Heart Failure

Description
Heart failure, also known as congestive heart failure, is a disorder in which the heart loses its ability to pump blood efficiently, or relax and fill with blood normally.

Risk factors
The risk factors for heart failure increase with advancing age. Additional risk factors for developing heart failure may include:

• Ischemia, heart attacks or poor blood flow to the heart
• Valve leakage or valve obstruction
• Viral infection
• Bacterial infection
• Family history of heart failure
• Alcohol abuse
• Drug use, including cocaine
• Idiopathic, meaning an unknown cause

Symptoms
Patients with congenital heart disease may present with one or several of the following symptoms:

• Fatigue
• Shortness of breath, with exertion or at rest
• Edema of feet and legs, or abdominal swelling
• Decreasing ability to tolerate physical exertion
• Cough
• Palpitations, rapid heartbeat or irregular heartbeat
• Loss of appetite or getting full easily

Diagnostic Tools
There are many tests to diagnose congestive heart failure. More than one test is done before a definitive diagnosis can be made. These tests may include:

• Physical examination and patient history
• Echocardiogram
• Chest x-ray
• ECG
• Exercise stress test
• Coronary angiography
• Chest MRI
• Heart biopsy

Treatment Options
Both medication and surgeries are considered for patients with congestive heart failure. Medications, which are the first treatment considered, may include:

• ACE inhibitors
• Angiotensin receptor blockers (ARBS)
• Beta-blockers
• Digitalis glycosides
• Diuretics
• Vasodilators
• Experimental/investigational drugs
• Ultrafilitration, mechanical fluid removal

If medications fail or in more severe cases, physicians may recommend one of the following treatment options:

• Coronary bypass surgery
• Valve repair or valve replacement
• Surgical remodeling of the heart muscle
• Ventricular assist devices.  These devices are for patients waiting for a heart transplant or as an alternative to a transplant.  They may also be used as an alternative to acute shock such as a heart attack.  MedStar Heart Institute’s VAD program includes multiple types, including:
  • First generation:  HMXVE
  • Second generation:  HMII (continuous for pump)
  • Third generation:  Heartware™.  MedStar Heart Institute was the first center to implant this pump in North America.
• Bi-ventricular pacemaker/defibrillator (cardiac resynchronization therapy).  A device that  is placed in the heart chambers, to help coordinate the pumping action of both sides of the heart
• Heart transplantation
• Temporary ventricular assist devices and semi-permanent ventricular assist devices

Prevention
Steps to prevent or to reduce the risk of heart failure may include:  

• Avoiding alcohol
• Increasing exercise (as recommended)
• Quitting smoking
• Reducing salt intake
• Taking an ACE inhibitor or similar medication if you have heart disease, diabetes or high blood pressure
• Treating an underlying thyroid disorder
• Treating arrhythmias (abnormal heart rhythms) and keeping your heart rate under control
• Treating high blood pressure with diet, exercise, and medication if necessary
• Treating high cholesterol with diet, exercise, and medication if necessary