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Taking control of heart failure

Created date

May 24th, 2011

It used to be that with heart failure you were encouraged to take it easy and you had significant limitations in your daily functioning. Today, if you are diagnosed with heart failure, by no means is it an imminently terminal or irreversible condition, says Michael Hudson, M.D., senior staff cardiologist and codirector of the cardiac intensive care unit at Henry Ford Hospital in Detroit, Mich. People can do well for years with current treatments. According to the American Academy of Family Physicians, deaths related specifically to heart failure have decreased with modern medical management. The fact remains, however, that up to 70% of people with the condition die within ten years of being diagnosed. Life expectancy depends on the condition s severity, if the cause can be corrected, and which treatments are used. Heart failure is most common in people 65 and older. Between one-fourth and one-third of adults over age 65 may develop heart failure, Hudson says.

A failure of the pump

Heart failure does not mean that your heart has stopped or is about to stop working it means that your heart is not able to pump blood the way it should. A common symptom is shortness of breath, especially when exercising, doing daily activities, or lying flat in bed, says Dimitri Cefalu, M.D., medical director of Seabrook in Tinton Falls, N.J. Other symptoms are fatigue, fluid buildup in the legs and feet, chest discomfort or palpitations, and weight gain, Hudson adds. The term congestive heart failure is outdated, according to Hudson. Some people have heart failure without the fluid buildup typical of congestive heart failure, he explains. Most types of heart failure are classified by how much function the heart has, Hudson continues. Systolic heart failure is when the pumping ability itself is affected. In diastolic heart failure, the pumping function may be fairly normal, but the heart is unable to fill adequately.

Why it happens

Any health condition that damages the heart can result in heart failure, Hudson says. The number one cause is coronary heart disease. Other common contributors are high blood pressure, alcohol abuse, heart valve abnormalities, heart muscle diseases [cardiomyopathy], heart rhythm problems such as atrial fibrillation, drug-induced heart damage [usually chemotherapy], thyroid disease, and infections, he adds. Heart failure is becoming more prevalent as the U.S. population ages because treatments for the underlying conditions have improved. Heart failure may be a natural progression of living longer with a damaged heart, Hudson explains.

Medications and devices

Medications commonly prescribed for heart failure include diuretics (which help your body eliminate excess fluid), beta blockers (which slow the heart beat and reduce blood pressure), and angiotensin-converting enzyme (ACE) inhibitors (which help relax blood vessels). Some of these medications have been shown to increase or preserve the heart s strength and prevent hospitalization and death, Hudson says. Certain people with heart failure may benefit from using oxygen or other special devices such as an implantable defibrillator. This device helps prevent cardiac arrest or life-threatening arrhythmias [heart rhythm abnormalities], Hudson says. People with end-stage heart failure may require a heart transplant. There are approximately 2,000 heart transplants performed in the U.S. each year, Hudson says. Transplant candidates are typically under 70 years old and have few other serious medical conditions. For some people who are not transplant candidates, there is another option. Surgically implanted pumps called left ventricular assist devices help maintain the heart s pumping ability and can be an effective long-term therapy, Hudson says.

Keeping track of all that medicine

For controlling symptoms or even reversing the progression of heart failure, strict adherence to your medication regimen is essential, Hudson says. Some people have difficulty adhering to their medication schedule. They may be taking many different drugs for four or five medical conditions, Cefalu explains. And occasionally, people won t take their medicines because of unpleasant side effects. For instance, if someone has to go shopping or to a family function, they may skip their diuretic. But even one missed dose can have severe consequences.

Other factors you can control

Even though many people with heart failure feel short of breath, exercise is essential. The old thinking was that you should not exercise, Hudson says. But now we recommend that you stay as active as you can. It s ideal to participate in a structured or individualized program, combining both aerobic and resistance training. If you keep the other parts of your body (like your muscles and lungs) in good shape, your body becomes more efficient with oxygen, which can relieve your heart s burden, he adds. Hudson also stresses the importance of restricting salt in your diet and checking your weight daily for any increases. In addition, people with heart failure should be vaccinated against respiratory infections like pneumonia and the flu.

If you are hospitalized

Heart failure is the number one reason older people are hospitalized, Hudson says. Someone can be following a treatment plan to the letter, but the nature of the disease is one of change and fluctuation. Most of the time, even after a hospitalization, people can get back to their prior level of functioning with some treatment adjustments, Hudson adds.

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