Congestive Heart Failure: Everything You Need To Know

What Is Congestive Heart Failure?

Essentially, congestive heart failure is a dysfunction of the heart muscle that occurs in those who have had a heart attack, or other condition where the heart muscle as a pump does not work as well. This results in what we call ‘pump’ failure, or reduced ejection fraction. The heart is big and baggy and doesn’t squeeze well. This weakness of the pumping action of the heart is called heart failure with reduced ejection fraction. Among the common causes leading to this type of heart failure are heart attacks or ‘myocardial infarction’, viral infection attacking the heart muscle, or a leaky or tight heart valve. When the heart does not squeeze, blood circulation is affected, resulting in fluid getting backed up into the lungs, the liver, and the legs more commonly, but also the arms/forearms. A test called an Echo will give vital information.

Both Sets Of Patients Feel Short Of Breath

Common symptoms of congestive heart failure include:

• The most common symptom is shortness of breath, followed by swelling of legs.
• Fatigue is the next common symptom.
• This is followed by weight gain which is unintentional
• Inability to sleep in a flat position. Most patients report sleeping on 2-4 pillows and some even get relief only by sleeping in a recliner.
• A few patients with congestive heart failure may wake up gasping for breath, a condition called, PND (paroxysmal nocturnal dyspnea).

Any of these symptoms are not ones you should wait on. Get the patient to an experienced Family medicine or Internal medicine physician. A routine exam, an EKG (Electrocardiogram) showing normal or abnormal rhythm, and a blood test called BNP (Brain Natriuretic Peptide), will give some clues. That’s right, the brain natriuretic peptide is elevated in congestive heart failure. The next test called an “Echo” and is vitally important to give additional information on heart valves, as well as whether the heart is big and baggy or exhibits reduced ejection fraction – in these cases, the pump is not working correctly.  Depending on these test results, it may be necessary to begin the 4 pillars of therapy.

What Are The Four Pillars Of Pharmacological Therapy For Heart Failure With Reduced Ejection Fraction?

• Beta Blockers
• Aldosterone Antagonists
• A fairly new and exciting drug called sacubitril/valsartan
• SGLT2 inhibitors such as empagafloxin and dapagafloxin- although used in diabetics, they are also used in nondiabetics for their benefits related to CHF (Chronic Heart Failure) management.

When the 4 pillars of therapy are appropriate, it’s important not to back off meds. Titration to the highest dose is needed for the best outcomes.

For our patients with heart failure with preserved ejection fraction, no therapy except diuretics, and salt and fluid restriction are used.

Surgery

Sometimes surgery for a valve problem may help. In a small percentage of patients, with a very low ejection fraction of 25 percent or less, a defibrillator/ICD placement may offer the best chance of survival.

Are You Or Someone You Care About Exhibiting Symptoms Of Congestive Heart Failure?

If you think you or someone you love has any of the signs and symptoms of congestive heart failure, please do not wait.  Get seen by your primary care physician as soon as possible.

Disclaimer

As always, this article is not meant to give medical advice. Please consult with your primary care physicians for specific questions related to your health. Please read our Legacy Physicians Website Disclaimer and Privacy Statement