Congestive Heart Failure (cont.)
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Congestive heart failure facts
- What is congestive heart failure?
- What causes congestive heart failure?
- What are the symptoms of congestive heart failure (CHF)?
- How is congestive heart failure diagnosed?
- What is the treatment of congestive heart failure?
- Lifestyle modifications
- Heart transplant
- Other mechanical therapies
- What is the long term outlook for patients with congestive heart failure?
- What are the areas of new research in congestive heart failure?
- Find a local Cardiologist in your town
What is the treatment of congestive heart failure?
After congestive heart failure is diagnosed, treatment should be started immediately. Perhaps the most important and yet most neglected aspect of treatment involves lifestyle modifications. Sodium causes an increase in fluid accumulation in the body's tissues. Because the body is often congested with excess fluid, patients become very sensitive to the levels of intake of sodium and water. Restricting salt and fluid intake is often recommended because of the tendency of fluid to accumulate in the lungs and surrounding tissues. An American "no added salt" diet can still contain 4 to 6 grams (4000 to 6000 milligrams) of sodium per day. In individuals with congestive heart failure, an intake of no more than 2 grams (2000 milligrams) of sodium per day is generally advised. Reading food labels and paying close attention to total sodium intake is very important. Severe restriction of alcohol consumption also is advised.
Likewise, the total amount of fluid consumed must be regulated. Although many people with congestive heart failure take diuretics to aid in the elimination of excess fluid, the action of these medications can be overwhelmed by an excess intake of water and other fluids. The maxim that "drinking eight glasses of water a day is healthy" certainly does not apply to patients with congestive heart failure. In fact, patients with more advanced cases of congestive heart failure are often advised to limit their total daily fluid intake from all sources to 2 quarts. The above guidelines for sodium and fluid intake may vary depending on the severity of congestive heart failure in any given individual and should be discussed with their physician.
An important tool for monitoring an appropriate fluid balance is the frequent measurement of body weight. An early sign of fluid accumulation is an increase in body weight. This may occur even before shortness of breath or swelling in the legs and other body tissues (edema) is detected. A weight gain of two to three pounds over two to three days should prompt a call to the physician, who may order an increase in the dose of diuretics or other methods designed to stop the early stages of fluid accumulation before it becomes more severe.
Aerobic exercise, once discouraged for congestive heart failure patients, has been shown to be beneficial in maintaining overall functional capacity, quality of life, and perhaps even improving survival. Each person's body has its own unique ability to compensate for the failing heart. Given the same degree of heart muscle weakness, individuals may display widely varying degrees of limitation of function. Regular exercise, when tailored to the person's tolerance level, appears to provide significant benefits and should be used only when the individual is compensated and stable.
Addressing potentially reversible factors
Depending on the underlying cause of congestive heart failure, potentially reversible factors should be explored. For example:
- In certain persons whose congestive heart failure is caused by inadequate blood flow to the heart
muscle, restoration of the blood flow through coronary artery surgery or catheter procedures
(angioplasty, intracoronary stenting) may be considered.
- Congestive heart
failure that is due to severe disease of the valves may be alleviated by valve
surgery in appropriate patients.
congestive heart failure is caused by chronic,
uncontrolled high blood pressure (hypertension), aggressive blood pressure control will often improve the
- Heart muscle weakness that is due to longstanding, severe alcohol abuse can
improve significantly with abstinence from drinking.
- Congestive heart failure that is caused by other disease states may be similarly partially or completely reversible by appropriate measures.
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