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Coronary Heart Disease

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Heart Failure

Symptoms

Severe fatigue and weakness.

Irregular or rapid heartbeat.

Shortness of breath and wheezing after limited physical exertion. In advanced cases shortness of breath occurs even at rest, and attacks of severe breathlessness disturb sleep (left-sided failure).

Dry cough or cough that produces frothy or bloody sputum (left-sided failure).

Frequent urination during the night (right-sided failure).

Swelling of the ankles and feet, or swelling in the lower back if the patient is bedridden (right-sided failure).

Rapid weight gain due to fluid retention (right-sided failure).

Abdominal pain and a feeling of fullness (right-sided failure).

Swollen neck veins (right-sided failure).

Loss of appetite (anorexia); nausea and/or vomiting.

General feeling of poor health.

Anxiety; in severe cases irritability, restlessness, and mental confusion may occur.

When To Call Your Doctor

Call an ambulance immediately if you experience severe breathlessness.

Call an ambulance if you experience crushing chest pain with or without nausea, vomiting, profuse sweating, breathlessness, weakness, or intense feelings of dread. Such symptoms may indicate a heart attack.

Make an appointment with a doctor if you regularly experience fatigue and shortness of breath after mild physical activity.

Call a doctor if you experience any of the following during treatment for heart failure: fever, rapid or irregular heartbeat, wheezing, severe shortness of breath, or any worsening of the other symptoms of heart failure.


What Is It?

Heart failure is a serious condition marked by the inability of the heart to pump enough blood to meet the body’s oxygen demands. Heart failure can result from either a reduced ability of the heart muscle to contract or from a mechanical problem that limits the ability of the heart’s chambers to fill with blood. When weakened, the heart is unable to keep up with the demands placed upon it; blood returns to the heart faster than it can be pumped out so that it gets backed up or congested—hence the name of the disorder.

The heart attempts to compensate in a number of ways. It beats faster and expands somewhat more than usual as it fills with blood, so that when it contracts, more blood is forced out to the body. In addition, the decreased volume of blood reaching the kidneys causes them to stimulate a hormonal cascade called the renin-angiotensin system, which results in the retention of sodium and water. These efforts help meet the body’s demands in the short term, but they ultimately have deleterious long-term effects. Faster beating allows less time for the heart to refill after each contraction, and less blood ends up being circulated. Also, the extra effort increases the heart muscle’s demand for oxygen; if this need is not met adequately, heart rhythm can become dangerously erratic and ultimately fatal.

Heart failure can occur in the left side of the heart, the right side, or both sides. Left-sided failure is most common. It leads to increased pressure in the pulmonary veins in the lungs, which forces fluid into the surrounding alveoli, the microscopic air sacs that transfer oxygen to the blood. As the alveoli fill with fluid, they no longer function properly, which limits the amount of oxygen available to the body and produces the most characteristic symptoms of heart failure: fatigue and shortness of breath. In right-sided failure, the increased pressure in the veins returning blood to the heart from the rest of the body combined with the compensatory retention of sodium and water leads to fluid accumulation and swelling in the abdomen, liver, and legs.

Heart failure should not be confused with a heart attack, which involves sudden death of the heart muscle. Although heart failure may occur suddenly in some cases, gradual loss of function is more common. Fatigue, shortness of breath on exertion, and increased frequency of nighttime urination develop and worsen over time. Shortness of breath is often worse when lying down—a condition known as orthopnea—as fluid from the legs pools in the lungs. Elevating the head with pillows eases chest congestion, but in advanced stages the patient may be unable to recline at all without severe breathlessness, and may need to sleep upright in a chair.

Heart failure occurs most frequently in those over age 60 and is the leading cause of hospitalization and death in that age group. In over 50 percent of cases, sudden death occurs due to an arrhythmia, an irregular heartbeat. Unfortunately, antiarrhythmic medications may not be effective in controlling arrhythmias caused by heart failure.

