Medical History And Physical Exam
Bring a list of your symptoms to your doctors appointment, including how often they happen and when they started. Also, bring a list of any prescription and over-the-counter medicines you take. Let your doctor know if you have any risk factors for heart failure.
During your physical exam, your doctor will:
- Measure your heart rate, blood pressure, and body weight.
- Listen to your heart with a stethoscope for sounds that suggest that your heart is not working properly.
- Listen to your lungs for the sounds of fluid buildup.
- Look for swelling in your ankles, feet, legs, liver, and veins in your neck.
Mitral Valve Replacement In The Current Era: New Guidelines And Practical Considerations To Tailor The Treatment To Every Patient
Chairpersons: Prof. Schäfers
During this scientific session, you will learn about the practical consideration of surgical mitral valve replacement taking into account the recently published ESC/EACTS Guidelines on VHD. Our speakers will also share best practices for MR replacement in SMR and how to support patients with long-life expectancy. Lastly, you will be introduced to a new solution that Heart Teams can leverage for MR patients.
AGENDA
Mental And Behavioral Home Health Services
A congestive heart failure diagnosis comes with a high emotional cost. Its life-changing, and its never easy. Living with congestive heart failure takes a toll on your physical health and your mental health. Centric Healthcare offers compassionate professional services to help as you learn to cope with your new normal. Its important to remember as you live with your disease that you dont need to do it alone. We can help.
To schedule a free consultation and learn more about these and other services offered by Centric Healthcare, call us at 224-5535 in the Twin Cities, or call us at 205-7322 in Rochester.
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What Causes Heart Failure
Heart failure is caused by many conditions that damage the heart muscle, including:
- Coronary artery disease.Coronary artery disease , a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.
- Heart attack. A heart attack happens when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that doesnât work the way it should.
- Cardiomyopathy. Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse.
- Conditions that overwork the heart. Conditions including high blood pressure, valve disease, thyroid disease, kidney disease, diabetes, or heart defects present at birth can all cause heart failure. In addition, heart failure can happen when several diseases or conditions are present at once.
About Congestive Heart Failure
Heart failure, sometimes called congestive cardiac failure , is a condition in which the heart muscle is weakened and cant pump as well as it usually does. The main pumping chambers of the heart can change size and thickness, and either cant contract or cant relax as well as they should. This triggers fluid retention, particularly in the lungs, legs and abdomen.
The major causes of heart failure include coronary heart disease and heart attack, high blood pressure, damage to the heart muscle , heart valve problems and abnormal heart rhythms. Of these, coronary heart disease and heart attack are the most common causes.
The major factors that contribute to coronary heart disease include:
- reduced emotional and social wellbeing
- physical inactivity.
Heart failure is more common in elderly people. The survival rate for people with this disorder depends on the severity of their condition.
Most common treatments for heart failure are medications and self-managed lifestyle changes. Some less-common treatments may require insertion of implantable cardiac devices or valve replacement.
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Congestive Heart Failure Life Expectancy
Your life expectancy after receiving a diagnosis of congestive heart failure will depend upon several factors. Among them:
The current stage of progression of your heart failure
The underlying causes of your heart failure
The degree to which other organs are involved with your heart failure
The way your body responds to treatment
Although a diagnosis of congestive heart failure will probably mean major life changes and treatment for the rest of your life, it is important to keep in mind that there are things you can do to stay healthier longer and maximize the quality of your life.
Medical Definition Of Congestive Heart Failure
- Medical Editor: Jay W. Marks, MD
Reviewed on 6/3/2021
Congestive heart failure: Inability of the heart to keep up with the demands on it, with failure of the heart to pump blood with normal efficiency. When this occurs, the heart is unable to provide adequate blood flow to other organs, such as the brain, liver, and kidneys. Abbreviated CHF. CHF may be due to failure of the right or left ventricle, or both. The symptoms can include shortness of breath , asthma due to the heart , pooling of blood in the general body circulation or in the liver’s circulation, swelling , blueness or duskiness , and enlargement of the heart. The many causes of CHF include coronary artery disease leading to heart attacks and heart muscle weakness primary heart muscle weakness from viral infections or toxins, such as prolonged alcohol exposure heart valve disease causing heart muscle weakness due to too much leaking of blood or causing heart muscle stiffness from a blocked valve hyperthyroidism and high blood pressure.
