CONGESTIVE HEART FAILURE (CHF)

What is Congestive Heart Failure (CHF)?

Congestive Heart Failure (CHF) is a condition in which your heart is not pumping as well as it should. CHF can cause symptoms such as shortness of breath, generalized weakness, and swelling in the ankles, feet, and abdomen. Coronary artery disease, heart attack, high blood pressure, and heart valve disease are common causes of CHF.

Causes of Heart Failure

Coronary Artery Disease

Coronary artery disease is caused by atherosclerosis (also called hardening of the arteries). This condition occurs when plaque (deposits of fat, cholesterol, and other materials) collects in the walls of the arteries. As plaque builds up, the arteries narrow and this reduces blood flow to the heart muscle. The muscle can weaken, and heart failure can develop.

Heart Attack

Congestive heart failure can be a complication of a heart attack. A heart attack occurs when a blood clot forms in a narrowed coronary artery, and blocks blood flow to a coronary artery. As a result, there is damage to the heart muscle. The damaged portion of the heart muscle loses its ability to pump well. Over time, the strained heart muscle weakens and heart failure can develop.

High Blood Pressure (Hypertension)

Blood pressure measures the force of the blood pumped by your heart through your body’s blood vessels. If arteries throughout your body are narrowed from a build-up of fatty deposits, your heart has to work harder than it should to circulate blood. The heart muscle may become weakened by the extra workload, and fail to effectively pump blood forward causing your blood pressure to increase.

Faulty Heart Valves

Valve disease occurs when the valves between the heart’s chambers do not open or close properly. A damaged heart valve forces your heart to work harder to keep the blood flowing correctly. Over time, this extra work can weaken the heart and lead to heart failure.

Cardiomyopathy

Cardiomyopathy is a diseased heart muscle. The heart chambers enlarge and the heart muscle stretches and weakens. Causes of cardiomyopathy include infections, alcohol abuse, and the toxic effects of drugs such as cocaine and some drugs used for chemotherapy.

Other Related Health Problems

Certain health problems can strain and weaken the heart. Diabetes, severe anemia, hyperthyroidism, kidney or liver failure, and emphysema may precipitate heart failure. A rapid or irregular heartbeat may occur along with heart failure.

What to Expect During Your Hospital Stay

• You may stay in the hospital for 2-4 days.

• You may wear a heart monitor that will record your heart rhythm at a central station in the nursing unit.

• Your doctor may order one or more of the following tests to better understand your heart condition: blood tests, electrocardiogram (EKG), nuclear scan, echocardiogram (echo), chest x-ray, and cardiac catheterization.

• You will have at least one intravenous line (IV) to give you fluids and medicines. An IV is a small, thin plastic catheter (tube) that is placed in a vein in your arm.

• You will receive oxygen through a mask that fits over your nose and mouth or through a small cannula (soft tube) that is placed under your nose.

• Your care will include:

o Taking diuretics that remove excess fluid from your body.

o Taking medicines to relax the blood vessels and help your heart pump more easily.

o Close observation of your fluid intake and output, daily weights, potassium, and sodium blood levels.

o Resting and paced activity.

o Education about cardiac risk factors and a heart-healthy lifestyle.

Tests to Evaluate Your Heart

Your doctor may order 1 or more of the following tests:

• Electrocardiogram (EKG or ECG): A test that shows the pattern of your heartbeat and the size of your heart.

• Echocardiogram (Echo): A non-invasive test to evaluate the structure and motion of heart function, heart valves, and blood flow through the heart. Echocardiogram uses ultrasound (high-frequency sound waves) to create an image of your heart on a television screen (monitor). This test identifies whether an area of your heart has been damaged by a heart attack.

• Cardiac Catheterization & Coronary Angiogram: Cardiac catheterization is an invasive, non-surgical procedure. A coronary angiogram is a specialized x-ray procedure that is done as part of a cardiac catheterization. A cardiac catheterization and a coronary angiogram are done to study the structure of the

arteries that bring blood to the heart muscle and to evaluate the function of the main pumping chamber of the heart. During a cardiac catheterization, the cardiologist inserts a small hollow tube (catheter) into an artery or vein and then advances it into the heart. The cardiologist injects contrast (x-ray dye) through the catheter to outline the arteries to show any blockages or narrowings that may exist within them.

• Stress Testing: This test is performed to find out if your coronary arteries have any blockages. While you exercise on a treadmill, your doctor and a technician will watch your blood pressure, pulse, and electrocardiogram (EKG). During the test, you start walking and slowly the speed of the treadmill gets faster. Thallium treadmill and Persantine Thallium tests are different kinds of stress tests.

o The Thallium treadmill test is a basic stress test, except that Thallium, a radioisotope, is put into your IV before you exercise.

o The Persantine Thallium test is also a stress test, but you do not have to walk on a treadmill.

