Congestive Heart Failure Mayo Clinic

Some Predictors Of Poor Outcome In Chronic Heart Failure

• High NYHA functional class
• Reduced sodium concentration
• Raised plasma catecholamine and natriuretic peptide concentrations

Survival can be prolonged in chronic heart failure that results from systolic dysfunction if angiotensin converting enzyme inhibitors are given. Longitudinal data from the Framingham study and the Mayo Clinic suggest, however, that there is still only a limited improvement in the one year survival rate of patients with newly diagnosed symptomatic chronic heart failure, which remains at 60-70%. In these studies only a minority of patients with congestive heart failure were appropriately treated, with less than 25% of them receiving angiotensin converting enzyme inhibitors, and even among treated patients the dose used was much lower than doses used in the clinical trials.

What Causes Heart Failure

Although the risk of heart failure doesnt change as you get older, youre more likely to have heart failure when youre older.

Many medical conditions that damage the heart muscle can cause heart failure. Common conditions include:

• Tobacco and recreational drug use.
• Medications. Some drugs used to fight cancer can lead to heart failure.

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Prognosis At Different Ages

In general, younger people diagnosed with CHF tend to have a better outlook than older people.

A report averaging several smaller studies found that people under age 65 generally had a 5-year survival rate of 78.8 percent following CHF diagnosis. The same report found that people over age 75 had an average 5-year survival rate of 49.5 percent following diagnosis.

Older people diagnosed with CHF may already have other chronic health conditions. This can make it difficult to manage CHF and create a more challenging outlook for them.

for congestive heart failure. The treatment thats best for you will depend on:

• your overall health
• any other health conditions you have
• how you respond to any medications
• what stage of CHF you have

Common options include:

There are lifestyle changes a person with CHF can make that have been shown to help slow the conditions progression. Talk with your doctor before making changes to your diet or starting an exercise routine.

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Left Ventricular Assist Devices

These may be implanted in the chest to increase heart pumping action. Until recently, LVADs required that the patient be hooked up to a large, hospital-based console while awaiting a transplant. Miniaturized battery-powered LVAD units, however, are allowing many patients to leave the hospital. The devices may be used as a primary treatment or as a bridge to heart transplant in adults.

How Is Congestive Heart Failure Diagnosed

Patients will typically have an intake visit with a heart specialist and nurse or physicians assistant. During this visit, the doctor will review the patients prior records and his or her current health status. This allows the doctor to establish a picture of where the patient is along the spectrum, and make a plan for prognosis and treatment.

The process often takes more than one meeting and involves both the patients local cardiologist or referring physician.

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Congestive Heart Failure: Prevention Treatment And Research

Congestive heart failure is a serious condition in which the heart doesnt pump blood as efficiently as it should. Despite its name, heart failure doesnt mean that the heart has literally failed or is about to stop working. Rather, it means that the heart muscle has become less able to contract over time or has a mechanical problem that limits its ability to fill with blood. As a result, it cant keep up with the bodys demand, and blood returns to the heart faster than it can be pumped outit becomes congested, or backed up. This pumping problem means that not enough oxygen-rich blood can get to the bodys other organs.

The body tries to compensate in different ways. The heart beats faster to take less time for refilling after it contractsbut over the long run, less blood circulates, and the extra effort can cause heart palpitations. The heart also enlarges a bit to make room for the blood. The lungs fill with fluid, causing shortness of breath. The kidneys, when they dont receive enough blood, begin to retain water and sodium, which can lead to kidney failure. With or without treatment, heart failure is often and typically progressive, meaning it gradually gets worse.

More than 5 million people in the United States have congestive heart failure. Its the most common diagnosis in hospitalized patients over age 65. One in nine deaths has heart failure as a contributing cause.

Essential Facts About Congestive Heart Failure

Do you or someone you love suffer from Congestive Heart Failure or CHF? Is CHF the same thing as a heart attack? How is CHF treated? Get answers to these essential questions and more!

Every year, roughly 670,000 Americans are diagnosed with heart disease â thatâs more than one a minute. In the time it takes you to read this article, half a dozen individuals will have experienced a major shift in their quality of life. Heart disease is the leading cause of hospitalization in people over 65, and the #1 killer of both men and women in the U.S. Itâs more deadly than all forms of cancer combined, and while there are many different types of heart failure, congestive heart failure is particularly complex.

