MEDICAL SURFARI: LOOKING OUT FOR SIGNS OF CONGESTIVE HEART FAILURE

The heart is a muscular pump that pumps approximately five quarts of blood per minute through the body to supply it with oxygen and energy. The heart's work is an incessant job, and one that is generally taken for granted until it begins to show signs of failure.

The human heart has four chambers, two atria and two ventricles. It is the left ventricle that is responsible for pumping oxygen rich blood to the tissues and organs of the body. When the heart can no longer pump strongly to meet the needs of his body's other organs, congestive heart failure may develop. This can result from narrowed arteries supplying blood to the heart muscle, prior heart attack resulting in scar tissue that interferes with the normal work of the heart muscle, high blood pressure, heart valve disease, as well as viral or bacterial infections that may weaken the heart. When the heart pumps ineffectively, it does not empty the pumping chambers completely. This causes an overcrowding of the heart and lungs, encumbering their normal function. The heart compensates for this congestion by enlarging and by inducing itself to pump faster, in an attempt to keep with the overload.

Nearly everyone loses some pumping capacity with aging. As the condition worsens, the heart eventually fails to adequately compensate, and this is when the more florid symptoms of congestive heart failure appear. The symptoms of congestive heart failure may be mild to severe, generally resulting in shortness of breath with or without activity, increased water weight gain of several pounds over 24 to 72 hours, excessive swelling of the hands, feet, legs, ankles, or even the abdomen. This may result in increased tiredness with activity, dry hacking cough, and the need to use several pillows to elevate one's head while sleeping. If you have noticed these symptoms, call your doctor.

Congestive heart failure affects two to three million Americans, and there are 400,000 new cases diagnosed each year. It is more common among men than women, and twice as common among African-Americans, compared to Caucasians. The death rate attributed to heart failure rose 64% from 1970 to 1990, while the death rate from coronary heart disease dropped by 49% during the same period. This is most likely a reflection of our nation's changing population, as people are living longer, and heart failure increases with age, affecting 5% of people age 75.

The risk factors for congestive heart failure are closely associated with major risk factors for coronary heart disease: Smoking, high cholesterol levels, high blood pressure, diabetes, and obesity. Reducing or eliminating these risk factors lower the risk of developing heart disease and heart failure. This condition is generally diagnosed by the patient's history and physical examination, as well as a chest x-ray. An echocardiogram is useful to evaluate the hearts pumping ability to measure the degree of failure. About two thirds of all patient's with heart failure die within five years of diagnosis, although some may live beyond five years and even into old age. This depends upon the patient's age, severity of failure, overall health, and other risk factors. The best defense against heart failure is prevention of heart disease, and almost all major risk factors can be controlled or eliminated, so don't write yourself a prescription for poor health or failure.

World Wide Web Resources

National Heart, Lung, and Blood Institute

www.nhlbi.nih.gov/nhlbi/cardio/other/gp/hrtfail.htm

This site from the National Institutes of Health provides a comprehensive view of heart failure, the symptoms, diagnosis, and treatment.

American Heart Association

www.amhrt.org/Heart_and_Stroke_A_Z_guide/congest.html

The American Heart Association provides a wealth of information on all aspects of heart disease, including congestive heart failure.

AHCPR Guidelines - Heart Failure

text.nlm.nih.gov/ahcpr/lvd/www/lvdctxt.html

These guidelines from the Agency for Health Care Policy and Research (AHCPR) would be most helpful for health care professionals who provide care for persons with heart failure.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701.