IN heart failure, the pumping action of your heart becomes inefficient, for one of several reasons: because your heart muscle is weakened by disease, it has been weakened by a mechanical fault in the valves that control the flow of blood, it has to work too hard because of high blood pressure, or it has to pump an overload of blood. Heart failure does not mean that your heart stops pumping, as in cardiac arrest; it means that it is not working effectively.
Heart failure usually affects both sides of the heart; however, in some cases it affects only one side.
If your heart cannot pump out a normal volume of blood sufficient to meet your body’s demands, blood accumulates in the veins leading to it.
The body interprets what is happening as a lack of blood supply to the organs, and to compensate, the kidneys begin to retain salt and water, thus increasing the volume of blood.
This increased volume of blood stretches the ventricles and increases the output of the heart, thus increasing the blood flow to the organs. In left-sided heart failure the blood accumulates in the veins that carry blood from the lungs, increasing the blood pressure in the capillaries of the lungs. As a result, the lungs become swollen and congested with fluid. The fluid then passes from the blood vessels into lung tissues leading to pulmonary edema. In right-sided heart failure blood accumulates in the veins that lead to the heart from other parts of the body. The affected parts, most obviously the legs, and then becomes waterlogged.
The “congestion” in the organs produced by this heart failure gives the name congestive heart failure. At times the major problem is not that the heart fails to put out enough to cause an increase in capillary pressure, which in turn causes congestion of the lungs.
Despite its name, heart failure is not necessarily an immediate life-threatening disease. The outcome depends on the seriousness of the underlying disorder and weather you get treatment promptly.
What are the symptoms?
Left-sided heart failure: The main symptom is breathlessness. At first you may feel breathless only after exercising, but this symptom becomes more and more apparent, especially in the evenings when you are tired. Because it may be hard to breathe when you lie down, you may need to sleep with several pillows under your head or even sitting up.
Severe attacks of breathlessness can awaken you from sleep and may become so bad that you want to go outside to breathe fresh air. Difficult breathing may be accompanied by wheezing, which can be mistaken for asthma. Bad attacks usually last no more than an hour. But the experience can be disturbing.
Sometimes the lungs become so congested that you may hear a bubbling sound when you breathe. You may also have chest pain and frothy, blood-flecked sputum, or phlegm. The fluid in your lungs decreases your resistance to infection; pneumonia for example, is a common complication of left-sided heart failure.
Right-sided heart failure: The most common symptom is fatigue, but this is a sign of so many illnesses that on its own it is not conclusive. A more reliable symptom is swelling of the lowest part of your body from accumulation of fluid. If you are up and around, your ankles may swell. If you are bedridden, the swelling will be noticeable in the lower part of your back. Internal organs such as the liver can also become swollen, and this can cause abdominal pain. In addition, weight gain results from fluid accumulation.
What are the risks?
Untreated heart failure imposes a strain on your entire system that can be fatal. If heart failure is successfully treated, the main risks are those caused by the underlying disorders.
What should be done?
If you have symptoms of heart failure, see your physician, who will perform a physical examination. Diagnostic tests may include a chest X-ray to look for lung problems and to check your heart size and an electrocardiogram (ECG) to look for valve disease, evaluate individual heart chamber size and function, and look for other diseases. An ECG may help determine the type of heart problem, and other tests may be necessary.
What is the treatment?
Self-help: Get plenty of rest to conserve energy. Although you should reduce your physical activities, do not become bedridden. An incident of heart failure does not mean you must lead a restricted life indefinitely. Treatment of heart failure and the underlying condition may eventually allow you to resume your normal activities. Even while resting, keep your legs in motion by frequently shifting your position. This helps because your circulation is sluggish after you have heart failure, and your blood tends to clot, especially in your legs. You should also substantially restrict your daily intake of sodium, because it leads to fluid retention.
Professional help: Your physician can prescribe drugs that relieve your symptoms. Among these are diuretics, which cause you to pass more urine than usual and thus lower the fluid content of your body. It is usually best to take a diuretic in the morning, because most people find it more convenient to urinate during day than to disturb their sleep at night.
Once given medications you have to follow your physician’s instructions exactly. Such drug treatment is often so successful that you want to stop taking your medication and this would be a serious mistake.
Acute, or sudden, heart failure, with extremely severe breathlessness, is a medical emergency. If this occurs, go to the hospital, where oxygen can be administered and medications are injected to help relieve the symptoms quickly.
What are the long-term prospects?
With drug treatment your symptoms of breathlessness and swelling should subside. If you carefully follow a low-sodium diet and take your medications regularly, you can probably expect many years of nearly normal life ahead of you. If heart failure reaches a point where it no longer responds to rest, diet, and drugs, however, the only remaining possibilities are a heart transplant or the use of an artificial, mechanical heart.
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