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Gaps In Current Definitions Of Hf
Combined Definition With Hemodynamic Characterization of HF
- Coats AJS
- et al.
Eur Heart J.
N Engl J Med.
Cardiomyopathy and HF
- Fonarow GC
- et al.
Circulation.
- Arnett D
- et al.
Circulation.N Engl J Med.
J Am Coll Cardiol.
- Fonarow GC
- et al.
Circulation.
Biomarkers in the Definition of HF
- Drazner MH
- et al.
Circulation.
- Coats AJS
- et al.
Eur Heart J.
- Kitakaze M
- et al.
Circ J.
- Colvin MM
- et al.
Circulation.
- Coats AJS
- et al.
Eur Heart J.
- Colvin MM
- et al.
Circulation.
Circulation.
Circulation.
- Peralata CA
- et al.
Am J Kidney Dis.
- Colvin MM
- et al.
Circulation.
Clinical and Research Aspects of Defining HF
Circulation.
JAMA Cardiol.
Patient and Clinician Perspective
Eur J Heart Fail.
- Abdela OA
- Zeleke EG.
PLoS One.Circulation.
Eur J Cardiovasc Nurs.
Competing diagnoses
Heart.
What Is Congestive Heart Failure
CHF usually develops over a long period of time. The course and symptoms of heart failure depend on which regions of the heart are affected.
CHF can lead to severe complications, and the condition requires ongoing medical treatment.
Types of CHF include:
- Right-sided heart failure: The heart does not sufficiently accommodate blood returning from the rest of the body.
- Left-sided heart failure: The heart cannot efficiently pump oxygenated blood throughout the body,
CHF can also be caused by heart failure with preserved ejection fraction. Heart failure on one side of the heart predisposes to heart failure on the other side, so it is common to have both types.
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Is There A Treatment For Heart Failure
There are more treatment options available for heart failure than ever before. Tight control over your medications and lifestyle, coupled with careful monitoring, are the first steps. As the condition progresses, doctors specializing in the treatment of heart failure can offer more advanced treatment options.
The goals of treating heart failure are to try to keep it from getting worse , to ease symptoms, and to improve quality of life.
Some common types of medicines used to treat it are:
- ACE inhibitors
- Aldosterone antagonists
- ARBs
- ARNIs
- Selective sinus node inhibitors
- Soluble guanylate cyclase stimulator
Your doctor may also recommend a program called cardiac rehabilitation to help you exercise safely and keep up a heart-healthy lifestyle. It usually includes workouts that are designed just for you, education, and tips to lower your chance of heart trouble, like quitting smoking or changing your diet.
Cardiac rehab also offers emotional support. You can meet people like you who can help you stay on track.
Common Signs And Symptoms Of Heart Failure
It is very important for you to manage your other health conditions, such as diabetes, kidney disease, anemia, high blood pressure, thyroid disease and asthma or chronic lung disease. Some conditions have signs and symptoms that are similar to heart failure. If you have new or worsening non-urgent symptoms, tell your healthcare provider.
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Heart Failure Treatment Is A Team Effort
Heart failure management is a team effort, and you are the key player on the team. Your heart doctor will prescribe your medications and manage other medical problems. Other team members — including nurses, dietitians, pharmacists, exercise specialists, and social workers — will help you achieve success. But it is up to YOU to take your medications, make dietary changes, live a healthy lifestyle, keep your follow-up appointments, and be an active member of the team.
If you notice anything unusual, don’t wait until your next appointment to discuss it with your doctor. Call them right away if you have:
- Unexplained weight gain
- Swelling in your ankles, feet, legs, or belly that gets worse
- Shortness of breath that gets worse or happens more often, especially if you wake up feeling that way
- Bloating with a loss of appetite or nausea
- Extreme fatigue or more trouble finishing your daily activities
- A lung infection or a cough that gets worse
- Fast heart rate
- New irregular heartbeat
Myocytes And Myocardial Remodeling
In the failing heart, increased myocardial volume is characterized by larger myocytes approaching the end of their life cycle. As more myocytes drop out, an increased load is placed on the remaining myocardium, and this unfavorable environment is transmitted to the progenitor cells responsible for replacing lost myocytes.
