We recently sat down to talk with Dr. Garrie Haas, the Program Advisor for The Macintosh Heart Health Program, to talk about Congestive Heart Failure (CHF). Summer can be a tough time of year for people who live with this chronic disease.
Q: What causes Congestive Heart Failure?
CHF represents symptoms caused by injury to the heart. The injury causes the heart muscle to function abnormally, where it either becomes weakened or stiff. In either case, symptoms are similar. There are a large number of medical problems that may produce this heart injury. In the United States, the most common cause is coronary artery disease and injury to the heart muscle from a heart attack. Chronic, poorly controlled high blood pressure is another common cause. CHF may run in families and thus have a genetic component, and it is also associated with certain types of infections (usually viruses) of the heart muscle (this is called myocarditis). CHF can also be caused by certain drugs, particularly those used to treat certain types of cancer. Excessive alcohol consumption may also injure the heart and cause CHF. In many cases, it is not clear what caused the problem, and in these cases, the CHF is idiopathic. The term cardiomyopathy is used to describe the disease of the heart muscle, and CHF (congestive heart failure) represents the symptoms resulting from the cardiomyopathy. A person can have cardiomyopathy without having symptoms of CHF.
Q: What are the symptoms of CHF?
“CHF” identifies a set of symptoms that include shortness of breath with activities, or sometimes at rest, difficulty breathing while lying down (orthopnea), fluid retention such as ankle swelling or abdominal bloating, increased palpitations, chest pressure or heaviness, progressive fatigue, poor appetite, sudden awakening at night with shortness of breath (PND), palpitations, and syncope (passing out).
Q: How do you recognize the symptoms?
The symptoms may occur suddenly or occur very gradually over months. When of sudden onset, the patient will often easily recognize that there is a problem and thus seek medical attention. When symptoms progress very gradually, there may be a delay in seeking medical attention. Sometimes, the symptoms may be confusing and lead to several possible diagnoses. CHF may be confused with other conditions, such as pneumonia or other types of lung disease.
Q: How is CHF diagnosed?
CHF is usually diagnosed in a patient presenting with the typical symptoms and findings on the physical exam. The most common test utilized to identify the underlying heart problem causing CHF is the echocardiogram. There are certain blood tests that may also suggest CHF. A “BNP” test may be used to differentiate shortness of breath caused by lung disease versus heart disease. A significant elevation in BNP (which is a blood test) strongly suggests that a patient’s breathing symptoms are secondary to heart disease / CHF.
Q: How can someone prevent Congestive Heart Failure?
Since CHF is commonly secondary to problems like poorly controlled hypertension, coronary artery disease, and obesity, several preventive measures are encouraged. These include a heart healthy diet, maintenance of optimal cholesterol levels, avoidance of obesity, treatment of high BP, to name a few. Any risk factors for the development of coronary artery disease should be managed, including tobacco cessation. Regular exercise is encouraged. There are instances where Cardiomyopathy cannot be avoided (genetic cause, chemotherapy, valve problem) and in these situations, early recognition and institution of appropriate treatment, at an early phase of the disease, is important.
Q: What is the outlook for people with CHF?
The outlook for this condition depends on many factors. Most important is the underlying cause of the CHF, and the degree of symptoms. Many patients with CHF are very well managed with medications. Sometimes devices are required to manage arrhythmia. In some cases (the minority of cases), the condition advances to the point where heart transplantation may be warranted. There is a very broad spectrum of treatment possibilities – and outcomes.
Q: What are the different types or degrees of severity for CHF?
CHF is classified as stage A-D, with stage A being those at risk for CHF (ie, they have coronary artery disease), stage B is evidence of heart muscle problems but no symptoms, stage C is symptomatic CHF, and stage D is symptoms despite optimal medical and device therapy. Patients are also classified according to NYHA class – with class I being asymptomatic and class IV symptoms at rest.
Q: Are there any medications to avoid or diet changes to be made when dealing with CHF?
For most patients, the major medications to avoid are NSAID’s (such as ibuprofen). These medications will worsen kidney function and symptoms of CHF. A low sodium diet is almost always recommended, and sometimes, a fluid restriction is recommended. My recommendation is to discuss any new medication with the physician before taking it.
About Dr. Garrie Haas
In addition to his work with The Macintosh Group, Dr. Haas is a professor of Clinical Medicine and Section Director of Heart Failure and Transplant at the Wexner Medical Center at The Ohio State University. His research includes heart failure and hemodynamic monitoring, cardiorenal syndrome, heart failure disease management and cardiomyopathy.