Usually letters behind your name is a positive, pride filled achievement. M.D., D.O., DDS, even LLC. We all strive to have meaning and recognition and those letters are easily recognized, as they should be, reflecting the hard work and effort behind the letters. There are letters, however, that as a society, are recognized with fear and trepidation. We all know many of those terror inducing letters, and CHF is among the letters that I fear. This fear is hard earned and I come by this honestly.
January 12, 1997 my father, William Blazek, died suddenly as a result of CHF. I was five months pregnant with my youngest son and my world crashed around me in waves of grief and shock. In 2014 I met my future husband and best friend, the absolute love of my life, Lew Cohn. He came with the diagnosis of CHF. My terror and underlying fear of loss is palpable on some days, others a dim nagging hum. When my father died I was in medical administration, as a career, by the time I met my future husband in 2014 I was an established Registered Nurse. This understanding of the disease makes it easier to understand, if not less frightening. So what, exactly, is CHF?
Congestive Heart Failure (CHF) occurs when the heart is not strong enough to pump blood through your body as well as it should. CHF (also referred to as heart failure) is a serious condition that, despite it’s name, does not mean the heart has literally failed or has stopped, or is about to stop working. It means that the heart has become less able to contract over time or has developed a functionality problem that decreases its ability to fill with blood. As a result of this mechanical dysfunction the heart can not keep up with the body’s demands, and blood returns to the heart faster than the heart muscle can keep up, becoming congested, or backed up. In turn this pumping issue means that not enough oxygen-rich blood can get to the body’s other vital organs.
The body then tries to compensate in many different ways. The heart beats faster to take less time for refilling after it contracts (increasing the pulse). However over the long run less blood circulates and the extra effort can lead to heart palpitations (irregular or skipped heart beats). The heart enlarges a bit at a time to make room for the excess blood. The lungs then fill with fluid, which causes shortness of breath. The kidneys, as a direct result of not receiving enough blood, begin to retain water and sodium which in turn leads to kidney failure. Both with and without treatment congestive heart failure typically is progressive, meaning it gradually worsens over time.
More than five million people in the United States live with congestive heart failure, and it is the most common diagnosis in hospitalized patients 65 years of age and older. In fact one in every nine deaths has heart failure as a direct or contributing factor. To say this is a big problem in American society is an understatement. So how did we get here? What causes CHF and how do we live better with this diagnosis?
Diabetes and hypertension (high blood pressure) greatly increase the chances of CHF susceptibility, leading directly to the condition in many cases. This is related to the effects of hypertension on the heart muscle and other vital organs, which in turn put extra work on the heart, which then leads to increased heart muscle size, and the cycle begins, eventually creating a weakening of the heart muscle that can not handle the expected volume of blood required to maintain the physiological systemic functioning of the human body. Another leading factor is coronary artery disease (narrowing of the arteries in your heart) which likewise lead to less blood getting through to the heart causing it to over work.
Once diagnosed your provider will assess your heart in many ways, one of which is a measurement called ejection fraction. This represents the percentage of blood leaving your heart each time it contracts. The goal is, of course, to have the best ejection fraction possible to keep all organs functioning and healthy. Lab tests and echocardiograms are also frequently used to gauge the health of all involved organs and the current functionality of the heart with the condition.
If you are at risk of CHF (through familial diagnosis or history of family with the same condition or lifestyle) there are ways that you can decrease your chances of having the disease or increase your chances of a longer, healthier life with the disease. There is no cure for CHF once you are diagnosed but many ways in which you can live a healthy, happy and fulfilling life. These include stop smoking or don’t start if you are a non-smoker. Eat in heart healthy ways (low saturated fat, trans fat, salt and sugar and high amounts of fruits, vegetables, lean protein and dairy, fish, olive oil and avocados). Maintain a healthy weight, losing weigh if necessary and. you will be asked to decrease or eliminate alcohol consumption and may be asked to monitor/limit your total fluid intake to decrease the risk of excess fluid around the heart and lungs. You will also be required to follow closely with a provider for your ongoing monitoring and medication management, which may include any or all of the following:
Vasodilators (expand blood vessels, ease blood flow and reduce blood pressure), Diuretics (correct fluid retention), Aldosterone inhibitors (help with fluid retention and improve life expectancy), ACE inhibitors or ARB drugs (improve heart function and life expectancy), Digitalis glycosides (strengthen the heart’s contractions), Anticoagulants or anti platelets (help prevent blood clots), Beta Blockers (improve heart function and chances of living longer) and Tranquilizers (reduces anxiety). There are surgical procedures that are used to unblock or bypass arteries or correct pacing (pace maker placement) in the treatment and management of congestive heart failure.
There are several ways that your provider can diagnose heart failure. These include EKGs (electrocardiograms), Chest X-rays, BNP (B-type natriuretic peptide) blood test which tests hormone level for a marker of severity and prognosis of heart failure. Echocardiogram (ultrasound of the heart), holter monitor (a portable device which measures the electrical activity of your heart), and stress tests (exercise and/or chemical to measure heart performance.
The most important thing to remember with congestive heart failure is to monitor your health. Monitor for fluid in the feet or legs, or even abdomen. Keep close track of blood pressure, body weight, vital signs and lab work. A flu and pneumonia vaccine can help avoid infections that would be otherwise concerning for an already compromised heart and lung system. Also, try to keep a very positive attitude as this serious condition can cause anxiety and depression, leading to further stress and further problems for your heart. Seek out support groups, family support, therapists, and relaxing hobbies that you enjoy and that enrich your life.
Betty Cohn is a retired registered nurse with 35 years of experience in the medical field in a variety of roles. She will write a semi-monthly column about medical-related topics and welcomes questions and suggestions at firstname.lastname@example.org.