Keeping Your Heart Healthy

by Avaraham Henoh

Congestive heart failure (CHF) means that the heart is unable to pump blood effectively enough throughout the body. CHF is not the same as cardiac arrest (when the heart stops beating) or a heart attack (when the heart muscle is suddenly damaged by an inadequate blood supply). But it is also a serious condition requiring regular medical attention. Because of the strain it places on the heart and other parts of the body, CHF can be life threatening if left untreated.

It is called congestive heart failure because congestion of the lungs causes some of the main symptoms, which include tiredness and shortness of breath-even when the person is at rest. Causes of CHF include: damage to the heart muscle following a heart attack; high blood pressure left untreated over a long period; damage to the heart valves; drinking too much alcohol; over-or underactivity of the thyroid gland; viral infections; and coronary artery disease.

In people whose hearts are already weakened, the following factors can worsen or trigger CHF: severe anemia; high fever; rapid heartbeat; lung infection; pulmonary embolism (a blood clot that is carried to the lungs and blocks blood flow); too much salt in the diet; drinking too much fluid; being overweight; putting too much physical strain on your body; emotional stress; and use of medications that slow the heart rate.

The Symptoms of CHF The main symptoms are tiredness, shortness of breath or difficulty breathing. You may awaken at night having trouble breathing or difficulty lying flat in bed because of shortness of breath. Swollen ankles and feet and weight gain may also result, from too much fluid in the body. Loss of appetite is typical as well.

How to find out if you have CHF Your doctor will discuss your symptoms with you and do a physical exam. You may also be given some or all of the following tests: a chest x-ray to look for lung problems and view the size of your heart; an electrocardiogram (ECG), a recording of the electrical activity of your heart; and complete analyses of blood and urine samples. You may also receive an echocardiogram, an ultrasound test that can show heart size, heart function, and possible heart valve disease.

How is CHF treated? The cornerstones of CHF treatment are: Treat any underlying causes or factors that make it worse; use medications that increase the ability of the heart pump effectively; eliminate excess water in the body with medication, diet, and rest; and reduce extra strain on the heart.

Your doctor may prescribe "ACE" inhibitors, drugs which widen the arteries so blood can flow through more easily, allowing the heart to pump with less effort. Diuretics increase urination and help get rid of excess fluid in the body. Digitalis may slow the heart rate and helps improve its pumping ability.

It is important that you discuss with your doctor the possible side effects of these medications and report right away any symptoms that you are experiencing. Make sure that you take your medication (s) exactly as the doctor prescribes.

Other aspects of treatment for CHF include a low-sodium (low-salt) diet, as salt causes the body to retain water, which increases the workload on the heart. Certain nonprescription medications-such as antacids, cough syrups, and laxatives-are high in sodium, so you may be advised to avoid them. Ask your doctor which "over-the-counter" medications to use.

Regular exercise under the supervision of your doctor may help improve your symptoms. Also, taking rest periods between activities, so you don't get too tired, can decrease the amount of work your heart has to do.

Learning to live with CHF By making certain lifestyle changes and following their doctor's recommendations, people with CHF can enjoy many years of near-normal living. Observing the following guidelines can help.

● Get enough rest, shorten your working hours, and reduce the emotional stress in your life. ● Learn techniques to reduce feelings of anxiety and anger, which can increase your heart rate and blood pressure. ● Check your pulse rate daily and learn how to take your own blood pressure (or have a family member do it) ●Accept that taking heart medication and making lifestyle changes are a permanent part of your life. ● Keep your weight under control by following a written diet plan that emphasizes a reduction in fats (particularly saturated fats) ● Weigh yourself at least every other day, and contact your doctor if you are gaining weight rapidly (this may mean that your body is retaining excess fluid) ● Be aware of the signs and symptoms of potassium loss (muscle cramps or weakness, irritability, and, occasionally, irregular heartbeat). ● Increase activities gradually, making sure they do not make you too tired or short of breath. ● Avoid extremes of hot and cold, which cause your heart to work harder. ● Keep regular appointments with your doctor.

Supported as an educational service by Novartis Pharmaceuticals Corporation. This information is not intended for use as medical advice. You should discuss this information with your doctor.

Avaraham Henoch, MD 564 West 160th Street New York, NY 10032 Phone: (212) 740-6400