About Heart Failure

Expert's Corner
Our Expert's Corner offers you the opportunity to read friendly and exclusive information about heart failure. In this section we will post helpful information and advice from Trinitas professionals on various aspects of this serious medical condition. Featured Experts: Dr. Peter Lenchur, Cardiologist and Dr. Michael Brescia, Pulmonologist.


   
Helpful Documents
Daily Exercise Chart
Medication Log
Appointments
Daily Weight Monitoring

Cardiac Events
Cardiac Events (English)
Cardiac Events (Spanish)

Infectious Causes of Heart Failure

William Farrer, MD, FACP, FIDSA

While the most common identifiable causes of congestive heart failure (CHF) are high blood pressure and coronary artery disease, many infections can lead to heart failure. Viruses such as Coxsackie are the most common causes of carditis, an inflammation of the heart muscle that can lead to severe heart failure. Infection of the heart valves, endocarditis, can also lead to CHF if the valves are severely damaged. In some parts of Latin America, a parasitic infection called Chagas disease is a common cause of CHF. Patients with advanced HIV infection (AIDS) can develop CHF from cardiomyopathy as well as from myocarditis, heart valve problems, and unusual infections involving the heart. Lyme disease, caused by a spirochete bacterium and spread by tick bites, occasionally causes cardiomyopathy as well.




Heart failure is a serious yet common health condition affecting millions of people worldwide. The American Heart Association (www.aha.org) and the Heart Failure Society of America (www.hfsa.org) estimate that about 5 million Americans are living with heart failure. Most of the times heart failure presents as the end stage of many heart diseases. The severity of your heart failure is likely to progress and is a major cause of hospitalizations. In many cases, there is no cure for heart failure but following your treatment plan as recommended by your doctor and modifying your lifestyle can help you control its progression. The aim of the content in this section is to help you understand your condition, what you can do to keep it under control, and how to follow your doctor's advice to help you live a longer and healthier life.

How the Normal Heart Works
Your heart is a specialized muscle about the size of your clenched fist and its function is to pump blood to all parts of your body. Your heart is divided into a right side and a left side. The heart and the lungs work very closely. From the right side of the heart, the lungs receive blood poor in oxygen and carrying waste. In the lungs the blood gets oxygen and deposits waste products. After your blood gets oxygen it returns to the left side of the heart where this oxygen rich blood is pumped to the arteries. The arteries carry oxygen-rich blood to your body. Your body in turn, collects oxygen and nutrients from the blood and deposits waste into the blood. The oxygen depleted blood is carried out of the body by veins, and returns from the body to the right side of the heart to re-start the process. Your body depends on this process to maintain an adequate supply of oxygen and nutrients for your body to work effectively [1].

This diagram from the National Heart Lung and Blood Institute (www.NHLBI.nhi.gov) illustrates blood circulation in the heart.

What is Heart Failure?
Heart failure is a serious medical condition where your heart is weak and is not pumping enough blood to meet your body needs or your heart cannot relax properly to fill with blood. When your heart is not pumping enough blood your body cannot receive as much oxygen and nutrients as needed which may cause you , for example, to get tired easily. Also, your body is not able to get rid of waste as effectively as before and fluid can back up in the lungs and other parts of the body such as feet, ankles, legs, hands, and abdomen.

Heart failure usually develops gradually after diseases such as long standing high blood pressure, a heart attack or another condition has damaged or weakened the heart muscle. The majority of heart failure patients are over 65 years of age and there is a strong connection between old age and heart failure but it can develop at any age. It is also more common among men and African American because of the high incidence of high blood pressure in this population [2].

Causes of Heart Failure
There are many causes of heart failure; you can develop heart failure if you had or currently have a medical condition which weakened your heart. In United States the most common reason for heart failure is coronary artery disease, a disease in which plaque builds up inside the arteries that supply your heart with oxygen- rich blood. Other common causes of heart failure are [1]:
 

Heart attack

 

High blood pressure

 

Heart valve disease

 

Inflammation of the heart

 

Congenital heart defects

 

Lung conditions

 

Alcohol or drug abuse Infections, anemia, thyroid gland problems, lung, diabetes and kidney diseases are some conditions that can trigger and worsen your heart failure.



