Congestive heart failure

More than 300,000 Australians and New Zealanders live with congestive heart failure, a serious condition requiring long-term treatment, and 30,000 new cases are diagnosed each year. Medical research is keeping pace with new treatment breakthroughs.

What is happening

When you experience congestive heart failure (CHF)  often called just 'heart failure', your heart is no longer pumping in an efficient manner. Instead, blood and other fluids back up into your lungs and other tissues. Eventually this build-up, or congestion (hence the name 'congestive' heart failure), prevents your body from getting enough of the oxygen-rich blood and nutrients it needs to thrive. You may notice you're easily tired and short of breath. You may have developed a hacking cough or experience swelling (oedema) in your ankles and legs. Simple tasks such as climbing stairs or even working around the house may become increasingly difficult. You may have additional complications if other vital body systems begin to be affected.

LIKELY FIRST STEPS

• Diuretic drugs to reduce fluid build-up in conjuction with ACE inhibitors to open blood vessels.
• Other medications may be added as well, including beta-blockers to ease the heart's pumping action.
• Medical management of related underlying problems, such as coronary heart disease, high-blood pressure or anaemia.
• Heart-healthy lifestyle changes, to maximise the effects of medications and other treatments. 

   The good news is that unlike having a heart attack, odds are you'll probably be able to live with CHF for many years, given good care. Although sudden flare-ups can arise, requiring visits to the hospital, and your condition may worsen over time, successful long-term management is definitely now the rule, not the exception.

Treatments
As frightening as the phrase 'heart failure' might sound, restoring the heart's ability to pump efficiently is a fairly simple process. Once you are feeling better, the main task will be to determine just why your heart started to perform poorly in the first place. Sometimes the cause has nothing to do with your heart at all: it may be the result of another ailment altogether or it may be the use of certain medications (including muscle-enhancing steroids).

QUESTIONS TO ASK

• What was the actual cause of my heart failure, and is there anything I can do to keep it from getting worse?
• what is the damage to my heart and how long will I need to stay on medications?
• Would a pacemaker help my condition?
• Am I a good candidate for a heart transplant?

   But if your episode of heart failure is like most people's---a consequence of an already existing cardiac condition---then you'll need to work with your doctor to deal with the underlying ailment. Here, the ultimate goal is to allow you to resume your normal activities while at the same time preventing a heart attack, stroke or other compication down the road. (For more specific treatments
for common underlying conditions, see Atrial fibrillation, Coronary heart disease, Heart attack and High blood pressure,)
 To treat congestive heart failure itself, your doctor will probably begin by prescribing medicines to promote the shedding of fluids from your tissues, to open your blood vessels and strengthen your heart. The earlier such a regimen is started, the better your longterm outlook. If your illness is more advanced, portable pumps and other technological advances are revolutionising treatment for CHF. Such devices can ease your symptoms and perhaps even reverse some of the damage to your heart, forestalling the need for a heart transplant.

                                            Treatment Options 
MEDICATIONS
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Diuretics                                               Essential to relieve fluid build-up
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ACE inhibitors                                    Dilate vessels; used along with diuretics
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 Beta-blockers                                     Slow heart down, making pumping easier.
-----------------------------------------------------------------------------------------------------------------------------   Digitalis drugs                                     Alternative if other drugs can't be used.

Procedures
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Heart transplant                                    Reserved for most severe cases.
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Heart-stabilising devices                      LVAD; assists left ventricle pumping.
                                                              Pacemaker: steadies heartbeat.
                                                              Defibrilllator: treats rhythm problems.

LIFESTYLE CHANGES
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 Diet & exercise                                     Keep salt low and get moderately active.
                                                                Weight reduction helps if obese.
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Stress reduction                                      Proven benefits for heart disease.
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Water restriction                                     Limit water intake to 1.5 litres per day.

 NATURAL METHODS
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 Supplements                                         Consider amino acids and coenzyme Q10- 
                                                               Reduce homocysteine levels.
                                                               Increase intake of folate.

TAKING CONTROL

• Have an echo. All patients with suspected CHF need to have an echocardiogram--an ultrasound of the heart. This will determine how well your heart muscle is functioning.
• Weigh yourself daily. Rapid increases in weight may mean you're retaining fluids; your doctor may need to change your medications or up your dose. On the other hand, rapid loss of weight (5 to 7 kilos over six months) may singal a serious problem.
• Be careful of NSAIDs, such as aspirin, ibuprofen (Nurofen), naproxen (Naprogesic) and the COX-2 inhibitors (Celebrex, Vioxx). These common pain relievers may increase the risk of  relapse if you have CHF. Check with your doctor if you use these over-the-counter drugs.
• Watch it in the winter. Surveys show that people with heart failure show up in emergency rooms more often during the winter months. Other bad times: Mondays, and the hours from 8 a.m. to 3 p.m.
• Avoid overheating. Warm baths and saunas, once considered taboo for those with heart failure, may actually offer benefits, provided you limit your exposure to 10 minutes or so. Check with your doctor, and never soak or sit in a sauna without letting someone know.
• Monitor your symptoms. If your skin suddenly becomes clammy and pale, your breathing is laboured or symptoms rapidly worsen, go to a hospital emergency ward immediately.

Medications
If you've been diagnosed with congestive heart failure, your doctor will probably prescribe many medicines to get the condition under control. Fortunately, these drugs are often remarkably effective in making you feel better quickly, and can reduce your risk of complications if taken long term. It's worth nothing that you may not have to be an medications forever. It all depends on how well you respond and how reversible the damage to your heart is.
     First on the list is a broad group of drugs known as diuretics, commonly called 'water pills'. They help your body get rid of the excess fluids that can build up in your legs, lungs and belly during heart failure, and thereby relieve such symptoms as coughing, oedema and shortness of breath. Less fluid allows your heart to pump more easily. You may receive one or more of  these drugs: spironoloactone (Aldactone), hydrochlorothiazide (Moduretic, Dichlotride) and/or the extra-potent frusemide (Lasix). Your doctor will gradually adjust your dose to promote optimal fluid loss, and periodically monitor you for side effects such as fatigue or irregular heart rhythms.