• Transesophageal Echocardiogram (TEE): For this study, a doctor places a plastic tube, about the size of your finger, through your mouth into your esophagus. The tip of the scope makes and accepts sound waves. TEE takes better pictures of the heart’s movement than a regular EKG. Before the doctor places the tube in your throat, he or she will numb your throat and give you medicine in your intravenous line (IV) to make you sleepy. You should experience little or no discomfort. The test will take about 30 minutes.

Understand Your Medications

Your doctor will order medicines to help your heart work better and help some of your symptoms. Your medicines may include:

• ACE Inhibitors: This medicine helps your heart pump more easily by relaxing the blood vessels. Some common ACE Inhibitors are Capoten (Captopril), Zestril, Prinivil (Lisinopril), and Vasotec (Enalopril). A dry cough or dizziness should be reported to your doctor.

• Angiotensin Receptor Blockers: This medicine may be used instead of an ACE inhibitor. It has many of the beneficial effects of ACE inhibitors. Some common ARB’s are Cozaar (Losartan) and Diovan (Valsartan).

• Beta-Blockers: This medicine helps strengthen your heart. A beta-blocker is usually started at a low dose and gradually increased over time. Common betablockers are Coreg (Carvedilol), Inderal (Propranolol), Lopressor, Toprol XL (Metroprolol), and Tenormin (Atenolol). If you experience fatigue and dizziness please report these symptoms to your doctor.

• Digitalis - Lanoxin (Digoxin): This medicine helps your heart to pump with more strength. Digoxin can also help regulate your heartbeat.

• Diuretics (also called “water pills”): Diuretics are medicines that get rid of the extra water in your body. Excess water can cause swelling in your ankles, feet, or abdomen. Diuretics also increase the amount of urine the body makes and the dose may be linked to your daily weight. Common diuretics are Furosemide (Lasix) and Hydrochlorothiazide.

• Diuretic (Potassium Sparing) Aldactone (Spironolactone): This medicine is a diuretic that spares potassium and helps the heart muscle.

• Potassium: An electrolyte that is important for muscle function and maintaining a regular heartbeat. Regular use of a diuretic causes the body to lose potassium. Your doctor may order a potassium replacement.

Note: Make sure to tell your doctor about any non-prescription drugs you may be taking, such as cold remedies, sleep aids, or herbal medicines.

Manage Your Pain

CHF does not usually cause pain. However, you may experience some discomfort, or you may have pain from another existing condition. If you are having pain, it is important to take action to control your pain as soon as the pain starts. Managing pain early and adequately is important in effective pain control. Please let your doctor or nurse know if you are having pain.

Your Activity in the Hospital

• You may get out of bed to sit in a chair or go to the bathroom, if you are not short of breath. You will need to ask for help the first few times you get out of bed.

• When you feel better, you may take a walk in the hall 2 or 3 times a day. About Your Diet

• Salt makes the body hold onto water that can make Congestive Heart Failure worse. Most doctors allow you to have no more than 2-3 grams (2000-3000 milligrams) of sodium (salt) each day.

• You will be asked to follow a low-salt diet. You may also follow a heart-healthy diet (low in fat). After you leave the hospital, you may need to continue these diet restrictions. If you have questions about your diet, please ask to ask a dietitian.

• You may drink a moderate amount of liquids (4 cups a day is a moderate amount). Juice, water, milk, decaffeinated coffee or teas are recommended.

• Avoid drinking large amounts of liquids. Drinking more than 6 cups of liquid in a day is considered a large amount.

• You may not feel like eating because you are tired or find it hard to breathe. Eating is very important. If you would like smaller meals more often or lighter food, please ask your nurse or dietitian to arrange this for you.

Caring for Yourself at Home – Living Well with CHF

People with CHF can live better and longer if they learn to follow these seven essential lifestyle practices:

1. Be knowledgeable about your diagnosis and treatment.

2. Eat a healthy, low-sodium diet.

3. Follow the medicine plan as prescribed.

4. Know what signs and symptoms to monitor and when to report them

• New or increased shortness of breath or cough.

• Weight gain of more than 3 pounds a day or 5 pounds a week.

• Increased swelling of ankles, feet or abdomen.

• Persistent nausea or inability to eat.

• Feeling of rapid heartbeats or palpitations.

• Dizziness not related to change in body position.

• Tightness, discomfort, or pain in the chest, jaw, or arm.

5. Stay active and exercise within the limits of your illness.

6. Modify risk factors such as smoking, obesity, high blood pressure, and cholesterol.

7. Learn to cope with stress.

Special Instructions on How to Take Your Medications

• Take your medicines at the same time each day.

• Use a medicine organizer to keep track of your medicine schedule.

• Do not stop taking any medicines unless your doctors tell you to do so.

• Tell your doctor if you have any side effects from your medicines, such as a headache, dizziness, upset stomach, or cough.

• Do not skip a pill. If you do miss a pill, do not take two pills the next time.