Progenitor cells become progressively less effective as the underlying pathologic process worsens and myocardial failure accelerates. These featuresnamely, the increased myocardial volume and mass, along with a net loss of myocytesare the hallmark of myocardial remodeling. This remodeling process leads to early adaptive mechanisms, such as augmentation of stroke volume and decreased wall stress and, later, to maladaptive mechanisms such as increased myocardial oxygen demand, myocardial ischemia, impaired contractility, and arrhythmogenesis.
As heart failure advances, there is a relative decline in the counterregulatory effects of endogenous vasodilators, including nitric oxide , prostaglandins , bradykinin , atrial natriuretic peptide , and B-type natriuretic peptide . This decline occurs simultaneously with the increase in vasoconstrictor substances from the RAAS and the adrenergic system, which fosters further increases in vasoconstriction and thus preload and afterload. This results in cellular proliferation, adverse myocardial remodeling, and antinatriuresis, with total body fluid excess and worsening of heart failure symptoms.
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Facts About Heart Failure In The United States
- About 6.2 million adults in the United States have heart failure.1
- In 2018, heart failure was mentioned on 379,800 death certificates .1
- Heart failure costs the nation an estimated $30.7 billion in 2012.2 This total includes the cost of health care services, medicines to treat heart failure, and missed days of work.
What Do The Numbers Mean
Ejection Fraction 55% to 70%
- Pumping Ability of the Heart: Normal.
- Level of Heart Failure/Effect on Pumping: Heart function may be normal or you may have heart failure with preserved EF .
Ejection Fraction 40% to 54%
- Pumping Ability of the Heart: Slightly below normal.
- Level of Heart Failure/Effect on Pumping: Less blood is available so less blood is ejected from the ventricles. There is a lower-than-normal amount of oxygen-rich blood available to the rest of the body. You may not have symptoms.
Ejection Fraction 35% to 39%
- Pumping Ability of the Heart: Moderately below normal.
- Level of Heart Failure/Effect on Pumping: Mild heart failure with reduced EF .
Ejection Fraction Less than 35%
- Pumping Ability of the Heart: Severely below normal.
- Level of Heart Failure/Effect on Pumping: Moderate-to-severe HF-rEF. Severe HF-rEF increases risk of life-threatening heartbeats and cardiac dyssynchrony/desynchronization .
Normal Heart. A normal left ventricular ejection fraction ranges from 55% to 70%. An LVEF of 65%, for example means that 65% of total amount of blood in the 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.
HF-pEF. If you have HF-pEF, your EF is in the normal range because your left ventricle is still pumping properly. Your doctor will measure your EF and may check your heart valves and muscle stiffness to see how severe your heart failure is.
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How Is Congestive Heart Failure Treated
We assess the current health status of the patient to establish a baseline and develop a long-term health plan with the goal of improving the patients health, says Dr. Jacoby. This may involve the optimization of medicines and therapies, adding new medication or maybe enrollment in one of the clinical trials going on here.
Theres no quick fix, he says. Stabilizing and/or reversing a patients condition often involves long-term collaborative follow-up with a referring cardiologist or physician, Dr. Jacoby says.
In worst-case scenarios, we may offer advanced therapies, which include mechanical solutions, a heart transplant or hospice, Dr. Jacoby says. But first, we work very closely with our partners in cardiology and Interventional Cardiology Program at Yale to see if the patient would benefit from any interventional strategies.
“Yale has the best program in the area for heart transplants and artificial parts, but we want to exhaust all other options to avoid either if we can.
Symptoms Of Congestive Heart Failure
The severity and duration of heart failure symptoms depend on several factors, including the type and class of heart failure.
Some of the most common symptoms include:
- Shortness of breath: Thismay be more prominent with exertion or when lying down. Shortness of breath with exertion occurs due to insufficient blood supply to the body’s cells and tissues with left heart failure. Shortness of breath when lying down can develop when fluid congestion backs up in the lungs due to right heart failure.