What are the Symptoms of Heart Failure?
Common symptoms of heart failure are the result of fluid build up, congestion in your lungs and less oxygen-rich blood circulating in your body. Symptoms of heart failure include [2]:

Difficulty breathing when lying down

Shortness of breath

Dry, hacking cough

Weight gain

Swelling

Fatigue

Weakness

Loss of appetite

Rapid heart beat

Confusion and/or impaired memory


Diagnosing Heart Failure
Your doctor will ask you questions to complete your medical history and will perform a physical exam. Routine diagnostic test for heart failure are [3]:

1


Electrocardiogram- to record your heart's electrical impulses because heart failure can cause changes that are shown on the electrocardiogram.

2

Blood tests to find out if you have anemia or problems with your kidneys or liver.

3


BNP or brain natriuretic peptide- this is a blood test to measure BNP, a substance produced by your heart in response to pressure due to excess fluid.

4

Chest x-ray- to show the size and shape of your heart.

5




Echocardiogram- it is the preferred test to assess your heart function. This test can be done at the bedside and at your doctor's office. If your doctor orders an echocardiogram find out what is your ejection fraction; this number tells you how well your heart pumps with each beat.


Heart Failure Treatment
Your doctor will talk to you about heart failure and the different ways to manage your condition. The cause of your heart failure will determine your treatment plan and it is likely to include medications, diet, exercise, and other lifestyle changes. Your doctor may start one medication at a time and then add others and increase the doses over a period of time. The following medications are recommended for all patients with heart failure [4].

Medications


Angiotensin converting enzyme (ACE) inhibitors
These medications widen blood vessels, reduce the work of your heart, and control blood pressure. They are given to improve symptoms, to prevent worsening of heart failure that may lead to hospital admission, and increase survival. Symptoms improve within a few weeks to a few months of starting treatment.

Adverse effects: dizziness, low blood pressure, dry cough, may affect your kidneys. Rarely, swelling of your face, tongue, hands or feet (call your doctor immediately if this happens). Take this medication at the same time each day. To reduce the risk of dizziness, get up slowly from a sitting or lying position and avoid stressful exercise. Avoid drinking alcohol, as it may lead to dizziness.

Your doctor may prescribe any of the following ACE inhibitors: Captopril (Capoten), Enalapril (Vasotec), Lisinopril, Quinapril (Accupril), Ramipril (Altace), or Fosinopril

 

Angiotensin receptor blockers (ARBs)
These medications have the same effect as the ACE inhibitors: widen blood vessels, reduce the work of your heart, and control blood pressure. They are given to improve symptoms, to prevent worsening of heart failure that may lead to hospital admission, and increase survival. Symptoms improve within a few weeks to a few months of starting treatment.

Adverse effects: dizziness, low blood pressure, dry cough, may affect your kidneys. Take this medication at the same time each day. To reduce the risk of dizziness, get up slowly from a sitting or lying position and avoid stressful exercise. Avoid drinking alcohol, as it may lead to dizziness.

Your doctor may prescribed any of the following angiotensin receptor blockers (ARBs): Candesartan (Atacand), Irbesartan (Avapro), Losartan (Cozaar), Telmisartan (Micardis), or Valsartan (Diovan).


Beta-blockers
These medications slow heart rate, improve heart function, and reduce the work your heart does. Beta-blockers are given to improve symptoms, to prevent worsening of heart failure leading to hospital admission, and to improve survival. Improvement may develop slowly after starting treatment with these medications; it may take from 3 to 6 months and sometimes longer.

Adverse effect: tiredness, dizziness, lightheadedness, temporary worsening of shortness of breath or fluid retention, and slow heart rate. Take this medication at the same time every day. Take this medication at least 2 hours before you have taken your ACE inhibitor. Doses are often started very low, and are gradually increased over a period of 1-3 months, so remember that your dosage will change. In the morning, take this medication with food and in the evening, take this medication right after dinner.

Your doctor may prescribe any of the following beta-blockers: Carvedilol (Coreg), Metoprolol (Lopresor, Toprol XL), Atenolol (Tenormin), Bucindolol (Bextra), or Bisoprolol (Monocor).


Diuretics
Diuretics are given to patients with heart failure because they eliminate water and salt (sodium) from your body, prevent or reduce shortness of breath, swelling and bloating.

Adverse effects: frequent urination, weakness, dizziness, and loss of potassium, which in turn may cause: dry mouth, increased thirst, irregular heartbeat, muscle cramps, weakness, and fatigue. Take this medication with meals to avoid stomach upset. Recommendations: take your last dose before 5:00 p.m., to prevent having to get up in the night to urinate.

