Monday, April 30, 2018

Congestive Heart Failure

Congestive heart failure is a progressive disease that gets worse over time, especially if it remains untreated. It is often caused by other conditions that weaken the heart, such as heart attack, coronary heart disease, high blood pressure and inflammation or damage to the heart muscle.

A 2016 study estimated that about half of people who develop heart failure live beyond 5 years after being diagnosed. However, there is no simple answer for life expectancy rates, as the average life expectancy for each stage of CHF varies greatly. CHF is not curable, but early detection and treatment may help improve a person’s life expectancy. Following a treatment plan that includes lifestyle changes may help improve their quality of life.

When a person has CHF, their heart has difficulty pumping blood to the other organs in the body. This problem occurs because the walls of the ventricles, which typically pump the blood through the body, become too weak, causing the blood [to] stay in the ventricle, rather than pushing it out. Blood remaining in the heart can cause fluid retention because the heart is not pumping enough blood through the body to push out excess fluids.

CHF has four stages based on the severity of symptoms. Common symptoms include swelling in the legs and feet caused by a buildup of excess fluid, bloating, shortness of breath, fatigue, nausea and chest pain.

Medical treatment for CHF involves reducing the amount of fluid in the body to ease some of the strain on the heart and improving the heart’s ability to pump blood. Doctors may prescribe angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to help the heart pump blood more effectively. In some cases, doctors may also prescribe beta-blockers to support these efforts and control the heart rate. Doctors also commonly prescribe diuretics for people with CHF, as they may help the body eliminate excess liquid.

My Take:
This is the new format for NIH. They no longer publish reviews on cutting edge research, rather they put together “helpful hints” on a range of health issues. The weekly online publication now starts with ads for the treatment of 3 or 4 diseases and then answers questions like “What causes a chronic cough?” or “Why do some people sneeze after eating?”. Unfortunately, the New York Times and other news organizations have followed suit and gaining access to new evidence-based publications is getting much harder.

This whole article is out of sequence. We all eventually die from congestive heart failure whether we take a bullet to the head or slowly succumb over the course of thirty years. Regardless of the cause, congestive heart failure is when the pump (the heart) loses its prime, failing to get enough blood back from the extremities and lungs.

The most common causes are the medications mentioned as treatment. ACE inhibitors, ARBs and beta-blockers reduce the force of the heart contraction causing CHF. They are initially used for hypertension. By reducing the blood pressure, they cause CHF as a side effect.

Statin drugs are also a common cause. Approximately 10% of patients on statins will develop cardiac myopathy (heart muscle disease). This is the weakening of the ventricles mentioned as the cause at the beginning of this article.

The Bottom Line:
If you notice the signs of congestive heart failure and take any of the medications I’ve noted, please consult your physician about a medication review. Fluid retention in the legs is the cardinal sign and must be addressed immediately.

Source: April 18, 2018 National Institutes of Health

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