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Precipitating Causes Of Heart Failure

• Arrhythmias, especially atrial fibrillation
• Angina pectoris or recurrent myocardial ischaemia
• Iatrogenic causefor example, postoperative fluid replacement or administration of steroids or non-steroidal anti-inflammatory drugs
• Poor drug compliance, especially in antihypertensive treatment
• Thyroid disordersfor example, thyrotoxicosis
• Pulmonary embolism

In a patient with appropriate symptoms and a number of physical signs, including a displaced apex beat, elevated venous pressure, oedema, and a third heart sound, the clinical diagnosis of heart failure may be made with some confidence. However, the clinical suspicion of heart failure should also be confirmed with objective investigations and the demonstration of cardiac dysfunction at rest. It is important to note that, in some patients, exercise-induced myocardial ischaemia may lead to a rise in ventricular filling pressures and a fall in cardiac output, leading to symptoms of heart failure during exertion.

Cardiac Mortality In Placebo Controlled Heart Failure Trials

Trial
33	1.2

EF ejection fraction. SOLVD-P, SOLVD-T=studies of left ventricular dysfunction prevention arm and treatment arm .

H-ISDN=hydralazine and isosorbide dinitrate.

*Treatment with H-ISDN.

Treatment with angiotensin converting enzyme inhibitors prevents or delays the onset of symptomatic heart failure in patients with asymptomatic, or minimally symptomatic, left ventricular systolic dysfunction. The increase in mortality with the development of symptoms suggests that the optimal time for intervention with these agents is well before the onset of substantial left ventricular dysfunction, even in the absence of overt clinical symptoms of heart failure. This benefit has been confirmed in several large, well conducted, postmyocardial infarction studies.

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Can Surgery Be Used To Treat Heart Failure

In heart failure, surgery may sometimes prevent further damage to the heart and improve the heart’s function. Procedures used include:

• Coronary artery bypass grafting surgery. The most common surgery for heart failure caused by coronary artery disease is . Although surgery is more risky for people with heart failure, new strategies before, during, and after surgery have reduced the risks and improved outcomes.
• Heart valve surgery. Diseased heart valves can be treated both surgically and non-surgically .
• Implantable left ventricular assist device . The LVAD is known as the “bridge to transplantation” for patients who haven’t responded to other treatments and are hospitalized with severe systolic heart failure. This device helps your heart pump blood throughout your body. It allows you to be mobile, sometimes returning home to await a heart transplant. It may also be used as destination therapy for long-term support in patients who are not eligible for transplant.
• Heart transplant. A heart transplant is considered when heart failure is so severe that it doesn’t respond to all other therapies, but the person’s health is otherwise good.

What Is The Importance Of Ejection Fraction

Your ejection fraction is one way to measure the severity of your condition. If its below normal, it can mean that you have heart failure. Your ejection fraction tells your healthcare provider how good of a job your left or right ventricle is doing at pumping blood. Usually, your EF number is talking about how much blood your left ventricle is pumping out because its your heart’s main pumping chamber.

Several non-invasive tests can measure your EF. With this information, your healthcare provider can decide how to treat you or find out if a treatment is working as it should.

A normal left ventricular ejection fraction is 53% to 70%. An LVEF of 65%, for example, means that 65% of the total amount of blood in your left ventricle is pumped out with each heartbeat. Your EF can go up and down, based on your heart condition and how well your treatment works.

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What Are The Symptoms Of Heart Failure

You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms can include:

• Congested lungs. Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
• Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen , and weight gain. Symptoms may cause an increased need to urinate during the night. Bloating in your stomach may cause a loss of appetite or nausea.
• Dizziness, fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
• Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a rapid or irregular heartbeat.

If you have heart failure, you may have one or all of these symptoms or you may have none of them. They may or may not indicate a weakened heart.

Common Causes Of Lower Limb Oedema

• Gravitational disorderfor example, immobility
• Congestive heart failure
• Venous thrombosis or obstruction, varicose veins
• Hypoproteinaemiafor example, nephrotic syndrome, liver disease
• Lymphatic obstruction

Fatigue and lethargy

Fatigue and lethargy in chronic heart failure are, in part, related to abnormalities in skeletal muscle, with premature muscle lactate release, impaired muscle blood flow, deficient endothelial function, and abnormalities in skeletal muscle structure and function. Reduced cerebral blood flow, when accompanied by abnormal sleep patterns, may occasionally lead to somnolence and confusion in severe chronic heart failure.

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Mayo Clinic Q And A: Congestive Heart Failure And Diet

DEAR MAYO CLINIC: My doctor told me that I have congestive heart failure and I have to change my lifestyle, including my diet. What kind of diet should I be on?