Some commonly prescribed diuretics are: lasix (Furosemide), demadex (torsemide), and Metolazone which is usually given with furosemide for maximum effect.

Other medications used in the medical treatment of heart failure are: Aldosterone ,digitales, and antiarrhythmics

To keep track of your medications download the medication log here link to medication log


Living with Heart Failure


To reduce symptoms of heart failure and help you feel better doctors recommend a combination of both medications and lifestyle changes [4]. There are many things that you can do to help yourself including changes to your diet, exercise, alcohol and smoking habits.

Weight Monitoring, Diet and Alcohol
Maintain a healthy weight and monitor sudden weight changes. If you are overweight, lose weight because excess weight puts extra strain on your heart. Weigh yourself daily before having breakfast and after emptying your bladder and keep track of your weight. Click here to download a daily weight chart you can use to track your weight.

Lower your salt intake; heart failure causes your body to retain water and salt. When you limit the amount of salt that you eat you can get rid off extra fluid and reduce swelling of your ankles, feet, or stomach. Avoid products high in salt such as cheese, cold cuts, sausages, hams, canned soups, frozen meals, and ketchup. Read the food labels to check for sodium (salt) content. Remove the salt shaker from your table and use herbs and other seasonings instead of salt. If your heart failure is worsening your doctor may ask you to limit your fluid intake and you should not drink more than 1.5 to 2 liters per day. Click here for balanced, heart healthy recipes.

Illegal drugs use and excessive alcohol intake can damage your heart. Try to limit alcohol consumption to one drink per day or stop drinking it and avoid drugs.

Exercise and rest
Mild physical activity is beneficial for most patients with heart failure; it improves symptoms and the functional capacity of your heart. Remember to have periods of rest between activities or when exercising. Talk to your doctor before starting a regular exercise program.

Smoking
Smoking causes narrowing of your blood vessels; it also increases your heart rate and blood pressure making your heart work harder. Nicotine worsens your heart failure, if you smoke, stop now. If you need help to quit smoking follow the link www.smokefree.org

Vaccines
Make sure that your vaccines are up to date. Respiratory problems are more dangerous for people who have heart failure. To quote Michael Brescia, MD "The heart and the lungs are anatomically and physiologically intimately related. Usually, when either system develops a problem, the other is sure to develop one as well". Get a pneumonia vaccine if you did not get it before and every year get a flu shot; both vaccines are usually safe and rarely cause severe reactions. Tell your health care provider if you have any allergies.

It is very important for you to keep your doctor's appointments! Click here for a form you can download to keep track of your scheduled appointments.


When to Call your Doctor
You should pay attention to changes in your condition and watch for the following signs and symptoms [1].

Weight gain of more than 2 lbs overnight or 5 lbs in one week

Increased shortness of breath

Increased swelling in your feet, legs, hands, or stomach

Dry cough

Difficulty breathing when lying down

Nausea and vomiting

Sudden weakness or dizziness, even if it is temporary


If you experience any of these worsening symptoms call your doctor.


Community Resources


CHF Help Line 908-994-5251 English/Spanish

 

Dolis Lebreault, RN-BC, BSN


CHF Program Coordinator 908-994-8916 English/Spanish


Prescription Assistance Program 908-994-5423


Fitness Center www.trinitashospital.org/fitness_center.htm


Cardiac Rehabilitation 1-908-994-5695


Diabetes Management


Senior Services


Brother Bonaventure Extended Care Facility


Educational resources
For additional information on heart failure and smoking cessation visit the following sites.


americanheart.org

 

heartfailurematters.org


hfsa.org


abouthf.org


heartfailure.org


nlm.nih.gov/medlineplus/heartfailure


acc.org/media/patient/chd/chf.htm


cdc.gov/tobacco/quit_smoking/how_to_quit/index.htm


cancer.org


nstep.org



References
1.
American Heart Association www.americanheart.org
2.
Heart Failure Society of America www.hfsa.org
3.


Hess, O. & Carroll, J. (2008). Clinical Assessment of Heart Failure. In P. Libby, R. Bonow, D. Mann & D. Zipes (Eds.), Brawnwald's Heart Disease a textbook of cardiovascular medicine 8th ed. (561-581). Philadelphia, PA: Saunders.
4.




McMurray, J. & Pfeffer, M. (2008). Heart Failure: Management and Prognosis. In L. Goldman & D. Ausiello (Eds.), Cecil Medicine 23rd edition (354-372). Philadelphia, PA: Saunders

 

    

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