There is no cure for heart failure, although measures are taken to treat the underlying cause, if possible. Restricted salt intake and medication are used to ease the strain on the heart and to relieve symptoms. Heart failure is a serious health risk; for many patients the outlook is uncertain and depends on the extent of the disease and the patient’s response to therapy. However, with proper treatment it is possible for many patients to live with heart failure and to manage many symptoms effectively. It is important that patients adhere to prescribed treatment regimens; noncompliance with a doctor’s recommendations regarding diet or medication increases the risk that the disease will worsen.

What Causes It?

Coronary heart disease (obstruction of the coronary arteries by atherosclerotic plaque) often leads to a heart attack, which damages the heart muscle and causes heart failure.

Heart muscle injury due to viral infections or long-term drug or alcohol use may result in heart failure.
o Conditions that overwork the heart may lead to heart failure. Such conditions include heart valve defects, high blood pressure, increased levels of thyroid hormones, and anemia.

Infiltration of the heart muscle by other tissue, as occurs in a disorder called amyloidosis (accumulation of a waxy substance), may cause heart failure.

Triggers for the development of heart failure in a weakened heart include pulmonary embolism (a blood clot in the lungs), severe bacterial or viral infections, pregnancy or childbirth, and physical overexertion.

Right-sided heart failure commonly results from left-sided heart failure.

Heart failure may result from restricted entry of blood into the heart due to thickening of the tissue surrounding the heart or to accumulation of excessive fibrous tissue in the heart muscle.

Prevention

Don’t smoke.

Consume no more than two alcoholic beverages a day.

Eat a healthy, balanced diet low in salt and fat, exercise regularly, and lose weight if you are overweight.

Adhere to a prescribed treatment program for other forms of heart disease that you have been diagnosed with.

Diagnosis

Patient history and physical examination.

Chest x-rays.

Blood and urine tests.

An electrocardiogram (ECG) may be performed to measure the electrical activity of the heart. ECG abnormalities can indicate rhythm disturbances, heart muscle damage, inadequate blood flow to segments of the heart, and enlargement of the heart muscle. You may be given a portable ECG device, known as a Holter monitor, to measure the heart’s electrical activity over a 24-hour period.

Exercise stress testing, in which blood pressure, heart rate, ECG, and oxygen consumption rates are measured while you walk on a treadmill.

An echocardiogram, which uses sound waves to produce images of the heart, may be performed.

Coronary angiography may be performed to evaluate narrowings of the coronary arteries. In this procedure a tiny catheter is inserted into an artery in the groin and threaded up to the coronary arteries. A contrast material is then injected, which provides a clear image of the blood vessels when x-rays are taken.

Treatment

Your doctor will advise you to reduce your salt intake (salt contributes to fluid retention and swelling) and to eat smaller, more frequent meals (less effort is required to digest smaller portions).

Caffeine, which may exacerbate heartbeat irregularities, should be avoided.

Vasodilators, such as hydralazine and ACE inhibitors (for example, captopril and enalapril), may be prescribed to dilate blood vessels, thus reducing blood pressure and easing blood flow.

Various types of diuretics, such as hydrochlorothiazide, metolazone, furosemide, or bumetanide, are prescribed to help eliminate excess fluid from body tissues.

Digitalis glycosides may be prescribed to strengthen contractions of the heart muscle. (In the United States digoxin is the most commonly prescribed type of digitalis.)

Other medications, including anticoagulants such as warfarin, beta-blockers such as carvedilol, calcium channel blockers such as amlodipine, and tranquilizers such as diazepam, may be prescribed to improve blood flow, ease breathing, and relieve anxiety.

Special elastic support stockings that reduce swelling in the legs may be prescribed.

In severe cases it may be necessary to administer oxygen through a nasal tube. Mechanical devices for administration of oxygen are available for home use after the condition has stabilized in the hospital.

Surgery may be required to repair or replace heart valves or bypass blocked coronary arteries.

Percutaneous transluminal coronary angioplasty (PTCA; insertion and then inflation of a small balloon in an obstructed coronary artery via a catheter) may be performed to widen the artery and improve blood flow.

A heart transplant may be advised if the heart muscle has been badly damaged. The survival rate for this surgery is 85 percent after one year and 65 percent after five years.

 

From Johns Hopkins Symptoms and Remedies, the complete home medical reference. You can order this book now on our secure server.

 

 

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