Congestive Heart Failure

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.

Symptoms of heart failure

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.

Investigations for heart failure

Treatment of heart failure

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:

• ACE inhibitors - these include medications such as Enalapril, Ramipril, Perindopril and Lisinopril. These work indirectly by reducing blood pressure, but are also thought to have a role in cardiac remodeling.
• 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 failure 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).

Prognosis of heart failure

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.