MARK GARDNER, MD
Heart failure, also known as congestive heart failure (CHF), is not the stopping of the heartbeat. Rather, it is the medical diagnosis of a family of conditions whose common consequence is a deficit in cardiac performance, thus failing to maintain the energy needs of the body’s organs.
Common manifestations of CHF are shortness of breath and fluid retention, as well as fatigue and weakness. Heart failure can be chronic or can start suddenly. Sudden heart failure is dramatic and very frightening for a patient, and will almost always result in a call to 911 and a trip to the emergency room. Partially compensated chronic heart failure patients may have much more subtle nonspecific complaints such as “I’m more tired than usual”, lack of appetite, and / or shortness of breath when lying flat. .
Congestive heart failure is an important part of medicine. Some facts about CHF in the United States: More than 6 million Americans have CHF (a quarter of patients are under 60) and the prevalence is increasing.
The aging of the American population, the prolongation of the life of heart patients through modern therapeutic innovations, and the increased survival of a number of patients with chronic diseases have led to an increase in the incidence of CHF. .
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It is the most frequent reason for hospitalization in people over 65 years of age. There are more visits to doctors and hospitals for CHF than for all forms of cancer combined. The healthcare cost of CHF is estimated to exceed $ 30 billion per year, and it will double by 2030.
In addition to the morbidity and financial hardship it can cause, a CHF diagnosis leads to a shortened life expectancy, with most studies showing an average survival of only 50% of patients five years after diagnosis. Sudden death is also increased, up to five to ten times compared to the general population.
“OK, Dr Mark, this is serious, we understand… let’s listen to the advice!” “
First of all, it’s a good idea to understand some basic risk factors for CHF and modify any modifiable risk factors.
The biggest risks for CHF are coronary artery disease, hypertension, smoking, excessive alcohol consumption, physical inactivity, diabetes, sleep apnea and obesity.
I have written about coronary heart disease in a number of previous columns, discussing early diagnosis and aggressive guideline-based blood pressure and cholesterol management to improve prognosis.
Adopting a healthy, active lifestyle, along with regular exercise, proper nutrition, limiting fat intake, and maintaining ideal body weight will reduce the chances of developing or improve a number of these conditions.
Then, if heart failure is diagnosed, along with immediate treatment to resolve CHF, it’s time to have a cardiologist do a full assessment to identify the cause. It is important to build a lasting patient-doctor relationship with a cardiologist (optimally) as treatment will likely require repeated visits to maintain health.
Determining the cause of a patient’s CHF is the first main step since it will directly inform treatment choices. For example, if a problem with one of the heart valves is the etiology, then in addition to medication and lifestyle adjustments, a heart valve repair or replacement procedure is most likely needed.
Some causes of heart failure should get better on their own: Broken heart syndrome, also called Takotsubo cardiomyopathy (also called “stress” cardiomyopathy) usually goes away completely within four weeks.
Postpartum cardiomyopathy, a condition in which CHF and weakness of the heart muscle begins from the last month of pregnancy to the first six months after childbirth, usually resolves and lasts from two to four weeks for up to a year .
If tachycardia due to poorly controlled atrial fibrillation (AF), the most common heart rhythm disturbance in adults, causes heart failure, then aggressive treatment of AF is essential.
There are too many aetiologies of heart failure to elucidate in this week’s column. My point is that any reversible cause must be found after haste. Prompt intervention for valvular heart disease or AF can have a huge benefit in quality of life and improve life expectancy.
If heart failure isn’t going to resolve on its own or with a definitive procedure, then the care partnership that I have struck up before is vital. The patient with heart failure should be prepared for a series of office visits to initiate and titrate a combination of drugs to treat CHF. Advances in therapy over the past 10 years have effectively reduced relapses of heart failure, cutting repeat hospitalizations by two-thirds and halving mortality.
Treatment regimens for heart failure have seen major breakthroughs over the past 25 years. In addition to a diuretic to manage volume and fluid buildup, the first-line treatment for heart failure involves two other major classes of drugs: preferably carvedilol or long-acting metoprolol).
To this basic “cocktail”, mineralocorticoid receptor antagonists are sometimes an adjunct, and the nitrates / hydralazine combination has a role in patients who cannot tolerate the first-line treatment. State-of-the-art treatment for CHF, essential for recovery and improved prognosis, will require weeks and sometimes months of medication monitoring and “tuning”, often involving repeated lab work, repeated chest x-rays, and heart ultrasounds (also called “echo”). It takes time and a good partnership between the provider and a patient to optimize treatment for CHF. Every effort is worth it: Referral care is the key. key to improving quality of life and prolonging survival in heart failure.
It is also a moment of self-management. A key to success, besides observing all doctor’s visits, lab appointments, etc., is lifestyle modification in the form of low salt (less than 3 grams per day ), low fat / low cholesterol (less than 7% fat, less than 200 mg of cholesterol per day). Stay physically active and fit, and watch carefully for fluid buildup in the form of unexpected weight gain. Once “dry weight” is established, monitoring daily weight and making sure it stays within 3 to 4 pounds of the baseline has been shown to be particularly effective in preventing cardiac decompensation.
My mantra to my CHF patients has always been, “Take your meds, avoid salt, and keep a daily weight diary.” Please call me if your weight has increased 3-4 pounds in a week no matter how well you feel.
Stay informed, stay active and enjoy the fall season, Napa Valley!
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Dr. Mark Gardner is a retired Napa Valley-based cardiologist who contributes a monthly column to the Napa Valley Register. Please send questions and comments to her through Editor-in-Chief Sasha Paulsen, [email protected]