Congestive Heart Failure: Prevention, Treatment and Research

Congestive heart failure (also called heart failure) is a serious condition in which the heart doesn’t pump blood as efficiently as it should. Despite its name, heart failure doesn’t mean that the heart has literally failed or is about to stop working. Rather, it means that the heart muscle has become less able to contract over time or has a mechanical problem that limits its ability to fill with blood. As a result, it can’t keep up with the body’s demand, and blood returns to the heart faster than it can be pumped out—it becomes congested, or backed up. This pumping problem means that not enough oxygen-rich blood can get to the body’s other organs. The body tries to compensate in different ways. The heart beats faster to take less time for refilling after it contracts—but over the long run, less blood circulates, and the extra effort can cause heart palpitations. The heart also enlarges a bit to make room for the blood. The lungs fill with fluid, causing shortness of breath. The kidneys, when they don’t receive enough blood, begin to retain water and sodium, which can lead to kidney failure. With or without treatment, heart failure is often and typically progressive, meaning it gradually gets worse. More than 5 million people in the United States have congestive heart failure. It’s the most common diagnosis in hospitalized patients over age 65. One in nine deaths has heart failure as a contributing cause. “To avoid heart failure, there’s a need to prevent other heart problems,” says Johns Hopkins cardiologist Steven Jones, M.D.

Prevention

The best way to avoid congestive heart failure is to avoid the conditions that contribute to it, or to carefully manage these conditions if they develop, says Jones.

• Stop smoking—better yet, don’t start. It’s a major factor in the arterial damage that can cause heart failure. Also steer clear of secondhand smoke.
• Eat in heart-healthy ways. The foods that help you are those that contain little saturated fat, trans fat, sugar or sodium. Think fruits and vegetables, low-fat dairy, lean protein such as chicken without the skin, and “good” fats such as those found in olive oil, fish and avocadoes. Get practical ideas to eat for heart health in Eat Smart.
• Lose pounds if you’re overweight. Along with diet, being physically active helps achieve this goal and is also great for your heart.
• If you have another type of heart disease or related condition, closely follow your treatment program. Ongoing care and adherence to prescribed medications, such as statin drugs to treat high cholesterol, can make a big difference. “Recent research shows that a major portion of the long-term benefit of statin therapy is in the prevention of heart failure by way of preventing heart attacks and coronary events that lead to it,” says Jones.

Diagnosis

There’s no one test to diagnose heart failure. Your doctor will consider your medical history, family history, a physical exam and the results of various tests.  These tests can include:

• Electrocardiogram (EKG): A painless test that gives information about your heart’s electrical activity, including how fast it beats and whether you’ve had previous heart attacks.
• Chest X-ray: A picture of the heart, lungs and other chest structures that reveals whether the heart is enlarged or there are signs of lung damage.
• BNP blood test: B-type natriuretic peptide (BNP) is a hormone that is a marker of severity and prognosis of heart failure.
• Echocardiogram: An ultrasound image of the heart. It’s different from another test, a Doppler ultrasound, which gives a picture of blood flow to the heart and lungs.
• Holter monitor: A measurement of your heart’s electrical activity, taken by a portable device that you wear for a day or two.
• Exercise stress test: You walk on a treadmill or ride a stationary bicycle to see how your heart performs when it has to work hard. If you’re unable to take an exercise test, stress can be induced by administering a drug that causes a similar reaction.

Treatment

There’s no cure for heart failure. Treatment aims to relieve symptoms and slow further damage. TheI exact plan depends on the stage and type of heart failure, underlying conditions and the individual patient. Among the components of a treatment plan: Lifestyle changes. These are the same changes as those for preventing heart failure. In addition, you may be advised to avoid salt (because of fluid retention) and caffeine (because of heartbeat irregularities). Your doctor will advise how much fluid and what kinds to drink, as sometimes fluid intake should be limited. Medications. According to Jones, the types of medications typically prescribed include these:

• Vasodilators expand blood vessels, ease blood flow, and reduce blood pressure.
• Diuretics correct fluid retention.
• Aldosterone inhibitors help with fluid retention and improve chances of living longer.
• ACE inhibitors or ARB drugs improve heart function and life expectancy.
• Digitalis glycosides strengthen the heart’s contractions.
• Anticoagulants or antiplatelets such as aspirin help prevent blood clots.
• Beta-blockers improve heart function and chances of living longer.
• Tranquilizers reduce anxiety.

Surgical procedures. In more severe cases, surgery is required to open or bypass blocked arteries, or to replace heart valves. Some congestive heart failure patients are candidates for a type of pacemaker called biventricular pacing therapy, which helps both sides of the heart work in concert, or an implantable cardioverter defibrillator, which shocks the heart into converting a potentially fatal fast rhythm to a normal one. Ventricular assist devices (VAD therapy) may be used as a bridge to heart transplantation or as a treatment in lieu of transplant, says Jones. A heart transplant is considered the last resort, with success rates of about 88 percent after one year and 75 percent after five years. Other treatments. Because sleep apnea—a condition in which the muscles that allow air into the lungs briefly collapse—is linked to heart failure, you may be evaluated and treated for it.

Living With…

Here are some of the things you’ll want to do in addition to sticking to the lifestyle changes that can improve the health of a damaged heart:

• Monitor your symptoms. Heart failure worsens over time, so you need to be familiar with changes in your body. Some of these can be addressed with different medications. Weighing yourself daily is one of the easiest ways to track fluid retention, indicated by a sudden gain. Swelling in the legs and feet can also mean more fluid is accumulating.
• Monitor your health. Keep track of blood pressure, weight and other vital signs as your doctor advises. Get lab work done as recommended, as it gives key clues to your heart health and medication needs. A flu shot and pneumonia vaccine can help you avoid infections that would be especially hard on your compromised lungs.
• Try to keep a positive attitude. Congestive heart failure is a serious condition, says Jones, but with the right help you can still lead a long and productive life. Because anxiety and depression, which can cause you to feel stressed, are common side effects, try to find outlets for your stress. This might be a support group or therapist, relaxing hobbies you love or confiding your concerns to someone you trust.
• Don’t be shy about asking questions. Depending on the stage of disease, your doctor will have different recommendations about how active you should be, including work, exercise and sex.

Research

Johns Hopkins researchers are on the forefront of the study of congestive heart failure. Among their recent findings:

• African-Americans are at increased risk of congestive heart failure. This is due to diabetes and high blood pressure, rather than race alone. In a study involving nearly 7,000 men and women, Johns Hopkins researchers were able to discover the underlying reason that African-Americans are known to develop heart disease more than any other race. When diabetes and high blood pressure are factored out, they face no higher risk.
• A simple blood test can determine which patients will fare better after hospital discharge. Johns Hopkins researchers realized that congestive heart failure patients with a certain level of a protein linked to heart stress were 57 percent more likely to be readmitted to the hospital.