Congestive Heart DiseaseCongestive heart disease or heart failure is a disease that involves the heart muscle as a whole failing to act as an efficient pump for the bodies circulatory system. There is a range of cardiovascular disease that may cause the heart muscle to fail, these include ischemic heart disease, hypertension, valvular heart disease and cardiomyopathy. Heart failure is a common medical condition in those over the age of 65, ranging from 6 to 10% of the population. It is usually a chronic condition that requires ongoing medical care and is associated with high health costs estimated to be around $35 billion per year in the US.
SymptomsHeart failure causes a wide range of symptoms and is often difficult to diagnose initially. This is because it produces symptoms similar to other conditions that the patient may also have. Some of the main symptoms of heart disease include:Shortness of breath ( orthopnea ) Coughing Ankle Swelling Tiredness The shortness of breath and coughing are commonly caused by accumulation of fluid in the lungs. This is due to the inability of the heart to pump the blood through the lungs effectively. These symptoms are often made worse when the patient lies down, known as orthopnea, as gravity no longer helps to drain the fluid out of the lungs. The opposite pattern is seen with the symptoms of ankle swelling in heart failure. The blood pools in the feet and ankles when the person is upright, however often improves when the person lies flat (reducing the effect of gravity). Therefore people with ankle swelling often try to keep their feet up as much as possible. Tiredness is caused by the general inability of the heart to provide enough blood supply to all of the organs of the body, including the muscles, liver, lungs and brain.
TreatmentTreatment of heart failure varies depending on its cause. Although the principle of treatment is to reduce the amount of work the heart has to do to pump the blood effectively. Some basic diet and lifestyle changes include:Weight loss and monitoring Salt restriction Fluid restriction Pharmacological management involves using a number of medications that help to reduce the strain on the heart during heart failure. Some of these medications work indirectly by reducing blood pressure, while others work directly on the heart to make it pump stronger and more efficiently. Some of the medications include:
Diuretics- these include medications such as Furosemide, Hydrochlorothiazide and Spirinolactone. Diuretics increase the rate of diuresis and thereby reduce the amount of fluid in the body. This helps to reduce the amount of work the heart has to do to pump blood. Beta Blockers- these include Carvedilol, Bisoprolol, Atenolol and Metoprolol. These medications act by reducing the rate and amount that the heart has to work. Digoxin- is a medication that is sometimes used when the combination of an ACE inhibitor, diuretics and beta blocker are not effective. Digoxin increases the contractility of the heart thereby making it function better as a pump. Surgical management of congestive heart disease is used when lifestyle and pharmacological measures have failed. Coronary artery bypass surgery or valvular surgery may help to treat ischemic heart disease or valvular disease. Pacemakers are sometimes inserted to improve the efficiency of the heart muscle contraction. Or as a last resort the heart muscle itself or replaced completely (heart transplant).
PrognosisThe prognosis of congestive heart disease is widely varied depending on the initial cause and its severity. In someone with valvular disease which is then repaired surgically the degree of heart failure may by reversed entirely. However someone who has long-term damage to the heart muscle causing heart failure will generally worsen.Heart failure is a leading cause of death in most countries and affects between 10 and 30% of people aged over 65. If it is treated quickly both with lifestyle and other medical management the prognosis is improved significantly. We recommend seeing your GP or primary care physician as soon as possible if you suspect you have congestive heart disease.
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