ANSWER: When patients have congestive heart failure, their heart isnt able to manage fluid well, and it builds up in the body. This fluid can cause shortness of breath, swelling in the abdomen or legs, and fatigue. If this occurs, diuretics, or water pills, often are prescribed to remove the excess fluid. Your health care provider also will recommend that you restrict your sodium, or salt, intake. Why is this important? Sodium makes your tissues act like a sponge, hanging on to water. This extra water retention, on top of the fluid retained from your heart not working properly, will make it harder for your water pill to work, and you likely will keep feeling poorly.

So, what does it mean to restrict your sodium? The American Heart Association recommends 2,000 to 3,000 milligrams of sodium per day for heart failure patients. Most Americans far exceed that recommendation.

How will you know how much sodium you are getting in your diet? First, be aware that any added salt will add up quickly. One teaspoon of table salt is over 2,000 mg of sodium. And it doesnt matter if its Himalayan salt, sea salt or kosher salt all should be avoided.

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What Are The Complications Of Heart Failure

Some of the complications from heart failure include:

• Irregular heartbeat.

• History of taking drugs that can damage your heart muscle, such as some cancer drugs.

Stage B

Stage B is considered pre-heart failure. It means your healthcare provider has given you a diagnosis of systolic left ventricular dysfunction but youve never had symptoms of heart failure. Most people with Stage B heart failure have an echocardiogram that shows an ejection fraction of 40% or less. This category includes people who have heart failure and reduced EF due to any cause.

Stage C

People with Stage C heart failure have a heart failure diagnosis and currently have or previously had signs and symptoms of the condition.

There are many possible symptoms of heart failure. The most common are:

• Shortness of breath.

• Need to urinate while resting at night.
• Rapid or irregular heartbeats .
• A dry, hacking cough.
• A full or hard stomach, loss of appetite or upset stomach .

There may be times that your symptoms are mild or you may not have any symptoms at all. This doesn’t mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe and may come and go.

Unfortunately, heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms.Its important to let your doctor know if you have new symptoms or if your symptoms get worse.

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What Are The Types Of Heart Failure

There are many causes of heart failure, but the condition is generally broken down into these types:

Left-sided heart failure

Heart failure with reduced left ventricular function The lower left chamber of your heart gets bigger and cannot squeeze hard enough to pump the right amount of oxygen-rich blood to the rest of your body.

Heart failure with preserved left ventricular function Your heart contracts and pumps normally, but the bottom chambers of your heart are thicker and stiffer than normal. Because of this, your ventricles can’t relax properly and fill up all the way. Because there’s less blood in your ventricles, your heart pumps out less blood to the rest of your body when it contracts.

Right-sided heart failure

Heart failure can also affect the right side of your heart. Left-sided heart failure is the most common cause of this. Other causes include certain lung problems and issues in other organs.

Congestive Heart Failure In Young People

My daughter, Heather, passed from Congestive Heart Failure at the age of 25. This was a total shock as she was very healthy and no examinations have ever revealed this possibility. She did have a kidney infection in Dec 2015 and went for diagnosis twice when she had the symptoms. Both times the doctors just passed it off as anxiety. She died in Feb 2015 at Tampa General. The surgeon tried to install VADs on both sides of her heart. When he came to us in the waiting room he said he never saw anything like the scars inside her heart.

I would like to know if anyone else has a story like this. We can only surmize that Heather must have had a dormant virus that was activated by something she took or was exposed to. I wished now we would have had an autopsy done but there may still be no way of finding out how she contracted this evil in her heart.

There are a few different conditions that should be screened for. Your best bet is to find a genetic counselor that specializes in cardiac disorders and have them order the appropriate tests for the living relatives. Where do you live? Mayo Clinic would be one place that could help but I may be able to help direct you to another closer to you. Cost is sometimes covered by insurance. Different companies may work with you. There are several companies that offer testing now.

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When To See A Doctor

See your doctor if you think you might be experiencing signs or symptoms of heart failure. Seek emergency treatment if you experience any of the following:

• Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting
• Sudden, severe shortness of breath and coughing up pink, foamy mucus

Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. Dont try to diagnose yourself. Call 911 or your local emergency number for immediate help. Emergency room health care providers will try to stabilize your condition and determine if your symptoms are due to heart failure or something else.

If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. Contact your doctor promptly.

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When Should I Get Emergency Care

Go to the ER or call 911 if you have:

• New, unexplained, and severe chest pain that comes with shortness of breath, sweating, nausea, or weakness
• Fast heart rate , especially if you are short of breath
• Shortness of breath that doesn’t get better if you rest
• Sudden weakness, or you can’t move your arms or legs
• Sudden, severe headache
• Fainting spells

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