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W. Clay Warnick, MD, Cardiology
The Chester County Hospital
Published: February 8, 2010
Using medical terms incorrectly can generate misunderstanding about certain illnesses, and the medical community is as much responsible as anyone else. For example, since "Congestive Heart Failure" is related to or can encompass such other clinical conditions as cardiomyopathy, pulmonary edema, lung congestion and heart attack, to use Congestive Heart Failure interchangeably with these terms can create confusion.
Congestive Heart Failure (CHF) is defined as a collection of symptoms (what the patient feels and reports) and signs (what the medical provider finds on examination) that describes certain patients. The symptoms most commonly include shortness of breath, weakness, lethargy, weight gain, and a loss of appetite. The signs include abnormal chest sounds consistent with fluid in the lungs, increased abdominal girth from fluid in the belly, and lower extremity swelling. There also can be abnormal heart sounds heard with a stethoscope and a trained ear. However, this description of a typical patient does not suggest any particular reason why the condition occurred in the first place.
It is important to understand this condition since it remains the #1 reason for U.S. hospital admissions. Since a hospital stay is expensive and a major contributor to healthcare costs, educating patients and family members about how to prevent CHF hospitalizations is important. Patients with coronary artery disease (blockages of the arteries that supply blood flow to the heart itself) are at risk for developing CHF, especially when they have had previous heart attacks (myocardial infarction), a major complication of such blockages. Heart muscle weakness resulting from a heart attack can lead to CHF, either soon after the event or many years later. Half of all CHF cases are due to underlying coronary artery disease. The other half result from a variety of conditions, such as poorly controlled high blood pressure (hypertension), heart rhythm disorders, structural abnormalities of the heart valves, or primary disorders of the heart muscle itself. Heart muscle (myocardium) can develop scar tissue due to an inherited disorder, viral infection, drug exposure such as cancer chemotherapy, or other diseases that infiltrate the muscle. These conditions lead primarily to a heart muscle problem known as a cardiomyopathy.
Prevention is key, and having a good understanding of one's family history is integral in predicting and trying to prevent the common cardiovascular diseases that might develop. A simple way to assess CHF risk is to know one's blood pressure - ideally 125/75 or less - blood sugar, blood cholesterol and waist size. If abnormalities exist then treatment of the hypertension, diabetes, elevated cholesterol, and obesity will reduce risk. Avoidance of tobacco and heavy alcohol use also minimizes CHF risk, as will treatment of other noncardiovasular conditions such as anemia, thyroid disease and kidney disease.
If CHF occurs, after addressing the underlying causes the mainstay of treatment is pharmacologic therapy with Beta-blockers and Angiotensin Converting Enzyme (ACE) inhibitors. Both of these drug classes have over 40 years of data combined in CHF treatment and prevention. Therefore, these medications have become quite inexpensive and reasonably well tolerated such that most patients can and will be able to take them regularly. Not only do they treat the episode of CHF when it occurs, but daily use can also prevent further episodes.
Finally, taking care of a patient with Congestive Heart Failure requires a team approach that includes the patient, family members, technologists, nurses, nurse practitioners and physicians. Each has a vital role in the education and reinforcement of treatment since this is often a chronic medical condition that will require lifetime care.
This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.
Last Updated: 2/8/2010