Congestive Heart Failure

What is Heart Failure?

Heart Failure (HF) is a very common problem in the United States. It affects over 550,000 Americans each year. It is the leading cause for adults over the age of 65 to be admitted to the hospital. The most common cause for a visit to the emergency room for someone with HF is fluid retention. In the past we have called this fluid retention congestive HF.

When HF occurs it can affect the left or right side of the heart, or both sides.

Right HF

This occurs when the right side of the heart cannot pump the blood very well to the lungs. This can happen due to problems in the lungs or because the left side of the heart has become too big and is pushing on the right side of the heart. When the right side loses its pumping power, it can cause blood to back up in the body’s veins causing swelling in the abdomen, legs and ankles.

Left HF

The left side of the heart moves blood filled with oxygen to the rest of the body. The left side of the heart is a very strong muscle and is bigger than the right side. There are two types of left-sided HF.

Systolic Failure

The first type, systolic, is a pumping problem where the left side of the heart does not pump blood well to the organs of the body. This is due to a weak muscle. The left side of the heart can become weak from many reasons, such as a heart attack, an infection, taking toxic medications, pregnancy, or a problem with one of the heart valves. There are also times when the cause is unknown. Simply put, systolic failure is when the left side of the heart cannot pump with enough force to push blood to the body.

Diastolic Failure

The second type of left HF is called diastolic failure. Diastolic failure occurs when the heart is not able to rest between heart beats. This happens because the heart muscle has become stiff. Normally, the heart rests between each heartbeat and fills with blood. With this type of HF, the blood cannot fill the chamber well causing a lower amount of blood to be pumped out to the body.
You can see that systolic and diastolic HF have the same end results. However, the causes and the actions of the heart differ. This is important because the treatment for the different types of HF also vary.

Causes of HF

The risk factors for HF include high blood pressure, high blood sugar, obesity, blood clots or plaque in the vessels, stroke, virus, a family history, and some types of toxic medications.

Symptoms of HF

Symptoms may be hard for the patient to identify and just as hard to treat. The first step in treating HF is to know the symptoms so they can be treated quickly. Common symptoms of HF include:

• Having trouble thinking or being sleepy
• Feeling dizzy
• Feeling weak
• Unable to walk or do activity like in the past
• Being short of breath
• Cough
• Unable to lay flat
• Having chest pain or tightness
• Feeling heart beat fast
• Gaining weight
• Having abdomen swell or feeling sick to stomach
• Ankle swelling
• Cold hands and feet

When to call your Doctor or Nurse Practitioner

You need to call your heart failure team when you have any of the problems listed above. People often think they can wait a few days before calling their HF team because the symptoms will get better on their own, but waiting only makes it harder to stop the problem and could lead to a hospital stay.

Your HF team needs to decide if your symptoms can be treated at home, if you need to be seen in the clinic, or need to go straight to the hospital. No one likes to go to the hospital, but waiting may make your symptoms harder to treat. Talk often and closely with your HF team. There is much that you can do to stay well and healthy if you have HF.

Managing HF

Adhere to a Low Sodium Diet

Too much sodium in your system causes your body to retain (hold onto) water. This puts an extra burden on your heart and blood vessels. In some people, this may lead to high blood pressure and cause heart failure symptoms. Having less sodium in your diet may help you lower or avoid high blood pressure.

 Most people eat too much sodium, often without knowing it. One teaspoon of salt contains about 2,300 mg of sodium. Your body only needs 200 mg of sodium per day.  The average American eats about 3,000 to 3,600 mg of sodium a day.  Patients with a diagnosis of Heart Failure should reduce the amount of sodium in their diet to less than 1,500 mg a day.

Increase Daily Exercise

One of the ways that patients with heart failure (HF) can feel better is to stay active. In the past, patients were told to rest and avoid many of their common activities. Recent research has shown that daily activity is safe for most people with HF and may improve symptoms and sense of well-being. By staying active, people are often able to do more of the things that they enjoy. Walking, light weight-lifting and water workouts will improve muscle strength and energy levels.

Diagnosing Heart Failure

Your health care team may need to do some tests to see how the heart is working, to find out the cause of heart failure (HF), and to see if you have other problems that may make HF worse. You may feel better by treating all found problems.

There are many tests that can be done to assess your heart function. The type of test will depend on what your heart failure team is looking for. One of the things they need to know is how much blood the heart is squeezing out with each beat. This is called the "ejection fraction" or EF. A normal EF is 55-70%- meaning that about 55% of the blood is squeezed out of the left side of the heart with each heartbeat. An EF less than 45% indicates that you have "systolic" heart failure. This means that your heart is weak and can't pump very well. Some people have heart failure when their heart squeezes a normal amount but does not rest between beats. This is called “diastolic” heart failure. This occurs when the heart is stiff, with thick walls, and isn’t able to handle fluid changes in the heart.

Tests which help your HF team learn about your heart function include: echocardiogram, ventriculogram, cardiac MRI, or a MUGA scan. Your Heart Failure Team will need to evaluate your heart rhythm, Coronary Artery Disease, heart pressures, oxygen consumption, lung function and your lab work as well. 

Treatment of Heart Failure

Treatment for heart failure is based on what type of heart failure you have - systolic or diastolic - and is also based on your co-morbidities. 

Heart failure is an illness that can be managed with medications and close self-care. One aspect of self-care is understanding your illness.  Prognosis is hard to predict and your heart failure team may not be able to say how your body will respond to your weakened heart function. Having heart failure requires you and your family to work closely with your health care team.

Treatments can include many medications to help your heart and possibly, some advanced treatments or surgery. One of the best things a person with heart failure can do is to closely manage their own care.  Understanding symptoms, daily weight monitoring, adjusting diuretics accordingly, changing diet to accommodate a low sodium diet and partnering with your family and heart failure team can turn your heart failure into success.

For more information regarding heart failure, please call our Heart Failure Clinic at 954-229-7974

More information on Congestive Heart Failure

Patients diagnosed with congestive heart failure during their inpatient stay at Holy Cross Hospital may obtain more information about CHF by registering for and signing on to their MyHealth Patient Portal. Once logged in to your Patient Portal, more education on your condition is available under “My Health Tools.”