, but they have more difficulty performing normal daily activities than do men.
• Depression associated with heart failure is more common in women than in men.
• Although rare, peripartum cardiomyopathy is a cause of heart failure unique to women. Peripartum cardiomyopathy is the rare development of heart failure within the last month of pregnancy, or within five months after delivery. Peripartum cardiomyopathy occurs without an identifiable cause.

While there is still much to learn about the diagnosis and treatment of heart failure in women, the goals of treatment are the same for men and women: symptom relief, preventing progression of the condition, and improving quality of life. Treatment options also are the same for women and men, including lifestyle changes, medications, devices, and surgery.