- Dizziness, confusion, trouble concentrating, and/or fainting: This can occur with even a mild deficiency of oxygen-rich blood flow to the brain.
- Fatigue: Inadequate supply of oxygen-rich blood to the body’s organs and muscles leads to fatigue.
- Diminished ability to exercise: Due to fatigue and shortness of breath.
- Nocturia : This is caused by an excess of blood flowing through the kidneys when lying down at night. When the kidneys make more urine, it causes an increase in urination.
- Edema : Typically affecting the ankles, feet, lower legs, and abdomen, due to backup of blood to the right side of the heart with right-sided heart failure.
- Rapid or irregular heartbeats : With inefficient heart-pumping action, the heart may intermittently speed up.
- A dry, hacking cough: This is caused by pulmonary edema .
It is important to note that symptoms of CHF may wax and wane. If your symptoms improve, you should continue to follow your CHF treatment plan.
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Definitions Of Hf Used In Current Clinical Trials And Registries
Circulation.
| Trial Name | ||||
|---|---|---|---|---|
| Spironolactone for heart failure with preserved ejection fraction.N Engl J Med.2014 370: 1383-1392 | Within previous 12 months, with management of HF a major component | |||
| PARAGON-HF Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction.N Engl J Med.2019 381: 1609-1620 | LVEF 45% and LAE LVH | If NSR, NT-proBNP > 200 pg/mLIf AF: > 600 pg/mLOr if no previous hospitalization andIf NSR: NT-proBNP > 300 pg/mL, if AF: NT-proBNP > 900 pg/mL | Within previous 9 months | |
Evaluation of the effects of sodium-glucose co-transporter 2 inhibition with empagliflozin on morbidity and mortality in patients with chronic heart failure and a preserved ejection fraction: rationale for and design of the EMPEROR-Preserved Trial.Eur J Heart Fail.2019 21: 1279-1287 |
NYHA functional class II-IV | LVEF > 40% | NT-proBNP > 300 pg/mL in NSR or > 900 pg/mL in AF | Within 12 months OR evidence of structural changes on echo |
| DELIVER Dapagliflozin for heart failure with preserved ejection fraction will the DELIVER Study deliver?.Diabetes Ther.2020 11: 2207-2219 | Elevated natriuretic peptides | Medical history of HF 6 weeks before enrolment with at least intermittent need for diuretic treatment |
What Does Moving To Hospice Care Involve
If you and your family have made the decision to pursue hospice care while receiving inpatient care, a case manager or social worker can help facilitate the process. If you are at home and would like to transition to hospice care, hospice agencies can help make the arrangements. Hospice agencies will review your needs and have a doctor order the appropriate medications for you. These medications will focus not on treating your condition, but on managing your symptoms and comfort as much as possible.
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What Are The Signs And Symptoms Of Congestive Heart Failure
Difficulty breathing or shortness of breath are the most common and distinctive symptoms of congestive heart failure.
- Difficulty breathing may occur when a patient is at rest, during an activity, while lying flat, or even while waking up.
- Chest pain is another common symptom seen in patients with congestive heart failure.
- Due to water retention in the kidneys, patients will have a fluid overload in ankles, feet, stomach, and lungs, which is another key symptom seen in heart failure patients.
What Are The Risk Factors Of Congestive Heart Failure
Congestive heart failure primarily originates from problems with cardiovascular system of the body. Thus, it gets extremely important to go for regular routine checkups to ensure proper functioning of the heart and its valves. The risk factors include-
Hypertension: Increased blood pressure may lead to congestive heart failure. Hypertension is one of the chief causes of increased blood pressure.
Artery Blockage: Blockages in the arteries can lead to congestive heart failure. These blockages occur due to accumulation of fat and cholesterol in the blood vessels. Thus increased cholesterol content in the blood is a risk factor. Such blockages inhibit proper blood from the blood vessels thereby damaging them.
Heart Valve Conditions: This brings to the next risk factor which is the heart valve condition. Heart valves are extremely important as they carry blood to and fro from the heart to the organs in the body. In case these valves are damaged due to leak or blockage, the circulation gets affected. In turn the human heart pumps the blood harder which can lead to heart infection.
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