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CHF usually develops slowly. Symptoms may not
appear for years, and they tend to worsen gradually over time.
That is the reason why it is most commonly seen in old age. The slow
onset and progression of CHF results from the heart's own efforts to
deal with its gradual weakening. The heart compensates by enlarging
and by forcing itself to pump faster to circulate more blood.
Risk Factors
Symptoms
If the left side of the heart has not been working
well (left-sided heart failure), resulting in the flow of blood and
fluid back up into the lungs; patients will experience shortness of
breath, fatigue, and persistent coughing (especially at night).
In advanced cases, persons may begin to cough up pinkish, blood-tinged
sputum.
If the right side of the heart does not work properly
(right-sided heart failure), the slowed down blood flow causes a buildup
of fluid in the veins. The feet, legs, and ankles begin to swell
under the increased fluid volume. This swelling is called edema.
Sometimes, edema spreads to the lungs, liver, and the gastrointestinal
tract. Fluid buildup causes patients to urinate more frequently,
especially at night when body fluids are more evenly distributed.
Fluid buildup also taxes the kidneys' ability to dispose of sodium and
water, which can eventually lead to kidney failure. Once CHF is
treated, the kidneys' function usually returns to normal.
As heart failure progresses, the heart eventually
loses its ability to compensate and symptoms arise. In addition
to those listed above, other symptoms may include:
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Difficulty in breathing or difficulty in lying
flat because of shortness of breath.
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Fatigue, weakness, and an inability to exercise
or perform physical activities.
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Weight gain from excess fluid.
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Chest pain.
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Loss of appetite, indigestion.
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Swollen neck veins.
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Cold, sweaty skin.
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Rapid or irregular pulse.
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Restlessness, confusion, and decreased attention
span and memory.
Diagnosis
Most physicians can make a tentative diagnosis of
CHF from the presence of edema and shortness of breath.
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With a stethoscope, a physician can listen to
a patient's chest for the crackling sounds of fluid in the lungs,
the distinct sound of faulty valves (heart murmur), or the presence
of a very rapid heartbeat. Tapping on the patient's chest will reveal
if fluid has accumulated in the chest cavity.
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A chest X ray can reveal an enlarged heart and
fluid in and around the lungs.
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Electrocardiography (ECG or EKG) can be used to
check for arrhythmias and cardiac stress, as well as reveal previous
heart attacks.
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Echocardiography can be used to observe valve
function, heart wall motion abnormalities, and overall heart size.
Other imaging techniques such as nuclear ventriculography
and angiography can provide a firm diagnosis and reveal the extent of
the disease.
Treatment
Studies show that drugs also help improve overall
heart function and increase a patient's exercise capacity. The
following classes of drugs are often prescribed:
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Diuretics, which help rid the body of excess fluid.
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Inotropics, such as digitalis and digoxin, which
strengthen the heart's ability to pump.
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Vasodilators, such as nitroglycerine compounds.
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Calcium channel blockers, which keep vessels dilated
and lower blood pressure.
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Newer beta blockers, which have been shown to
help increase exercise tolerance and improve symptoms over time.
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ACE inhibitors, which decrease blood pressure
by inhibiting hormones that negatively impact blood pressure regulation.
Surgical And Interventional Procedures
Interventional Procedures
Surgical Procedures
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Heart valve repair or replacement
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Pacemaker insertion
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Correction of congenital heart defects
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Coronary artery bypass surgery
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Mechanical assist devices
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Heart transplantation
The best way to prevent heart failure is to practice
healthy lifestyle habits that reduce your chances of developing a heart
problem. It is also important to identify early any risk factors
that contribute to heart failure, such as high blood pressure or coronary
artery disease. The vast majority of patients with congestive
heart failure can be successfully treated, most commonly with interventional
procedures. Patients should carefully follow their physicians'
advice; and in doing so, they can continue to live full and productive
lives.
Lifestyle Changes
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Quit smoking.
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Control high blood pressure, cholesterol,
and diabetes.
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Eat a sensible diet that includes moderate caloric
intake and restricted salt.
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Limit consumption of alcohol and fluids, in general.
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Weigh daily to monitor fluid retention.
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Start a medically supervised aerobic exercise
program
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