Heart Failure
Between 2 to 3 million Americans have heart failure, and 400,000 new cases are diagnosed each year. The condition is slightly more common among men than women and is twice as common among African Americans as whites. Heart failure causes 39,000 deaths a year and is a contributing factor in another 225,000 deaths.

Heart failure occurs when the heart loses its ability to pump enough blood through the body. Many times, the loss in pumping action is a symptom of an underlying heart problem, such as coronary artery disease. Heart failure is closely associated with the major risk factors for coronary heart disease: smoking, high cholesterol levels, hypertension (persistent high blood pressure), diabetes and abnormal blood sugar levels and obesity.

Muscle damage and scarring caused by a heart attack greatly increase the risk of heart failure. Cardiac arrhythmias, or irregular heartbeats, also raise heart failure risk. Any disorder that causes abnormal swelling or thickening of the heart sets the stage for heart failure. Age is another factor that increases the risk of the disease.

Although the term heart failure suggests a sudden and complete stop of heart activity, the heart does not suddenly stop. Rather, heart failure usually develops slowly, often over years, as the heart gradually loses its pumping ability and works less efficiently.

The term congestive heart failure is often used to describe heart failure. In reality, congestion (the buildup of fluid) is just one feature of the condition and does not occur in all patients. Although there are two main categories of heart failure, although within each category, symptoms and effects may differ from person to person. The two categories are:

Systolic heart failure—This occurs when the heart's ability to contract decreases. The heart cannot pump with enough force to push a sufficient amount of blood into circulation. Blood coming into the heart from the lungs may back up and cause fluid to leak into the lungs, a condition known as pulmonary congestion.

Diastolic heart failure—This occurs when the heart has a problem relaxing. The heart cannot properly fill with blood because the muscle has become stiff, losing its ability to relax. This form may lead to fluid accumulation, especially in the feet, ankles, and legs. Some patients may have lung congestion.


What are the symptoms?
The best known symptom is shortness of breath ("dyspnea"). In heart failure, this may result from excess fluid in the lungs. Fatigue or easy tiring is another common symptom. As the heart's pumping capacity decreases, muscles and other tissues receive less oxygen and nutrition, which are carried in the blood. Fluid accumulation, or edema, may cause swelling of the feet, ankles, legs, and occasionally, the abdomen. Persistent coughing is another common sign, especially coughing that regularly produces mucus or pink, blood-tinged sputum. Some people develop raspy breathing or wheezing.

How is heart failure diagnosed?
If neither the symptoms nor your history point to a clear-cut diagnosis, your physician may recommend any of a variety of laboratory tests, including, initially, an electrocardiogram, which uses recording devices placed on the chest to evaluate the electrical activity of your heartbeat.

Echocardiography is another means of evaluating heart function from outside the body. Sound waves bounced off the heart are recorded and translated into images. The pictures can reveal abnormal heart size, shape, and movement.

Another possible test is the chest X-ray, which also determines the heart's size and shape, as well as the presence of congestion in the lungs.

What treatments are available?
You can minimize the effects of heart failure by controlling the risk factors for heart disease. Obvious steps include quitting smoking, losing weight if necessary, abstaining from alcohol, and making dietary changes to reduce the amount of salt and fat consumed. Regular, modest exercise is also helpful for many patients, though the amount and intensity should be carefully monitored by a physician.

But, most heart failure patients must take medication. Many patients receive two or more drugs. Several types of drugs have proven useful in the treatment of heart failure:

•   Diuretics help reduce the amount of fluid in the body and are useful for patients with fluid retention and hypertension.
     
•   Digitalis increases the force of the heart's contractions, helping to improve circulation.
     
•   Results of recent studies have placed more emphasis on the use of drugs known as angiotensin converting enzyme (ACE) inhibitors. ACE inhibitors help by, among other things, decreasing the pressure inside blood vessels. As a result, the heart does not have to work as hard to pump blood through the vessels.
     
•   Those who cannot take ACE inhibitors may get a nitrate and/or a drug called hydralazine, each of which helps relax tension in blood vessels to improve blood flow.


To learn more, call the Regional Heart Institute at OSF Saint Anthony at (815) 395-5493 or e-mail community.relations@osfhealthcare.org.